D. Michael Reilly

D. Michael Reilly

Lane Powell PC

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ERISA: 3rd Circuit — Denial Letters That Fail to Detail Plan’s Limitation Period Are Invalid

The courts are expecting more detail in your denial letters about the limitations period. Here’s the case of Mirza v. Insurance Administrator of America, Inc.., No. 13-3535 (3rd Cir. August 26, 2015)(“One very simple...more

9/2/2015 - Adverse Action Claim Denial Letters Deadlines Denial of Benefits ERISA Judicial Review Limitation Periods Plan Administrators

Best Practices for Best Employers: How to Become a Best Workplace Starting Today! - August 2015

Top 5 Legal Developments Every Employer Needs to Know Now - Laws affecting employers are changing faster than ever. If you don’t keep up, you can get burned. Here are a few of the most recent big changes every employer...more

8/21/2015

ERISA: Clarity on When ERISA Applies to Working Owners of Small Companies

You probably already know that in small, wholly owned “mom and pop” businesses, benefits covering only the owners of the business may be exempt from ERISA....more

8/14/2015 - Benefit Plan Sponsors ERISA Family Businesses Preemption Shareholders Small Business Spouses

ERISA (Sixth Circuit) — Medical Reviews: You Need to Explain WHY You are Rejecting the Treating Physician’s Opinions; and Don’t...

You already know that you do not have to give special deference to the opinions of treating physicians. But you need to explain why the treating physician’s opinions are being rejected....more

8/7/2015 - Conflicts of Interest Denial of Benefits ERISA Long Term Disability Insurance Notice for Independent Medical Exam Physicians Plan Administrators Plan Documents Standard of Review

ERISA (11th Cir.): Tougher for Claimants to Win ERISA Statutory Penalty Claims

We see plaintiffs asserting an ERISA claim for statutory penalties more frequently now. These claims seek statutory penalties (up to $110 per day), alleging the plan administrator “fail[ed] or refus[ed] to comply with a...more

7/22/2015 - Disclosure ERISA Plan Administrators Plan Documents Statutory Penalties

The Cost of Bad Performance Reviews: ‘I’m Getting Sued Because My Evaluations Were Too Nice?’

For many companies, employee performance reviews are often an afterthought. A recent survey showed that only 10 percent of employers actually found their current performance review process a “good use of time.” Many...more

7/10/2015 - Collaboration Employee Engagement Employee Evaluations Employee Retention Employer Liability Issues Harassment Performance Reviews Poor Job Performance Retaliation Wrongful Termination

ERISA 11th Circuit: Claimant Has “Duty to Investigate” When Asserting Equitable Tolling of a Contractual Limitations Provision

You already know that contractual limitations provisions in ERISA plans are generally enforceable and can bar untimely claims. But when does the court apply “equitable tolling” to extend the time by which a claimant may...more

6/13/2015 - Claim Denial Letters Disability Benefits Duty to Investigate Equitable Tolling ERISA Limitation Periods Long Term Disability Insurance

ERISA (9th Cir.) A Day Late, But Not A Dollar Short — Counting The 180 Day Appeal Period Gets Easier For Claimants

You know that under ERISA regulations a claimant has at least 180 days to appeal a benefit denial. ERISA plans set out contractual timelines for appeals. But what happens when that 180 day period runs out on a weekend?...more

6/3/2015 - Aetna Appeals Denial of Benefits Disability Disability Benefits Disability Insurance ERISA Exhaustion Doctrine FedEx Plan Administrators

ERISA (3rd Circuit): Even a Voluntary Settlement Can Mean “Some Success on the Merits” When Awarding Attorney Fees?

You know that a court has discretion to award attorney fees under ERISA if a party shows “some degree of success on the merits.” But how do you define “success”? A new third circuit case reminds one of that old Milton...more

5/20/2015 - Attorney's Fees Blue Cross ERISA Prevailing Party Settlement

ERISA: Public School Teacher’s Employee Benefits Governed by ERISA? Yes!

When you see a claim for disability or life insurance benefits by a public school teacher, you might assume the claim is not governed by ERISA because of the governmental plan exception....more

5/1/2015 - Disability Insurance Employee Benefits ERISA Life Insurance Public Employees Public Schools Teachers

ERISA: Supreme Court to Determine Whether Money is Fungible…When it Comes to Recovery of Overpayments from ERISA Beneficiaries

When it comes to recovery of overpayments from ERISA beneficiaries… money is a fungible commodity in the Eleventh Circuit, but is not a fungible commodity in the Ninth Circuit....more

4/7/2015 - ERISA Medical Reimbursement National Elevator v Montanile Overpayment SCOTUS Subrogation

ERISA: 6 New Trends in DOL Enforcement Actions

The U.S. Department of Labor (DOL) and the Employee Benefits Security Administration (EBSA) just issued a “Fact Sheet” describing Fiscal Year 2014 civil and criminal enforcement activity under ERISA....more

