Labor & Employment Insurance

Read need-to-know updates, commentary, and analysis on Labor & Employment issues written by leading professionals.
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Upcoming CLE examines ways to avoid tax traps in life insurance

Beware that an employer-owned life insurance contract might not qualify for the usual exclusion from regular income tax. An “employer-owned life insurance contract” (a term that applied to much more than one would think) does...more

Louisiana Supreme Court Adopts Pro Rata Allocation of Defense Costs Among Insurers and Insured

On September 7, 2016, the Louisiana Supreme Court applied, for the first time, a pro rata allocation method to defense costs where commercial general liability policies provided coverage during a portion of the time of...more

Maine WC Alert: WC Board Appellate Division Rules on Medical Marijuana Reimbursement

The Workers’ Compensation Board Appellate Division recently issued decisions in Bourgoin v. Twin Rivers Paper Company, WCB App. Div. No. 16-26 (August 23, 2016) and Noll v. Lepage Bakeries, Inc., WCB App. Div. No. 16-25...more

Louisiana Supreme Court Adopts Time on the Risk Allocation for Defense Costs

In its recent decision in Arceneaux v. Amstar Corp., 2016 La. LEXIS 1675 (La. Sept. 7, 2016), the Supreme Court of Louisiana had occasion to consider whether an insured must bear a pro rated share of defense costs for...more

Employers Who Self Administer Life Insurance Plans Had Better Do So Correctly

Many employers self-administer welfare benefit plans such as life insurance or disability insurance plans. This self administration requires the employer to determine eligibility for coverage, remit proper premiums and notify...more

Long Term Disability Payments: Standard for Abuse of Discretion

Insurance for long term disability – payments to an insured who is prevented from earning his or her income due to long term disability – is a fruitful field for litigation for many reasons. Though the insurance may be...more

California Court Finds That Discretionary Clauses in Health Insurance Policies Are Enforceable

In 2011, the California legislature passed Insurance Code Section 10110.6 which bans the use of discretionary clauses in any policy, contract, certificate, or agreement offered, issued, delivered, or renewed, whether or not...more

Federal District Court Enforces Forum Selection Clause Contained in ERISA Plan

A federal district court in the Eastern District of Pennsylvania transferred an ERISA lawsuit against Caterpillar Inc. to the Northern District of Illinois after finding the forum selection clause contained in the governing...more

United Behavioral Health v. MIHS

Medicare Part C, 42 U.S.C. §§ 1395w-21 et seq., permits enrollees to obtain Medicare-covered healthcare services from private healthcare organizations and their third-party contractors. The Employee Retirement Income Security...more

Check Your Neutral Policies: The EEOC Joins the ACLU’s Challenge to Dignity Health’s Exclusion of All Care Related to Sex...

The ACLU filed a complaint against Dignity Health, claiming that the total exclusion of care related to “sex transformation surgery” in Dignity’s employee health insurance plan is unlawful sex discrimination. Now the EEOC...more

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

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