We conclude our blog series on best practices in administering benefit claims with the three C’s: be clear, be consistent, and communicate. The key to effective benefit claim administration ultimately boils down to drafting...more
This week we discuss the importance of establishing good claims procedures and the benefits of following those procedures.
A plan’s claims procedures should be spelled out clearly in both the plan document and the summary...more
11/8/2019
/ Attorney-Client Privilege ,
Benefit Plan Sponsors ,
Best Practices ,
Claim Procedures ,
Compensation & Benefits ,
Discovery ,
Employee Benefits ,
Employee Retirement Income Security Act (ERISA) ,
Employer Group Health Plans ,
Fiduciary Duty ,
Summary Plan Description
This week in our blog series on best practices in administering benefit claims, we discuss the importance of knowing and, importantly, understanding the laws governing benefit claim administration.
Section 503 of ERISA...more
In this edition of our Newsletter, we take a look at a pair of cases that, while unrelated, together remind us of the importance of having clear plan rules in place that reflect the plan sponsor’s intention. The first article...more
10/11/2019
/ 401k ,
403(b) Plans ,
Affordable Care Act ,
Benefit Plan Sponsors ,
Breach of Duty ,
Class Action ,
Employee Benefits ,
Employee Retirement Income Security Act (ERISA) ,
Employer Group Health Plans ,
Fiduciary Duty ,
Foreign Nationals ,
Hardship Distributions ,
Health Insurance ,
IRS ,
Mental Health Parity Rule ,
Multiemployer Pension Plan Amendments Act (MPPAA) ,
Pensions ,
Retirement Plan ,
Safe Harbors ,
Standing ,
Statute of Limitations ,
Withdrawal Liability
ERISA health care plans typically include reimbursement and subrogation clauses, which give plans a right to reimbursement of medical expenses paid on behalf of a beneficiary where the injury is caused by a third party. While...more
10/2/2019
/ Benefit Plan Sponsors ,
Employee Benefits ,
Employee Retirement Income Security Act (ERISA) ,
Employer Group Health Plans ,
Employer Liability Issues ,
Insurance Risk Pool ,
Jurisdiction ,
Medical Expenses ,
Medical Reimbursement ,
Preemption ,
Savings Clause ,
State Law Claims ,
Subrogation
Editor’s Overview -
In 2016, we saw a considerable uptick in the number and variety of excessive fee lawsuits commenced against plan fiduciaries of defined contribution plans. We begin the year by taking a look at these...more
1/31/2017
/ 401k ,
403(b) Plans ,
AARP ,
Americans with Disabilities Act (ADA) ,
Benefit Plan Sponsors ,
Breach of Duty ,
Class Action ,
Collective Bargaining ,
Defined Contribution Plans ,
Dismissals ,
Employee Benefits ,
Employee Retirement Income Security Act (ERISA) ,
Employer Group Health Plans ,
Equal Employment Opportunity Commission (EEOC) ,
Excessive Fees ,
Fiduciary Duty ,
Financial Adviser ,
GINA ,
Investment Funds ,
Irreparable Harm ,
Lifetime Health Benefits ,
Preliminary Injunctions ,
Reservation of Rights ,
Retirement ,
Retirement Plan ,
Revenue Sharing ,
Self-Dealing ,
Unions ,
Vesting ,
Wellness Programs
This month Richard Zall, Chair of Proskauer's Health Care Department, explores developments likely to occur with respect to the Affordable Care Act as a result of the new administration. In our Rulings, Filings and...more
12/21/2016
/ 21st Century Cures Act ,
Affordable Care Act ,
CEOs ,
CMMI ,
Conflicts of Interest ,
Department of Labor (DOL) ,
Employee Benefits ,
Employee Retirement Income Security Act (ERISA) ,
Employer Group Health Plans ,
Fiduciary Rule ,
Flexible Spending Accounts ,
