Wow—You need to know what happened last week in the Sixth Circuit:
Disgorgement of profits as a remedy in an ERISA long term disability case?
Rochow v. LINA, __ F.3d __, 2013 WL 6333440 (6th Cir. December 6,…more
PROBLEM: During the claim process your claims administrator mistakenly tells the claimant that the ERISA-governed plan is NOT governed by ERISA. Uh oh.
Do you lose ERISA as the governing law over the policy and claim? …more
What language is needed in the ERISA plan to confer discretion?
The bar was just raised in the 4th Circuit.
Here’s the case of Cosey v. Prudential Insurance Company of America, [PDF] __F.3d__ (November 12,…more
What does it take to assert an effective exhaustion of remedies defense in ERISA cases? Properly drawn plan documents that expressly impose the duty upon the claimant to exhaust remedies before bringing a lawsuit…more
You already know that under ERISA a court may, in its discretion, award reasonable attorney’s fees and costs to a claimant seeking benefits if there is a showing of “some degree of success on the merits.”…more
How will a court construe ambiguities in ERISA plan terms?
If the plan confers discretion to the administrator “to interpret plan terms,” ambiguities may NOT be construed against the plan administrator…more
If the plan confers discretion to the administrator “to interpret plan terms”, ambiguities may NOT be construed against the plan administrator.
Here’s the case of Porter v. Lowe’s Companies, __ F.3d__ (5th Cir. September…more
Did you know that awarding at least some benefits, rather than denying benefits entirely, helps prove the claims administrator is “unbiased”?
Also, when there are sharp conflicting opinions between the claimant’s doctors…more
What happens when an independent, unsolicited source provides evidence that a disability claimant may be committing fraud? Can you consider emails hacked from a computer? What must the claim administrator do to evaluate the…more
An Insurance Commissioner’s non-binding opinion banning discretionary language in an ERISA governed plan has no effect.
Here’s the case of Frazier v. Life Insurance Company of North America, __ F.3d __ (6th Cir. August 5,…more
Who IS the proper defendant in a claim seeking ERISA benefits?
Generally the ERISA Plan is the proper defendant, BUT you need to know about this new case determining that the INSURER is a proper defendant. Larson v…more
See how the Supreme Court’s June 26, 2013 United States v. Windsor decision, which concluded the Defense of Marriage Act unconstitutionally restricted spousal benefits to members of the opposite sex, affects ERISA beneficiary…more
Where do you litigate an ERISA disability claim governed by a collective bargaining agreement?
It has to be sent to arbitration, not to federal court, if the Railway Labor Act applies…more
Does telling a claimant that you “will be happy to reconsider the claim” waive a contractual limitations provision? No.
Here is a great new case that highlights virtually every argument that could be used to trump…more
How do you handle a claim supported only by “subjective” evidence?
Can you reject the claim outright? No. You must weigh the subjective evidence. That’s a key point highlighted in a recent case…more
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