ERISA claims administrators sometimes are asked to “reopen” a claim, after appeal denial, to consider additional information.
How does “reopening” a claim affect the statute of limitations defense?
You have seen this one before: The ERISA plan pays hundreds of thousands of dollars in medical bills and secures an equitable lien. Then, the ERISA plan beneficiary settles a tort claim, but refuses to reimburse the ERISA...more
Can a court deny a successful ERISA claimant’s attorney fees solely because there is no evidence of bad faith? NO....more
How do you defeat two arguments frequently used to challenge an ERISA-governed disability claim denial?
Argument (1) the rationale for the claim denial changed, or
Argument (2) the denial letter failed to tell...more
What happens when a long term disability claimant declares bankruptcy, and fails to list the long term disability claim in the bankruptcy estate?
Is he judicially estopped from bringing the lawsuit alleging wrongful...more
You already know that a Social Security disability (SSDI) decision should be considered in the context of deciding whether the claimant is disabled under the terms of the disability policy....more
You already know that a “church plan” is exempt from ERISA, unless the Plan specifically elects to be governed by ERISA under Internal Revenue Code Section 410(d).
But what does it take to become a “church plan”?...more
Are those three year suit limitations provisions in ERISA-governed long term disability plans enforceable? YES!
Here’s today’s case, Heimeshoff v Hartford Life & Accident Insurance Co., __ U.S. __ (December 16, 2013)...more
Wow—You need to know what happened last week in the Sixth Circuit:
Disgorgement of profits as a remedy in an ERISA long term disability case?
Rochow v. LINA, __ F.3d __, 2013 WL 6333440 (6th Cir. December 6,...more
PROBLEM: During the claim process your claims administrator mistakenly tells the claimant that the ERISA-governed plan is NOT governed by ERISA. Uh oh.
Do you lose ERISA as the governing law over the policy and claim?...more
What language is needed in the ERISA plan to confer discretion?
The bar was just raised in the 4th Circuit.
Here’s the case of Cosey v. Prudential Insurance Company of America, [PDF] __F.3d__ (November 12,...more
What does it take to assert an effective exhaustion of remedies defense in ERISA cases? Properly drawn plan documents that expressly impose the duty upon the claimant to exhaust remedies before bringing a lawsuit....more
You already know that under ERISA a court may, in its discretion, award reasonable attorney’s fees and costs to a claimant seeking benefits if there is a showing of “some degree of success on the merits.”...more
How will a court construe ambiguities in ERISA plan terms?
If the plan confers discretion to the administrator “to interpret plan terms,” ambiguities may NOT be construed against the plan administrator....more
If the plan confers discretion to the administrator “to interpret plan terms”, ambiguities may NOT be construed against the plan administrator.
Here’s the case of Porter v. Lowe’s Companies, __ F.3d__ (5th Cir....more
Did you know that awarding at least some benefits, rather than denying benefits entirely, helps prove the claims administrator is “unbiased”?
Also, when there are sharp conflicting opinions between the claimant’s...more
What happens when an independent, unsolicited source provides evidence that a disability claimant may be committing fraud? Can you consider emails hacked from a computer? What must the claim administrator do to evaluate the...more
An Insurance Commissioner’s non-binding opinion banning discretionary language in an ERISA governed plan has no effect.
Here’s the case of Frazier v. Life Insurance Company of North America, __ F.3d __ (6th Cir. August...more
Where do you litigate an ERISA disability claim governed by a collective bargaining agreement?
It has to be sent to arbitration, not to federal court, if the Railway Labor Act applies....more
Does telling a claimant that you “will be happy to reconsider the claim” waive a contractual limitations provision? No.
Here is a great new case that highlights virtually every argument that could be used to trump...more
How do you handle a claim supported only by “subjective” evidence?
Can you reject the claim outright? No. You must weigh the subjective evidence. That’s a key point highlighted in a recent case....more
Companies are getting a big surprise these days: Employees are leaving with their LinkedIn accounts and the company’s proprietary list of business contacts. LinkedIn is a well-known, business-oriented social media website...more
You know that many ERISA governed plans provide basic life insurance benefits.
But what happens when the plan offers employees the choice to purchase supplemental life insurance? If the employee pays the entire premium...more
In Judge v. Metropolitan Life Insurance Company [PDF], 710 F.3d 651 (6th Cir. 2013), the Sixth Circuit rejected plaintiff’s proposed bright-line rule requiring plan administrators to obtain vocational evidence and an IME...more
You already know that an employee benefit plan qualified as a “government plan” is exempt from ERISA’s framework....more