Food and Drug Administration (FDA) ,
Health Insurance ,
Health Insurance Exchanges ,
Health Savings Accounts ,
Individual Mandate ,
Local Ordinance ,
Medicaid ,
Medical Devices ,
Medicare ,
Medicare Advantage ,
Pay Ratio ,
Pay Ratio Tax ,
Payroll Taxes ,
Pharmaceutical Industry ,
Preliminary Injunctions ,
Qualified Small Employer Health Reimbursement Plan (QSEHRAs) ,
Repeal ,
Subsidies ,
Tax Credits ,
Trump Administration
This month we review a recent Second Circuit decision addressing ERISA plan status as a class member in a securities shareholder class action. As discussed in the article, the decision exposes a potential conflict among the...more
12/1/2016
/ AARP ,
Administrative Procedure Act ,
Affordable Care Act ,
Americans with Disabilities Act (ADA) ,
Appeals ,
Best Interest Contract Exemptions ,
Budget Recollection Legislation ,
Class Action ,
Department of Labor (DOL) ,
Dismissals ,
Due Process ,
Employee Benefits ,
Employee Retirement Income Security Act (ERISA) ,
Employer Group Health Plans ,
Equal Employment Opportunity Commission (EEOC) ,
Fiduciary Duty ,
Fiduciary Rule ,
Filing Deadlines ,
GINA ,
Investment Adviser ,
IRS ,
National Association for Fixed Annuities (NAFA) ,
Preemption ,
Preliminary Injunctions ,
Presidential Elections ,
Repeal ,
Retirement Plan ,
Reversal ,
Securities Litigation ,
Shareholder Litigation ,
Slayer Statutes ,
Summary Judgment ,
Trump Administration ,
Wellness Programs
Editor's Overview -
This month’s newsletter features an article on the DOL’s recently published interim final rule that increases penalties for notice and disclosure violations, which generally became effective on...more
9/1/2016
/ Affordable Care Act ,
Annual Reports ,
Broker-Dealer ,
Civil Monetary Penalty ,
Commercial Speech ,
Constitutional Challenges ,
Defined Benefit Plans ,
Department of Labor (DOL) ,
Employee Benefits ,
Employee Retirement Income Security Act (ERISA) ,
Employer Group Health Plans ,
Fiduciary Duty ,
Fiduciary Rule ,
Health Insurance ,
Injunctive Relief ,
Investment Adviser ,
Investment Funds ,
Penalties ,
Pension Funds ,
Popular ,
Recordkeeping Requirements ,
Reporting Requirements ,
Statute of Limitations ,
Summary of Benefits and Coverage
Editor's Overview -
This month we focus on the EEOC's proposed rules concerning wellness programs. As our colleague, Amy Covert, discusses, a recent change of position by the EEOC provides employers with opportunities...more
5/22/2015
/ Affordable Care Act ,
Americans with Disabilities Act (ADA) ,
Best Management Practices ,
Department of Labor (DOL) ,
Employee Retirement Income Security Act (ERISA) ,
Employer Group Health Plans ,
EPCRS ,
Equal Employment Opportunity Commission (EEOC) ,
Health Insurance Portability and Accountability Act (HIPAA) ,
Incentives ,
Voluntary Participation ,
Wellness Programs
In a decision watched closely by both employers and unions, a unanimous Supreme Court has resolved a thirty-plus year split among the circuit courts on the standards governing claims for retiree health-care benefits arising...more
Editor's Overview -
As it is well known, in Cigna Corp. v. Amara, 131 S. Ct. 1866 (2011), the U.S. Supreme Court identified several forms of appropriate equitable relief that may be available under Section 502(a)(3) of...more
11/19/2014
/ ADEA ,
Choice-of-Venue ,
CIGNA v Amara ,
Compensatory Awards ,
Employee Retirement Income Security Act (ERISA) ,
Employer Group Health Plans ,
Employer Liability Issues ,
Equitable Estoppel ,
Equitable Relief ,
Equitable Surcharge ,
FSA ,
IRS ,
Life Insurance ,
Reformation ,
SCOTUS