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First Circuit Finds for Life Insurer in ERISA Class Action Challenging Retained Asset Accounts to Pay Life Insurance Benefits

In a unanimous panel decision, the U.S. Court of Appeals for the First Circuit reversed a trial court’s ruling that the defendant, Unum Life Insurance Company of America (Unum), had breached fiduciary duties under the...more

ERISA self-insured health plan not required to cover same sex spouses

In Roe v. Empire Blue Cross Blue Shield, No. 12–cv–04788 (NSR), 58 EBC 1077, 2014 WL 1760343 (S.D. N.Y. May 1, 2014), the United States District Court for the Southern District of New York held a self-insured health plan that...more

De Facto Plan Administrator Claims in the First Circuit

According to 29 U.S.C. § 1132(c)(1)(B) of ERISA, it is within a court’s discretion to award a penalty of up to $110 per day based on an administrator’s failure to comply with a plan participant’s or beneficiary’s request for...more

First Circuit Upholds Use of Retained Asset Accounts in ERISA Class Action

On July 2, 2014, a unanimous panel of the United States Court of Appeals for the First Circuit held that Unum Life Insurance Company’s practice of using Retained Asset Accounts (RAAs) to pay death benefits claims on group...more

Rules Will Allow Issuance of Longevity Insurance in Retirement Plans

On July 1, the U.S. Department of the Treasury (Treasury) and the Internal Revenue Service (IRS) issued final rules excluding qualifying longevity annuity contracts (QLACs) from the required minimum distribution rules (RMD...more

Federal Courts Continue To Find Claims Adjusters Exempt

We have previously discussed how, over the past 10+ years, courts have increasingly recognized that insurance claims adjusters are exempt under the Fair Labor Standards Act (FLSA). The recent cases of Estrada v. Maguire Ins....more

Summary of California Appellate Decisions - June 2014

Insurance Coverage; Professional Services Exclusion; Completed Operations; Duty To Defend: North Counties Engineering, Inc. v. State Farm General Insurance Company (2014) 224 Cal.App.4th 902, 169 Cal.Rptr.3d 726...more

A Day At The Beach: Fifth Circuit Rejects Expansive Situs Definition For LHWCA Comp In BP Beach Cleaning Case

The Fifth Circuit recently reversed, per curiam, a district court decision finding that a contract worker cleaning oiled beaches near Grand Isle, Louisiana, in the wake of the 2010 Macondo oil spill qualified as a...more

Construction E-Note - June 27, 2014

In This Issue: - Mississippi Legislature Expands State’s Lien Law to Protect Subcontractors, Suppliers, and Materialmen - The Alabama Supreme Court Broadens the Definition of “Occurrence” in a General...more

Recap: Early Responses on Twitter As SCOTUS Decides Hobby Lobby Contraceptives Case, 5-4

A quick look at early responses on Twitter regarding Monday's ruling by the U.S. Supreme Court in Burwell v. Hobby Lobby. ...more

Fifth Third Bancorp v. Dudenhoeffer – An Analysis of the U.S. Supreme Court’s Decision

For over two decades, federal courts have embraced the so-called Moench presumption of prudence in ERISA stock-drop cases. Pursuant to that presumption, courts have routinely dismissed such claims absent allegations in a...more

New Obamacare Benefit Mandate Takes Aim at Breast Cancer

Under the Affordable Care Act, insurers and employers that sponsor non-grandfathered medical plans must cover and pay the full cost of specified preventive services in accordance with recommendations issued by the U.S....more

Final Regulations on Orientation Periods Released

On June 20, the Federal regulatory agencies in charge of health care reform guidance (the Departments of Labor, Treasury, and Health and Human Services) released final regulations (“Final Regulations”) clarifying the...more

Introductory Periods Must Be Reconsidered in Light of Insurance Waiting Time Rules

Most employers have an “introductory” or “probationary” period for new full-time employees. This period is usually defined as a set period of time following the date of hire, usually 90 days in length, during which a new...more

Health Care Reform Implementation Update

The Affordable Care Act (ACA) received a great deal of attention this past week in Washington. The House held numerous hearings on implementation issues, including oversight of access to care for ACA enrollees and improper...more

In an Opinion with Far-Reaching Implications, the Second Circuit Finds Insurance Coverage for an ERISA Claim

When a general liability policy expressly provides coverage for employee benefits liability and the plaintiff in the underlying suit alleges a violation of the Employee Retirement Income Security Act of 1974 (“ERISA”), does...more

The Federal Court for the Southern District of New York Rules that Employers with Self-Insured Health Plans Need Not Offer Medical...

The issue of same-sex spousal rights is now largely resolved for qualified retirement plans. However, substantial questions about same-sex spouse health benefits remain unanswered. In Roe v. Empire Blue Cross Blue Shield,...more

Minnesota Federal District Court Explores Application of Corporate Practice of Medicine Doctrine to MRI Scans

On March 25, 2014, in State Farm Mutual Automobile Insurance Company v. Mobile Diagnostic Imaging, Inc., the U.S. District Court for the District of Minnesota held that a corporation not owned or controlled by physicians does...more

ERISA: “Derivative Standing” Allows Medical Provider To Obtain Reimbursement From ERISA Plan

Medical providers often have a patient/ERISA plan participant assign rights under an ERISA health care plan to allow the medical provider to seek payment for medical services provided....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

Dangers of Misclassifying an Employee as an Independent Contractor Highlighted Once Again in New York Appellate Court Decision

The issue of employee misclassification was once again on display, this time in Nance v. NYP Holdings, where a New York appellate court affirmed an earlier finding that the New York Post failed to classify one of its...more

Questions You Should Be Asking About Employment Practices Liability (EPL) Insurance

Every firm has employees, as well as individuals that it has “failed” to hire, or promote, or recognize and reward to the extent that the individuals believes befitting. This is what makes it difficult to completely avoid...more

CMS's Final Exchange and Insurance Market Standards Impact Qualified Health Plan Filings for 2015 and Beyond

On May 16, 2014, the Centers for Medicare & Medicaid Services ("CMS") released a final rule titled "Patient Protection and Affordable Care Act; Exchange and Insurance Market Standards for 2015 and Beyond" ("Final Rule")...more

I Can’t Get No SATISFACTION-- In the Eleventh Circuit, Is Discretionary Language Still "Satisfactory to Us"?

Ever since the United States Supreme Court addressed the question of whether a wholesale adoption of the "arbitrary and capricious" standard of review would be appropriate for judicial review of denial of benefit...more

Final Regulations Allow Retirement Plan Payments for Accident, Health and Disability Insurance

On May 9, 2014, the Internal Revenue Service finalized regulations that govern the tax treatment of payments made by retirement plans to pay accident or health insurance premiums. Under the final regulations, accident or...more

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