Civil Remedies Labor & Employment Insurance

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Health Plan Case Managers Entitled to Overtime Pay

Managed care companies help insurers and government programs coordinate healthcare plans by making coverage determinations for participants. In many situations, case managers conduct utilization reviews to determine the...more

Where Does a Third Party “Stand” on Liens?

Dion v. William Robert Batten, Sr. (8/2/16) Facts and Procedural History: Plaintiff was employed by Neuwirth as a servicing agent. In the course and scope of his employment with Neuwirth, he was involved in a car...more

Employing Insurance to Protect You From Wage & Hour Suits In Light of Updated Regulations

In 2014, we reported that wage and hour lawsuits—claims in which employees and companies dispute the amount owed to an employee or class of employees for overtime work— had increased 432 percent over the last two decades. ...more

ERISA: Court’s Short Checklist to Reduce Plaintiff/Claimant Attorney Fees

Attorney fees in ERISA cases continue to be a challenge. What happens when both sides can claim wins during a case? What is a reasonable hourly rate for Plaintiff’s attorneys?...more

New ADA and GINA Wellness Regulation Changes Complicate Wellness Program Compliance Analysis and Risks

Wellness programs should all be reviewed considering the Americans with Disabilities Act (“ADA”) and the Genetic Information Nondiscrimination Act (“GINA”) regulatory changes because noncompliance with the new requirements do...more

Supreme Court Decides Zubik v. Burwell and consolidated cases

Zubik v. Burwell and several consolidated cases challenged a federal regulation requiring employers to cover certain contraceptives as part of their health plans unless they submit a form either to their insurer or to the...more

Supreme Court Limits ERISA Reimbursement Rights: Insurers Will Need to be Diligent

On January 20, 2016, the United States Supreme Court held that an ERISA plan could not satisfy its reimbursement rights from a participant’s general assets. ERISA plans’ reimbursement rights are now so limited that...more

Supreme Court Limits Plan’s Ability to Recoup Medical Expense Payments

In Montanile v. Board of Trustees of the National Elevator Industry Health Benefit Plan, the US Supreme Court held that when an ERISA plan participant completely dissipates a settlement from a third party on items that are...more

Supreme Court Protects Health Insurers From Onerous State Claims Reporting

On Tuesday, March 1, 2016, the Supreme Court issued a ruling in Gobeille v. Liberty Mutual, finding that states do not have the authority to require self-insured plans (like Liberty Mutual Insurance Co.) to collect and report...more

Which Way Did Our Money Go? Supreme Court Decides ERISA Subrogation Issue

On January 20, 2016, the Supreme Court of the United States addressed the first of several ERISA-related cases on its October 2015 docket, reversing the Eleventh Circuit Court of Appeals and concluding that the trustees of...more

Benefits Litigation Update – July 2015

Welcome to the new, rejuvenated version of the Benefits Litigation Update, which we bring you jointly with the law firm of Epstein Becker Green. Our goal is to provide a concise and, we hope, insightful glimpse into recent...more

Tenth Circuit Addresses ERISA Limitations Provision in Class Action Decision

In Fulghum v. Embarq. Corp., 785 F.3d 395 (10th Cir. 2015), the Tenth Circuit Court of Appeals considered the claims of a class of telephone company retirees whose life and health insurance benefits were reduced or eliminated...more

Wisconsin Supreme Court Accepts New Cases: Occurrences, 12% Interest, and Donning and Doffing

Last Friday, Wisconsin’s supreme court announced that it had accepted seven new cases. Three of them are of particular interest to Wisconsin businesses. In Wis. Pharmacal Co. v. Nebraska Cultures of Cal.,...more

Is an Underinsured Motorist Policy Subject to the Automatic Bankruptcy Stay?

Imagine: an employee is injured in a car accident with another driver who is at fault. The employee settles with the at-fault driver for the limits of her liability policy. The employee, whose injuries exceed the at-fault...more

Summary of California Appellate Decisions - March 2015

HOW TO USE THIS CASE SERVICE - When you receive your summaries, each page will have an alphabetical letter located in the upper right-hand corner. Each alphabetical letter corresponds to a separate subject matter...more

En Banc Sixth Circuit Rules Against Disgorgement Remedy in Benefits Case

In Rochow v. Life Insurance Company of North America, No. 12-2074 (6th Cir. March 5, 2015), the U.S. Court of Appeals for the Sixth Circuit, sitting en banc, ruled that an insurance company that wrongfully denied benefits to...more

Disgorgement of Profits Not Available for Arbitrary and Capricious Benefits Denial – This Time

Wrongful denial of employee benefits will not expose plan fiduciaries to equitable remedies – such as disgorgement of profits – where restoration of benefits is adequate to make the claimant whole, says the Sixth Circuit in...more

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

Revisiting Rochow: The Sixth Circuit Rejects Earlier $3.8 Million Equitable Award in Recent En Banc Decision

Just over a year ago, a panel decision by the Sixth Circuit Court of Appeals in Rochow v. Life Insurance Company of North America, 737 F.3d 415 made big news when the court upheld the district court’s award of $3.8 million in...more

Sixth Circuit Overturns the Lower Court’s Award of $3.8 Million in Alleged Profits Arising From a Denial of Benefits

The U. S. Court of Appeals for the Sixth Circuit, sitting en banc, has overturned the decision of a divided three-judge Sixth Circuit panel which had affirmed the district court’s award of $3.8 million of “disgorged” profits,...more

District Court Defines Surcharge Broadly

A New York district court held that surcharge could include not only make-whole relief, but also consequential, exemplary, or punitive damages in limited circumstances where malice or fraud is involved. Plaintiff Janet...more

ERISA Fiduciaries Have a Duty to Inform

SUMMARY: In this case, the court found that the employer, serving as plan administrator of a group life insurance plan providing basic and supplemental coverage, may be liable for monetary damages for breach of its fiduciary...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

Equitable Surcharge Awarded to Life Insurance Plan Beneficiary

A federal district court in California awarded relief in the form of surcharge to a life insurance plan beneficiary who claimed that a plan administrator failed to provide complete and accurate information in response to...more

Ask And You Shall Receive! Employers Should Interpret Requests For Plan Documents Broadly

The Sixth Circuit Court of Appeals recently joined a number of other appellate courts in adopting the “clear notice” standard under which a written request for copies of benefit plan documents subject to the Employee...more

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