Lane Powell PC - ERISA Law Blog

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

ERISA — ATTORNEY FEES: What Happens When The Plan And The Insurer Don’t Agree On The Benefit Denial?

You already know that under ERISA the court has discretion to award attorney fees to a party that has “some success on the merits.”…more
| Civil Procedure, Commercial Law & Contracts, Finance & Banking, Insurance, Labor & Employment Law

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
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