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Can't You Hear Me Knocking? Amending ERISA

On October 15, 2013, the United States Supreme Court issued its opinion in Heimeshoff v. Hartford Life & Accident Ins. Co., 134 S.Ct. 604 (2013). The specific question before the Court in that case, as expressly stated by...more

Texas Supreme Court oral arguments (9/14)

No. 12-0803 -- Texas Dep't of Aging & Disability Servs. v. Cannon -- The plaintiff brought a wrongful-death case against the department and department employees. The department moved to dismiss the employees, arguing that...more

ERISA Fiduciary Obligations: More on Application to Life Insurance Coverage

This article examines the case of Biller v. Prudential Insurance, in which the U.S. District Court for the Northern District of Georgia denied a motion to dismiss a claim brought against an employer by the beneficiaries of a...more

D.C. Circuit Court of Appeals Agrees to Hear Halbig ACA Case Before Full Court

Following up on our Week 22 ACA Countdown to Compliance post, the D.C. Court of Appeals granted the government’s petition for en banc review in Halbig v. Burwell, which held low income subsidies to purchase coverage through...more

Full D.C. Circuit to Rehear ACA Premium Tax Credit Case

The full U.S. Court of Appeals for the D.C. Circuit has vacated the 2-1 panel decision issued July 22, 2014, in Halbig v. Burwell, which struck down the Internal Revenue Service (IRS) Rule providing for Affordable Care Act...more

Federal Appeals Courts Issue Contradictory Rulings on Federal Marketplace Subsidies under Affordable Care Act

Two federal appeals courts issued contradictory rulings on the validity of subsidies for the purchase of health insurance under the federal marketplace established pursuant to the Affordable Care Act (ACA). On July 22, a...more

Insurance Industry Sweeps Retained Asset Account Doubleheader

On August 26, the U.S. Court of Appeals for the First Circuit held in Vander Luitgaren v. Sun Life Ass. Co. of Canada, No. 13–2090, 2014 WL 4197947 (1st Cir. Aug. 26, 2014), that an insurer, acting as a claims administrator,...more

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

District Courts Reviewing ERISA Cases Under the Arbitrary and Capricious Review Standard Serve Only in an Appellate Role

In McCorkle v. Metro. Life Ins. Co., 13-30745, 2014 WL 2983360 (5th Cir. 2014), the Fifth Circuit reversed the district court’s holding that MetLife’s adverse determination regarding the plaintiff’s claim for benefits due to...more

Employers Should Monitor Closely Group Term Life Insurance Enrollments

Many employers offer group term life insurance, including supplemental life. Often an employee who wants to buy coverage above a particular level after an initial open enrollment period must show evidence of insurability....more

Burden of Proof: The "What Changed?" Argument from "A Medley of Interesting Disability Cases"

Hegger v. Unum Life Ins. Co. of America, 2013 U.S. Dist. LEXIS 28587 (N.D. Cal. 2013) - Facts and holding: Plaintiff Tami Hegger (“Hegger”) was employed as a medical device sales representative until she left work in...more

For Whom the Ring Tones: TCPA Litigation and the Insurance Industry

Insurance companies are increasingly the subject of Telephone Consumer Protection Act (TCPA) lawsuits. Any insurance company that communicates with its customers, job applicants, and others by phone or text using an automated...more

One Step Closer to the Supreme Court: The Fate of Obamacare Premium Tax Credits in the Face of the Circuit Split

Last month, two federal courts of appeals issued opposing decisions on whether the Patient Protection and Affordable Care Act (the “ACA”) permitted subsidies, in the form of premium tax credits, to health coverage bought...more

Insurer Claims Attorney-Client Privilege Of Third Parties Prohibits Disclosure To Its Own Attorneys

At first, this case seems somewhat pedestrian – a lawyer sues her erstwhile law firm for employment discrimination. But then things get complicated. It turns out that the lawyer was employed by a law firm that was employed...more

Cedent Wins Breach Of Contract Claim Against R & Q Reinsurance

A Wisconsin federal district court granted summary judgment in favor of plaintiff, Employers Insurance Company of Wausau, and against its reinsurer, R&Q Reinsurance Company, on Employers’ claim that R&Q breached its agreement...more

Third Circuit Holds Insurer’s Interpretation of Employer’s Liability Exclusion is Fairly Debatable

A recent 3rd Circuit decision, ArcelorMittal Plate, LLC v. Joulé Technical Services, Inc., 558 Fed.Appx. 205 (3d Cir. 2014) reiterates that under New Jersey law, an insurer does not act in bad faith when denying a claim that...more

Fiduciary Notice Obligations Associated with Change of Carriers

This case discusses the fiduciary obligation of plan administrators to inform participants in advance of ERISA’s statutory notice periods regarding the potential impact caused by a change of life insurance carrier under a...more

Affordable Care Act Update: Courts Divided on who is Eligible for Subsidies on the Exchange

On July 22, 2014, within 2 hours of each other, two U.S. Courts of Appeal issued conflicting rulings on whether subsidies may be offered in states that use the federal insurance exchange. Background. The...more

No delay of game – Affordable Care Act (ACA) compliance efforts should continue, despite court rulings

Perhaps you have put your compliance efforts on the back burner, hoping the ACA will just go away. We have heard many reasons for this procrastination, including the constitutional challenge to the individual mandate, the...more

Insurance Recovery Law - July 2014 #3

Washington Supreme Court Rules That It Was Error To Delay Adjudication Of Insurer’s Duty To Defend, But Should Stay Discovery As To Insurer’s Coverage Defenses - Why it matters: The Washington Supreme Court...more

ERISA (8th Circuit): Over-The-Counter Vitamin Supplements Trigger Pre-Existing Condition Exclusion

What sort of “medical treatment” triggers the pre-existing condition exclusion in an ERISA-governed disability policy?...more

HEAL Advisory: How Big Is Halbig? The Potential Effects of This Major Ruling Are Numerous and Significant

On July 22, 2014, the U.S. Court of Appeals for the D.C. Circuit and the U.S. Court of Appeals for the Fourth Circuit issued conflicting opinions on a key aspect of the Affordable Care Act ("ACA"). The cases are Halbig v....more

Circuit Courts Split on ACA Subsidies

On July 22, 2014, United States Circuit Courts of Appeals from two different circuits issued opposing rulings on the legality of the Federal government providing subsidies to eligible buyers of health insurance products from...more

The Affordable Care Act—Countdown to Compliance for Employers, Week 22: Charting the Future of the Premium Subsidies (and Employer...

On July 22, 2014, two federal appellate courts issued conflicting decisions, within hours of each other, regarding the IRS final rule published on May 23, 2012 (the “IRS Rule”), intended to implement the exchange-related tax...more

Conflicting Rulings on Health Insurance Subsidies Raise Concerns Among Insurers and Providers

On Tuesday, July 23rd 2014, separate federal circuit court panels issued conflicting rulings regarding whether the government could subsidize health insurance premiums for Americans enrolled in federally-run health exchanges....more

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