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What is Telemedicine? A Cool Benefit or a Hot Mess?

We’ve had numerous inquiries lately about telemedicine benefits. My clients most typically ask either “is this a group health plan?” or “is it just access to another provider?” Clearly, there is much confusion surrounding...more

Hospital and Fixed Indemnity Policies; Excepted Benefits; Supplemental Coverage under Recently Proposed Treasury Regulations; and...

We reported in a recent post on proposed regulations dealing with, among other things, the treatment of hospital indemnity or other fixed indemnity insurance products in the group market. This post takes a closer look at the...more

Michigan Health Insurance Claims Assessment Act is Not Preempted by ERISA

The Sixth Circuit, has decided, on remand from the Supreme Court, that the Michigan Health Insurance Claims Assessment Act (Act) is not preempted by ERISA. The Act imposes a 1 percent tax on all paid claims by insurers or...more

ERISA Preempts State Law Requiring Insurer “Prompt Payment”

Alaska’s prompt pay statute—which requires insurers to pay benefit claims within 30 days of submission—is preempted by federal laws governing employer-provided benefits and benefits for government workers, a federal judge...more

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

What is Title Insurance, Really?

All real estate buyers should consider purchasing title insurance. The premium is approximately $4.00 for every $1,000 of the purchase price. Some see this as an added cost to the deal.  But the cost is well worth the value...more

ERISA: “Key Evidence Needed to Prove the Intoxication Exclusion”

You know that many insurance policies and ERISA-governed plans exclude from coverage disabilities “resulting from, or related to…any accident related to the voluntary influence of any drug, narcotic, intoxicant or chemical….”...more

Bad Faith Actions for Excess Judgments….is There Trouble Brewing for Recalcitrant Primary Insurers

Can an excess carrier go ahead and fund an excess primary limits settlement and then assert a claim for bad faith against the primary insurer who previously refused to accept and fund a prior in-limits policy demand? On...more

Forgery May Not Constitute “Theft” Under an Employee Dishonesty Coverage

Ruling in favor of the insurer on a motion for summary judgment, on July 29, 2016 the Fifth Circuit Court of Appeals held that under the terms of a commercial crime policy, proof of a forgery by the insured’s employee in...more

Food and Beverage Law Update: August 2016

When food and beverage companies think of their largest risks, data breaches have not historically come to mind, but this is changing because of reports in the past few months of major breaches by companies such as Noodles &...more

ERISA — 7th Circuit: Under De Novo Review, the Court “Should NOT Resolve[] Doubts or Gaps in the Evidence in [the Claimant’s]...

You know that claimants have the burden to establish eligibility for ERISA-governed disability benefits. Sometimes gaps in coverage can occur when, for example, a claimant alleges disability while using accrued vacation....more

Tenth Circuit Drills Down Into Roots Of Moral Hazard, Comes Up Dry

Moral hazard (one of this blog’s preoccupations) usually comes up in disputes over the scope of coverage under an insurance policy. But state legislatures often address it, too—for example, by imposing limits on agreements...more

Proposed Changes to Form 5500 Would Significantly Increase Reporting Obligations for Health and Welfare Plan Sponsors

Summary - On July 11, 2016, the Department of Labor (DOL) and Internal Revenue Service (IRS) announced a proposal to implement significant changes to the forms and regulations that govern annual employee benefit plan...more

ERISA: 2nd Circuit — Mental Health Provider Lacks Standing to Challenge ERISA Benefit Denial

Who can challenge an ERISA benefit denial? Does a physician have standing to challenge the denial of a patient’s coverage? It depends....more

District Court Finds Forum Selection Clause Unenforceable in ERISA Action

A federal district court in Illinois ruled that a plan’s forum selection was unenforceable because it conflicts with ERISA’s public policy of providing plaintiffs “ready access to the Federal courts.” Darlene Harris...more

Commonsense Misconduct Not so "Common": Illinois Supreme Court Significantly Narrows Use of Commonsense Rationale in Employee...

In the absence of a rule prohibiting specific conduct, employers can no longer rely merely on what one would deem "commonsense" to deny unemployment benefits. In Petrovic v. Department of Employment Security, the Illinois...more

Form 1095-C and I-9 Compliance: How to handle "mismatches"

Employers complying with the Affordable Care Act (“ACA”) by filing Form 1095-C increasingly face another question: Are they in compliance with their I-9 obligations? The Affordable Care Act (ACA) requires employers with...more

Final ACA Nondiscrimination Rules Under Section 1557 Now Effective

This is the one hundred and first issue in our series of alerts for employers on selected topics on health care reform. (Click here to access our general Summary of Health Care Reform and other issues in this series.) This...more

The Problem With Providers Using Their Own Funds In Their 401(k) Plan

I always say that I come up with many ideas, but most of them are bad. Seriously, there are so many bad ideas out there in the 401(k) space and one of the really bad ideas out there are bundled plan providers using their own,...more

Appellate Division Finds c.78 Health Benefits Contributions Requirements Do Not Apply to Public Sector Disability Retirees

Last month, in Brick Twp. PBA Local 230 v. Twp. of Brick, the Appellate Division of the Superior Court of New Jersey confirmed that N.J.S.A. 40A:10-21.1, P.L. 2011, c. 78, § 42, more commonly known as Chapter 78, does not...more

Paying Employees to Opt Out of Insurance? BEWARE

Seyfarth Synopsis: That “win-win” in contract negotiation wherein employees are paid to opt out of employer insurance has become much more complicated thanks to the IRS. Basically, if bargaining parties do not follow new IRS...more

Life and Annuity Series: Class Certified in an ERISA “Unreasonable Compensation” Case

The Colorado federal court concluded last summer, in Teets v. Great-West Life & Ann. Ins. Co., that an insurer could be subject to ERISA liability for receiving unreasonable compensation in connection with a stable value...more

IRS Proposes Restrictions on Employer Opt-Out Payments for ACA Coverage Waivers

In early July the IRS issued proposed regulations addressing the effect that employer payments to employees who waive employer-sponsored health coverage, known as Opt-Out Payments, have on determining whether an ACA-covered...more

Waves of Guidance and Benefit Plan Developments Worth Watching

Notices on Second Round of Privacy and Security Audits are Out, Expat Plans, OON Surgery Center Billing Issues, and New Nondiscrimination Rules for Federal Contractors, New ERISA Civil Monetary Penalties, COBRA Notices and...more

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