Lane Powell PC - ERISA Law Blog

ERISA – Subrogation: Summary Plan Descriptions Can Be A “Controlling Document” Requiring Reimbursement… Sometimes

You already know that when a Summary Plan Description conflicts with ERISA plan language, the ERISA plan language controls. But what happens when all you have is a Summary Plan Description (SPD), and… no ERISA Plan? Can the…more
| Civil Procedure, Commercial Law & Contracts, Finance & Banking, Labor & Employment Law

ERISA — 7th Circuit: Illinois State Law Ban On Discretionary Clauses Upheld

You already know about the big trend in states to ban discretionary clauses in insurance policies that fund ERISA benefits. Chalk up another circuit deciding to enforce the ban…more
| Civil Procedure, Commercial Law & Contracts, Finance & Banking, Insurance, Labor & Employment Law

ERISA: When Does A Claimant Get To “Augment” The Administrative Record?

You already know that judicial review of ERISA claims generally will be limited to the administrative record considered by the claim administrator. But the courts will allow claimants to augment the record if ERISA claims…more
| Civil Procedure, Finance & Banking, Labor & Employment Law

ERISA: 3rd Circuit — Denial Letters That Fail to Detail Plan’s Limitation Period Are Invalid

The courts are expecting more detail in your denial letters about the limitations period. Here’s the case of Mirza v. Insurance Administrator of America, Inc.., No. 13-3535 (3rd Cir. August 26, 2015)(“One very simple…more
| Civil Procedure, Finance & Banking, Labor & Employment Law

ERISA: Clarity on When ERISA Applies to Working Owners of Small Companies

You probably already know that in small, wholly owned “mom and pop” businesses, benefits covering only the owners of the business may be exempt from ERISA…more
| Business Organizations, Conflict of Laws, Labor & Employment Law, Finance & Banking, Securities Law

ERISA (Sixth Circuit) — Medical Reviews: You Need to Explain WHY You are Rejecting the Treating Physician’s Opinions; and Don’t Overuse Your Independent Medical Advisors

You already know that you do not have to give special deference to the opinions of treating physicians. But you need to explain why the treating physician’s opinions are being rejected…more
| Civil Procedure, Health, Insurance, Labor & Employment Law

ERISA (11th Cir.): Tougher for Claimants to Win ERISA Statutory Penalty Claims

We see plaintiffs asserting an ERISA claim for statutory penalties more frequently now. These claims seek statutory penalties (up to $110 per day), alleging the plan administrator “fail[ed] or refus[ed] to comply with a…more
| Civil Procedure, Civil Remedies, Finance & Banking, Labor & Employment Law

ERISA 11th Circuit: Claimant Has “Duty to Investigate” When Asserting Equitable Tolling of a Contractual Limitations Provision

You already know that contractual limitations provisions in ERISA plans are generally enforceable and can bar untimely claims. But when does the court apply “equitable tolling” to extend the time by which a claimant may…more
| Civil Procedure, Commercial Law & Contracts, Insurance, Labor & Employment Law

ERISA (9th Cir.) A Day Late, But Not A Dollar Short — Counting The 180 Day Appeal Period Gets Easier For Claimants

You know that under ERISA regulations a claimant has at least 180 days to appeal a benefit denial. ERISA plans set out contractual timelines for appeals. But what happens when that 180 day period runs out on a weekend? Is…more
| Administrative Law, Civil Procedure, Insurance, Labor & Employment Law

ERISA (3rd Circuit): Even a Voluntary Settlement Can Mean “Some Success on the Merits” When Awarding Attorney Fees?

You know that a court has discretion to award attorney fees under ERISA if a party shows “some degree of success on the merits.” But how do you define “success”? A new third circuit case reminds one of that old Milton Berle…more
| Civil Remedies, Health, Insurance

ERISA: Public School Teacher’s Employee Benefits Governed by ERISA? Yes!

When you see a claim for disability or life insurance benefits by a public school teacher, you might assume the claim is not governed by ERISA because of the governmental plan exception…more
| Civil Procedure, Education, Labor & Employment Law, Insurance

ERISA: Supreme Court to Determine Whether Money is Fungible…When it Comes to Recovery of Overpayments from ERISA Beneficiaries

When it comes to recovery of overpayments from ERISA beneficiaries… money is a fungible commodity in the Eleventh Circuit, but is not a fungible commodity in the Ninth Circuit…more
| Civil Procedure, Civil Remedies, Labor & Employment Law, Finance & Banking

ERISA: 6 New Trends in DOL Enforcement Actions

The U.S. Department of Labor (DOL) and the Employee Benefits Security Administration (EBSA) just issued a “Fact Sheet” describing Fiscal Year 2014 civil and criminal enforcement activity under ERISA…more
| Administrative Law, Criminal Law, Labor & Employment Law, Finance & Banking

ERISA — 5 Quick Points: Blowing a Deadline for Decision is Not Necessarily Fatal to Abuse of Discretion Standard

You already know that ERISA regulations require the plan administrator to render a decision on an administrative appeal within 45 days…more
| Administrative Law, Civil Procedure, Labor & Employment Law, Finance & Banking

ERISA: 6th Circuit — Plop Plop, Fizz Fizz: Oh What A RELIEF It Is: No Disgorgement For Arbitrary Denial Of Benefits

Does an arbitrary and capricious denial of ERISA governed disability benefits create a right to disgorgement of profits? NO…more
| Civil Procedure, Civil Remedies, Labor & Employment Law, Business Torts, Insurance
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