Lane Powell PC - ERISA Law Blog

ERISA — 9th Circuit: Plaintiffs Can Now Simultaneously Bring Benefit Payment and Equitable Claims

Lane Powell attorney Mike Baylous writes an excellent summary here on big changes to ERISA in the 9th Circuit. Remember that old argument that equitable claims should be dismissed because they are duplicative?…more
| Civil Procedure, Civil Remedies, Finance & Banking, Labor & Employment Law

ERISA: Reviewing What Needs to Be Proved to Establish the Suicide Exclusion

For many reasons, some of the toughest cases to litigate involve the application of the suicide exclusion. There is a growing body of evidence challenging suicide exclusion determinations…more
| Civil Procedure, Commercial Law & Contracts, Conflict of Laws, Insurance, Labor & Employment Law

ERISA (6th Circuit): Mental Nervous Limitations and Dealing with Arguments of “Organic Cause”

You know that most ERISA disability plans contain a 24-month limitation related to mental/nervous disabilities. But what happens when the claimant alleges the mental illness is “organically caused”? Is that enough to…more
| Health, Labor & Employment Law

What Constitutes “Reasonable Efforts” to Inform Plan Participants of Plan Amendments, Which Include a Forum Selection Clause?

You know that many Plans have forum selection clauses. Are they enforceable? YES When a Plan participant claims they “did not know of a plan amendment,” how do you prove the Participant received notice of the amendment? A…more
| Civil Procedure, Commercial Law & Contracts, Finance & Banking, Labor & Employment Law

ERISA (9th Circuit): Denial Letters — Sometimes Forgotten Arguments to Enforce Contractual Limitations Provisions

Must denial letters inform the claimant, seeking ERISA-governed benefits, about the contractual limitations provision? A recent court trend, like with the First, Third and Sixth Circuits, requires denial letters to inform…more
| Commercial Law & Contracts, Insurance, Labor & Employment Law

ERISA: Sixth Circuit — No Conflict of Interest with Multi-Employer Benefit Plan, Saving Abuse of Discretion Standard of Review

You already know that evidence of a “conflict of interest” can change the standard of review the court applies in ERISA claims. But proper structuring of multi-employer benefit plans can avoid an inherent conflict of…more
| Civil Procedure, Labor & Employment Law, Worker’s Compensation

BIG NEWS: ERISA Preempts Hodgepodge of State Insurance Reporting Regulations

You know there has been a court trend toward narrowing ERISA preemption. But…that trend was brushed back today by the U.S. Supreme Court. Here’s today’s case: Gobeille v. Liberty Mutual Insurance Com., __ U.S. __ (March 1, 2016)…more
| Civil Procedure, Conflict of Laws, Insurance, Labor & Employment Law

ERISA — 10th Circuit: What Happens When a “Procedural Irregularity” Occurs in an Appeal Denial?

You know that procedural irregularities in an appeal denial of a claim for ERISA-governed benefits can change the standard of review from arbitrary and capricious to de novo review. But not all the time. The claimant should also…more
| Administrative Law, Civil Procedure, Labor & Employment Law

ERISA (5th Circuit): Are There Exceptions to the Exhaustion of Administrative Remedies Requirement

You already know that claimants with a denied claim must submit an appeal and exhaust administrative remedies before filing suit. But are phone calls sufficient to trigger the appeal process?…more
| Administrative Law, Civil Procedure, Civil Remedies, Finance & Banking, Labor & Employment Law

Bad News for ERISA Plan Reimbursements: Chase The Money Before Settlement Funds Dissipate, Supreme Court Rules

This just in…. A big debate was resolved today by the United States Supreme Court: Can an ERISA plan sue to recover medical expenses paid on the participant’s behalf after the settlement funds have dissipated?…more
| Civil Procedure, Civil Remedies, Health, Labor & Employment Law, Personal Injury

Avoiding ERISA Medical Treatment Class Actions with Arbitration Provisions?

Insurers are getting hit with more class actions regarding the denial of medical treatments, like behavioral therapy treatments for autism spectrum disorders. These can be expensive: In May 2015 ConAgra Foods Inc. and Blue Cross…more
| Alternative Dispute Resolution (ADR), Civil Procedure, Commercial Law & Contracts, Insurance, Labor & Employment Law

ERISA (6th Circuit): So How Many Hours Is Working “Full-time,” Anyway?

What happens when the ERISA long term disability benefit plan does not define “full-time”? The Department of Labor says “full-time” is defined by the employer…more
| Civil Procedure, Commercial Law & Contracts, Finance & Banking, Labor & Employment Law

Be On The Lookout: New Proposed Claims Procedures For ERISA-Governed Disability Benefits Are Coming

The Employee Benefits Security Administration (EBSA) announced plans to publish, on November 18, 2015, new proposed claims procedures for handling ERISA-governed disability benefits…more
| Civil Procedure, Finance & Banking, Labor & Employment Law

ERISA: Medical Providers Lack Standing For Reimbursement — Anti-Assignment Provisions Enforceable

You know that patients typically assign rights under a health insurance plan to the provider of medical services. This is accomplished by signing an assignment form upon intake/admission. Then, the healthcare provider sends the…more
| Commercial Law & Contracts, Finance & Banking, Health, Labor & Employment Law

ERISA: Shutting Down Equitable Relief Claims — Disgorgement Claim Dismissed On Rule 12(c) Motion

You already know that in March 2015, the 6th Circuit issued an en banc decision rejecting disgorgement of profits claims. Rochow v. Life Ins. Co. of N. Am., 780 F.3d 364, 372 (6th Cir. 2015)(en banc) (rejecting $3.8 million…more
| Civil Procedure, Civil Remedies, Finance & Banking, Labor & Employment Law
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