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Seventh Circuit Rules ERISA Does Not Preempt State Law Prohibiting Discretionary Clauses

In Fontaine v. Metropolitan Life Ins. Co., No. 14-1984, 2015 U.S. App. (7th Cir. Sept. 4, 2015), the Seventh Circuit affirmed a U.S. District Court for the Northern District of Illinois decision holding that Illinois’s...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

ERISA Preemption Trumps State Insurance Law Yet Again: Ninth Circuit Declines to Apply California’s Insurance Notice-Prejudice...

In a recent decision, the Ninth Circuit Court of Appeals rejected a Plan participant’s attempt to extend California insurance law’s notice-prejudice rule to self-insured ERISA plans. Zagon v. Am. Airlines, Inc., 2015 BL...more

Recent Federal Court Ruling: No ERISA Preemption of Texas Prompt Pay Law Regarding Payment Deadlines; Texas Legislature May Act on...

What's new. A Texas federal district court has ruled that ERISA does not preempt or prohibit application of the Texas Prompt Pay ("TPP") law to Third Party Administrators ("TPAs") of self-funded benefit plans. Judge Lynn...more

Circuit Court Split on ACA Could Impact Employer Penalties

In conflicting opinions released on July 22nd, two federal circuits split on whether Affordable Care Act subsidies are available under a federally operated health insurance exchange. “Pay or play” penalties apply only if...more

Halbig v. Burwell: A Death Blow for the Affordable Care Act?

On July 22, 2014, a three-judge panel of the U.S. Court of Appeals for the District of Columbia Circuit ruled in Halbig v. Burwell that the Affordable Care Act (ACA) authorizes the issuance of tax credits to assist...more

NY Bill Seeks to Strip Insurers of Discretion When Substance Abuse Services Should Be ERISA Preempted

The New York State Senate is considering passing Bill No. 4326 which seeks to address an epidemic of heroin and prescription drug abuse by requiring insurers to provide in-patient treatment to addicts. Publicity over the...more

Court Rejects Plaintiff’s Attempt to Prevent Plan from Recouping $250,000 Overpayment

A federal district court in the Northern District of California dismissed an equitable estoppel claim brought by a pension-plan participant seeking to prevent the plan from recouping an overpayment. See Groves v. Kaiser...more

Courts Split On Whether Mandatory Contraceptive Coverage Violates Religious Freedoms Of For-Profit Corporations

Under the Patient Protection and Affordable Care Act’s preventive services mandate, non-grandfathered group health plans must provide 100% coverage of contraceptives for women, subject to exemptions and safe harbors for...more

Hospital’s State Law Claims against Health Plan Held Preempted by ERISA, Rules NJ Appellate Division

Last month a NJ Appellate Division panel held in three consolidated appeals that a NJ hospital’s state law claims that a health care plan must pay full price for medical services the hospital provided to plan participants are...more

State Law Cannot Reallocate Life Insurance Proceeds That Accrued To Named Beneficiary Under Federal Law

The Supreme Court recently held that federal law pre-empts state law that attempts to reallocate proceeds accruing to the designated beneficiary of a federal life insurance policy. Hillman v. Maretta, 133 S. Ct. 1943 (2013)...more

Supreme Court Holds Federal Law Preempts State Law Allowing Litigation Over Proceeds of Federal Life Insurance Policy

Recently, in Hillman v. Maretta, the Supreme Court of the United States affirmed a Virginia Supreme Court ruling that held that federal law preempts a state law that allowed a deceased federal employee’s spouse to sue a...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

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

ERISA Does Not Preempt State Court Order Requiring Beneficiary to Renounce Right to Employee’s Plan Benefits, Fourth Circuit Rules

The scenario is not difficult to imagine: An employee designates her spouse as the primary beneficiary under her employer’s life insurance and retirement benefit plans. Years later, the couple divorces, and in the marital...more

Employees Who Smoke (Part II) – The Exception for Health Insurance Plans

So yesterday, I made a convincing case that employees who smoke outside the workplace can’t be treated differently than your non-smokers. ...more

The ERISA Litigation Newsletter - September 2012

In This Issue: - Editor's Overview - ERISA Preemption in Provider Misrepresentation Claims: An Overview of the Jurisprudence Leading Up to the Fifth Circuit's En Banc Review of Access Mediquip and What Lies...more

Affordable Care Act Runs Into Religious Freedom Issues in Court

Although the Supreme Court, in a landmark decision earlier this summer, affirmed the constitutionality of the Patient Protection and Affordable Care Act (ACA), the challenges to and controversies surrounding that Act are far...more

When Are Short Term Disability Claims NOT Governed by ERISA — This Case Explains When State Law Claims Are Not Preempted

When does ERISA govern short term disability payments? Take a look at this recent case, Behjou v. Bank of America et. al, [PDF] __ F.Supp. 3d __ (N.D. California May 1, 2012). FACTS: Behjou brought short term...more

Effect of New Michigan Health Insurance Claims Assessment Act on Group Health Plans

The new Michigan Health Insurance Claims Assessment Act imposes a 1-percent tax on “paid claims” for health-related services of employer-sponsored health and welfare plans. Employer plan sponsors with...more

Supreme Court to Hear Challenges to Health Care Reform

The Supreme Court announced on Monday, November 14, 2011 that it will hear challenges to the Patient Protection and Affordable Care Act (PPACA). President Obama signed PPACA on March 23, 2010, and legal challenges to the...more

Federal Court Dismisses Claim by Air Ambulance Company Seeking to Avoid California Workers' Compensation Official Medical Fee...

Earlier this year, California Shock Trauma Air Rescue (“CALSTAR”), an air ambulance company rendering services primarily in California, filed an action in federal court in Sacramento against more than 75 workers’ compensation...more

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