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Court Holds That ERISA Plaintiff Cannot Claim Equitable Remedies When the Plaintiff Has Adequate Remedies to Recover Plan...

A federal court has ruled that, although a recent U. S. Supreme Court decision expanded the kinds of equitable remedies available to a plaintiff under ERISA § 502(a)(3), those remedies are still unavailable when the ERISA...more

With Tax Season Looming, Appellate Division Refuses to Find Duty to Defend Against IRS Action

In William B. Kessler Memorial Hosp., Inc. v. North River Ins. Co., 2013 WL 6036678 (N.J. Super. Nov. 15, 2013), the Superior Court of New Jersey, Appellate Division, rejected the notion that an insurer’s promise to “defend...more

Sixth Circuit Issues Shocking Opinion Against ERISA Insurer, Dramatically Changes The ERISA Landscape

In what can only be described as a shocking opinion, the Sixth Circuit Court of Appeals issued a 2-1 decision affirming a lower court's award of $3.8 million dollars in disgorged profits to a former president of Arthur J....more

Sixth Circuit Expands Availability of Remedies Under ERISA

The Sixth Circuit recently concluded that a disability plan participant was entitled to relief consisting of benefits under the plan and disgorgement of defendant’s profits for delaying payment. In so ruling, the Court found...more

The Supreme Court Defers to Plan Language in U.S. Airways, Inc. v. McCutchen

Summary - In U.S. Airways, Inc. v. McCutchen, the US Supreme Court recently considered whether certain equitable defenses override the terms of a welfare plan in a plan fiduciary's suit for reimbursement under §...more

A Costly Change: Violation Of a Non-Solicitation Clause Results In a Multi-Million Dollar Award

A recent ruling entered in Pennsylvania state court is a stark reminder to employers and employees about the dangers associated with violating post-employment restrictive covenants such as non-compete and non-solicitation...more

Insurance Recovery Law -- Jul 11, 2013

A little knowledge can go a long way - The cases analyzed in this week's newsletter illustrate an important principle for policyholders: a basic understanding of how their policies work and the controlling insurance...more

7th Circuit Rules Employee May Recover Monetary Damages In ERISA Claim For Unpaid Benefits Against Insurer Who Denied Coverage...

The Seventh Circuit’s recent decision in Kenseth v. Dean Health Plan, Inc. provides a means for employees to collect monetary relief on their claim for benefits if they can show that the terms of the plan were not clear, and...more

Health Insurance Carriers Must Also Be Careful In What They Tell Plan Participants

I blogged recently warning employers to be careful when enrolling employees in plan benefits because the employer could be responsible to pay life insurance or disability benefits if an employee who is improperly enrolled...more

Express Plan Terms Allow Self-Insured Plan to Recover Medical Benefits Paid to Employee Post-McCutchen

In Quest Diagnostics v. Bomani, et al., 11-CV-00951 (D. Conn., June 19, 2013), the court granted Quest Diagnostic’s (“Quest”) motion for summary judgment, ruling that Quest, as the fiduciary to its self-insured medical plan,...more

Be Careful With Your Life Insurance Enrollments

Over the years there have been a number of cases that have involved employers improperly enrolling employees in group life or disability insurance benefits....more

Seventh Circuit Makes Damages More Available for Employees Given Wrong Information About Benefits

Kenseth v. Dean Health Plan, Inc., represents a significant departure from the decades of law prior to Cigna v. Amara holding that employees could not recover for misrepresentations by employers over benefit coverage if the...more

ERISA Litigation Alert: Check Your Plan Subrogation and Reimbursement Language to Eliminate “Contractual Gaps”

In U.S. Airways v. McCutchen, the U.S. Supreme Court upheld the ability of U.S. Airways’ health plan to recover medical expenses that it previously paid to the injured party from a third party settlement, but remanded the...more

High Court Holds Equitable Defenses Do Not Trump ERISA Plan’s Clear Reimbursement Language

The Supreme Court’s April decision in U.S. Airways, Inc. v. McCutchen resolves a circuit split on the issue of a medical plan’s right to reimbursement of medical expenses from a plan participant who recovers on a personal...more

Monthly Benefits Update - April 2013

Health Care Reform: Guidance on Required Future Modifications to SBC, Other Issues - The Internal Revenue Service (IRS), Department of Labor (DOL), and Department of Health and Human Services (HHS) issued new guidance...more

New Whistleblower Bounty Law On The Horizon In NY?

On March 22, 2013, the New York State Senate introduced the S4362 Proposal which, through a “bounty,” gives financial awards to whistleblowers who provide original information to the Department of Financial Services (DFS)...more

ERISA Legal News - 1st Quarter, 2013 • Volume 4, Number 1

In This Issue: - Supreme Court Update: Where Plan Reimbursement Or Recovery Terms Are Ambiguous Or Silent,Equitable Doctrines May Fill The Gaps: US Airways, Inc. v. McCutchen, 569 U.S. ___ (2013). In an...more

Supreme Court Upholds Health Plan’s Right To Recover Money from Third Party

The U.S. Supreme Court has ruled that the clear terms of an employer's group health plan override an employee's equitable defenses in determining the plan's right to recover amounts from a third party. This decision points...more

Multiple Employer Welfare Arrangements: New Reporting Requirements, Civil Penalties and Other Regulations

Generally, a multiple employer welfare arrangement (MEWA) is a welfare benefit program that is sponsored by a group of employers that have common business and industry interests, but not common ownership interests. The...more

Supreme Court “Dooms” Equitable Defenses to Plan’s Reimbursement Provisions

In a prior blog, I discussed the importance of including unambiguous reimbursement rights in health plan documents in order to manage healthcare costs. The enforceability of such rights was confirmed by the United States...more

High Court Rules Equitable Defenses Don’t Override ERISA Plan Terms

On April 16, 2013, the U.S. Supreme Court issued its decision in US Airways, Inc. v. McCutchen (No. 11–1285), deciding the issue of whether equitable defenses, such as the principle of unjust enrichment, can override the...more

U.S. Supreme Court: Equity Cannot Trump ERISA Plan Terms in ERISA Reimbursement Case

The U.S. Supreme Court yesterday strengthened the ability of employer health insurance plans to recoup payments for medical expenses paid for an injured plan participant who later sues to recover damages from a third...more

The U.S. Supreme Court Upholds Plan Sponsor’s Recovery Of Participant Damages Award

On April 16, 2013, the U.S. Supreme Court issued its opinion in U.S. Airways, Inc. v. McCutchen finding in favor of U.S. Airways in its quest to recover $66,866 in medical expenses incurred by its employee as a result of a...more

Saskatchewan Trial Court Awards Record Punitive Damages for Insurer Bad Faith

A Justice of the Saskatchewan Court of Queen’s Bench has assessed punitive damages totalling $4,500,000 against two insurers in a recent trial decision, Branco v. American Home Assurance et. al., 2013 SKQB 98. In rendering a...more

Religious Institutions Update: April 2013

Implementation of the Patient Protection and Affordable Care Act (PPACA) is in full swing. The law requires non-exempt religious organizations with fewer than 50 full-time employees to determine whether they are a large...more

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