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Labor & Employment Insurance

Read need-to-know updates, commentary, and analysis on Labor & Employment issues written by leading professionals.

Why Isn’t My “Free” Preventive Health Care Free?

by Snell & Wilmer on

In my opinion, one of the best changes made by the Affordable Care Act is the mandate that requires health plans to provide certain specified preventive services without imposing any cost sharing. This is sometimes referred...more

Health Care Reform Weekly Roundup – Issue 5

The Senate’s health care reform bill was released today, and we will report on that separately. In the meantime, below are key health care reform developments from the week of June 12th....more

NLRB Rules That Employers Have a Duty to Bargain Over ACA-Mandated Group Health Benefit Changes

On May 16, 2017, the National Labor Relations Board (“NLRB”) issued a decision holding an employer has the duty to bargain with a union over changes to a group health plan even though the changes were mandated by the...more

The Rise of the Group Health Insurance Captive

With its “employer mandate”—i.e., the requirement that applicable large employers make an offer of group health coverage to substantially all full-time employees or face the prospect of a penalty—the Affordable Care Act (ACA)...more

Fifth Circuit Reverses Mississippi District Court’s Interpretation of “Ambiguous” Language to Nullify Defense Within Limits...

by Carlton Fields on

Insurance policies that include the cost of defending a particular claim or action within the policy’s limit of liability, often referred to as “burning,” “eroding,” or “defense within” limits policies, are common in the...more

Fifth Circuit Holds That SPD Was An Enforceable Plan Document Through Which The Administrator Could Properly Seek Reimbursement

by DeWitt Law, LLC on

In another victory for plan administrators seeking reimbursement under the terms of ERISA plans, in Rhea v. Alan Ritchey, Inc. Welfare Benefit Plan, No. 16-41032, 2017 U.S. App. LEXIS 9482 (5th Cir. May 30, 2017), the Fifth...more

Second Circuit Affirms the Dismissal of a SOX Claim for Failing to Meet the “Reasonable Belief” Standard

On June 1, 2017, the Second Circuit affirmed the dismissal of a Sarbanes-Oxley Act (“SOX”) whistleblower retaliation claim brought by a former Metropolitan Life Insurance Co. (“Company”) employee because the employee lacked a...more

Fifth Circuit’s Pierre Deference In ERISA Cases Trumps Texas’s Anti-Discretionary Language Statute

by DeWitt Law, LLC on

In Ariana M. v. Humana Health Plan of Texas, Inc., No. 16-20174, 2017 U.S. App. LEXIS 7072(5th Cir. Apr. 21, 2017), which involved a claim for benefits under an ERISA-governed health policy, the Fifth Circuit held that...more

Court Vacates Arbitration Award For Arbitrator’s Evident Partiality

by Carlton Fields on

A New York Court vacated an arbitration award, finding that a party appointed arbitrator’s undisclosed relationships with the appointing party amounted to a relatively infrequent instance in which such nondisclosure...more

ERISA: 4 Quick Responses to Claimant’s Typical Challenges to Disability Benefit Denials

How do you respond to typical arguments by those seeking ERISA-governed disability benefits that the claim administrator: -“cherry-picked the record”; -ignored the social security disability determination; -improperly...more

Health Care Reform Weekly Roundup – Issue 3

Below are key health care reform developments from the week of May 22nd. CBO/JCT Estimate for AHCA Released. The Congressional Budget Office (CBO) and Joint Committee on Taxation (JCT) released an updated cost estimate...more

FIFTH CIRCUIT HOLDS THAT SPD WAS AN ENFORCEABLE PLAN DOCUMENT THROUGH WHICH THE ADMINISTRATOR COULD PROPERLY SEEK REIMBURSEMENT

by DeWitt Law, LLC on

In another victory for plan administrators seeking reimbursement under the terms of ERISA plans, in Rhea v. Alan Ritchey, Inc. Welfare Benefit Plan, No. 16-41032, 2017 U.S. App. LEXIS 9482 (5th Cir. May 30, 2017), the Fifth...more

Insurer fails to ensure it can recover losses from an insured employee

by Dentons on

Employees have an implied duty of care toward their employers to exercise reasonable care and skill when performing their duties. Where employees fail to act in this way, and it leads to a breach of contract, employers will...more

Efforts to Shore up MassHealth Should Favor Simplicity and Avoid Potential Conflict with Federal Law

In an effort to make up for a funding shortfall in the Commonwealth of Massachusetts’ Medicaid program, state policymakers have proposed solutions that include a “play-or-pay” option under which employers who fail to offer...more

Issues for Employers as Health Care Legislation Moves to the Senate

by Jones Day on

ABSTRACT - Although the American Health Care Act, as passed by the U.S. House of Representatives, mainly affects the individual and small group health insurance markets, it has implications for large employers. The repeal of...more

CBO Releases Updated Cost Estimate of American Health Care Act of 2017

On May 24, 2017, the Congressional Budget Office (“CBO”) and the staff of the Joint Committee on Taxation (“JCT”) released a cost estimate for H.R. 1628, known as the American Health Care Act of 2017 (the “AHCA”). The CBO and...more

The American Health Care Act, the Sequel Receives Its CBO Grade

Perhaps the high fives in the Rose Garden of the White House a few weeks ago may have been a bit premature. On Wednesday, May 24, 2017, the non-partisan Congressional Budget Office (CBO) released its analysis of the revised...more

European Commission Consults on Operations of European Supervisory Authorities

by Jones Day on

On 21 March 2017, the European Commission published a consultation paper on the operations of the European Supervisory Authorities ("ESAs")...more

Unemployment Benefits Cannot Be Denied Based on Eight Cash Transaction Inadvertent Errors Out of 80,000 Transactions in a 21-Month...

by Ruder Ware on

The Wisconsin Supreme Court has interpreted the meaning of “substantial fault” in an unemployment insurance case, which will be applicable in worker’s compensation cases, as well. The case is Operton v. Labor and Industry...more

Back to Basics – Costly Consequences of Ignoring Process in Benefits Administration

The stories of an employer and a long-term disability insurer and claims fiduciary for an ERISA plan, defendants in two recent cases, ring so true. In the first case, the insurer was designated as claims fiduciary for an...more

The Future of Discretionary Clauses in California Life and Disability Insurance Agreements

by McDermott Will & Emery on

On May 11, 2017, the United States Court of Appeals for the Ninth Circuit reversed a district court ruling, and upheld a California law that invalidates a plan provision that assigns the final determination on benefit payout...more

Health Care Reform Weekly Roundup – Issue 1

Efforts to repeal and replace the Affordable Care Act (“ACA”) are in full swing as the U.S. Senate considers whether to modify the House of Representative’s American Health Care Act (“AHCA”) or draft its own ACA repeal...more

ACA Repeal Could Be Bad News For Gig Economy

by Fisher Phillips on

The replacement for the Affordable Care Act (ACA) – the American Health Care Act (AHCA) – recently passed the House and is now being considered by the Senate. It has the full support of the president, and barring any...more

Grounding Deferential Review in California – No Preemption for Discretionary Clause Ban

by Seyfarth Shaw LLP on

Seyfarth Synopsis: In a decision with wide ranging implications, the Ninth Circuit has ruled that a discretionary clause in an employer drafted plan document is subject to, and invalidated by, California’s insurance...more

Employer Update: American Health Care Act

by Davis Brown Law Firm on

Last week, Republicans got one step closer to repealing portions of the Affordable Care Act (“ACA”) when the House of Representatives passed the American Health Care Act (“AHCA”). Due to procedural issues and division within...more

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