In This Issue:

- Supreme Court Update: Where Plan Reimbursement Or Recovery Terms Are Ambiguous Or Silent,Equitable Doctrines May Fill The Gaps:

US Airways, Inc. v. McCutchen, 569 U.S. ___ (2013).

In an opinion delivered by Justice Kagan, the Supreme Court recently clarified when equitable doctrines may apply in subrogation and reimbursement claims brought pursuant to ERISA § 502(a)(3), which authorizes plan administrators to bring suit to obtain appropriate equitable relief to enforce the terms of the plan. Not surprisingly, the High Court held that express terms of an ERISA plan govern. However, the Court expanded on its consideration of equitable defenses in the recent trilogy of cases including Great-West Life & Annuity Ins. Co. v. Knudson, 534 U.S. 204 (2002); Sereboff v. Mid Atlantic Medical Services, Inc., 547 U.S. 356 (2006); and Cigna Corp. v. Amara, 131 S.Ct. 1866 (2011), and found that, although equitable doctrines may not override the terms of a contract, where the terms of a plan leave gaps, courts may properly use equitable rules to construe the contracting parties’ intentions...

- Select Case Summaries: Sixth Circuit - Initial Application Of The Wrong Disability Definition Was Properly Corrected Upon Consideration During The Administrative Appeal:

Judge v. Metropolitan. Life Ins. Co., __ F.3d __ (6th Cir. 2013).

The plan participant, Thomas Judge, was covered by his employer’s term life insurance policy which provided for early payment of benefits if an employee became totally and permanently disabled, which was defined by the plan as being unable to do the employee’s own job, and any other job for which the employee is fit by education, training or experience. After Judge underwent heart surgery, he applied for benefits under the policy, claiming he was not able to return to any type of work. His treating providers recommended lifting and certain other restrictions, but indicated that he was recovering well with no evidence of complications. Yet, Judge’s doctors advised against returning to work....

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Topics:  CIGNA, Class Action, Class Certification, Disability, Disability Benefits, Employee Benefits, ERISA, Life Insurance, McCutchen v. U.S. Airways, Metropolitan Life Insurance Company, Reimbursements, Rule 23, SCOTUS, Social Security, Social Security Disability, US Airways

Published In: Civil Procedure Updates, Civil Remedies Updates, Health Updates, Insurance Updates, Labor & Employment Updates

DISCLAIMER: Because of the generality of this update, the information provided herein may not be applicable in all situations and should not be acted upon without specific legal advice based on particular situations.

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