3/30/2015 - DOL Employer Liability Issues ERISA Strategic Enforcement Plan

ERISA — 5 Quick Points: Blowing a Deadline for Decision is Not Necessarily Fatal to Abuse of Discretion Standard

You already know that ERISA regulations require the plan administrator to render a decision on an administrative appeal within 45 days....more

3/24/2015 - Abuse of Discretion Administrative Appeals ERISA Plan Administrators

ERISA: 6th Circuit — Plop Plop, Fizz Fizz: Oh What A RELIEF It Is: No Disgorgement For Arbitrary Denial Of Benefits

Does an arbitrary and capricious denial of ERISA governed disability benefits create a right to disgorgement of profits? NO....more

3/12/2015 - Appeals Denial of Benefits Disability Benefits Disgorgement ERISA

ERISA: Sometimes A Government Employee’s Benefits Could Be Governed By ERISA?

You already know that employee benefit plans established by governmental entities are exempt from ERISA. But ERISA might apply if the employee benefit for the government employee is established through an association....more

2/27/2015 - Benefit Plan Sponsors Employee Benefits ERISA Government Entities Public Employees Public School Boards Public Schools School Districts Trade Associations

ERISA – 9th Cir. Telephonic Beneficiary Designation Enforced — Beneficiary Designation Forms Are NOT Plan Documents

Can a participant designate a beneficiary merely with a phone call? You need to look at the plan documents. But are beneficiary designation forms ERISA “plan documents”? It depends, and it makes a difference....more

2/11/2015

The BYOD Question - Sound advice on ‘Bring Your Own Device’ to work.

The “Bring Your Own Device” to work movement, or BYOD, has drastically changed today’s workplace. In a recent study, Cisco Systems found that 95 percent of the 600 companies surveyed permitted the use of personal devices at...more

2/2/2015 - Bring Your Own Device Data Protection Employer Liability Issues Popular Privacy Concerns Wage and Hour

ERISA-Disability: 1 in 3 Social Security Administration Disability Determinations Involve Mental Disorder Diagnosis

As you know, ERISA plan administrators must consider Social Security Administration (SSA) disability determinations when making the disability benefit decision. ERISA plan administrators are not bound by the SSA’s...more

1/29/2015 - ERISA Mental Health Mental Illness Social Security Adminstration Social Security Benefits Social Security Disability

ERISA: 8th Circuit: Choice-Of-Law Provision Trumps Insurance Regulation Banning Discretionary Review

You already know that when a claimant brings suit alleging wrongful denial of ERISA-governed disability benefits, the first issue the court looks at is: what standard of review applies. If the plan or policy includes...more

1/9/2015 - Abuse of Discretion Choice-of-Law De Novo Standard of Review Disability Benefits ERISA Standard of Review

ERISA: 4th Circuit: When Is A Plan Administrator Obligated To Obtain Medical Records?

You already know that the primary responsibility for providing medical proof of disability undoubtedly rests with the claimant. But does the plan administrator sometimes have an obligation to obtain medical records and...more

1/6/2015 - Appeals Disability ERISA Medical Records Plan Administrators Wells Fargo

ERISA: 11th Circuit Says “Show Me The Money” In Equitable Recovery Of Medical Expenses Even After Disbursement Or Commingling Of...

Can the Plan get reimbursed even when the beneficiary’s settlement funds have been disbursed or commingled? Yes in the 11th Circuit. But watch out in the 9th Circuit....more

10/7/2014 - Beneficiaries Equitable Lien ERISA Insurers Qualified Settlement Funds

ERISA: Plaintiff’s Attorney Fees Denied — Filing Of Lawsuit Was Not Reason Why Benefits Were Granted

You already know that in ERISA cases a court may, in its discretion, award attorney fees if a party achieved “some degree of success on the merits.”...more

8/29/2014 - Attorney's Fees Disability Disability Benefits Employee Benefits ERISA

More Disabled Employees But Fewer Employees Covered With Long Term Disability Coverage

Here is a recent news item showing the scope of the employee disability problem. In a nutshell...more

7/25/2014 - Disability Disability Benefits Disability Insurance Employee Benefits

ERISA (1st Cir.): Lack of Cooperation During Functional Capacity Evaluation Bars Disability Claim

But what happens when the claimant refuses to perform tasks requested, or does not try hard enough during the FCE?...more

6/23/2014 - Disability ERISA Functional Capacity Evaluations

Internships: Yea or Nay? A good program will generate benefits, but be sure to do it right.

Steve Jobs and Bill Gates were interns. Best companies use internships to win the war to recruit talent. The website Internships.com indicates that 56 percent of employers plan to hire more interns this year, up 9 percent...more

6/23/2014 - Employer Liability Issues Internships Young Lawyers

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