News & Analysis as of

Third-Party Employee Retirement Income Security Act (ERISA)

ArentFox Schiff

Cross-Plan Offsetting: Recent Eighth Circuit Opinion Affirms Dismissal of Cross-Plan Offsetting Case Concluding Plaintiffs Did Not...

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In a recent opinion, Smith et al. v. UnitedHealth Group Inc. et al., the US Court of Appeals for the Eighth Circuit affirmed the dismissal of an Employee Retirement Income Security Act (ERISA) class action suit brought by...more

Frantz Ward LLP

Sixth Circuit Revives an Equitable Claim for Disgorgement Under ERISA Where an Insurer Obtained Reimbursement is Not Set Forth in...

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In Patterson v. United Healthcare Insurance Company, 76 F.4th 487 (6th Cir. 2023), the Sixth Circuit held that the plaintiff insured had stated an equitable claim for disgorgement under ERISA where he sought disgorgement of...more

Husch Blackwell LLP

When the Payor is Also the Decisionmaker in ERISA Benefits Lawsuits Under 29 U.S.C. § 1132(a)(1)(B)

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When the same health plan administrator both administers a benefit plan and pays the benefits due under the plan, it is considered by courts to have a structural conflict of interest. That conflict of interest is not...more

Proskauer - Employee Benefits & Executive...

District Court Holds Third-Party Administrator Violated ACA’s Anti-Discrimination Rules by Administering Self-Insured Plan’s...

On the heels of several recent court decisions concerning gender-affirming care, a federal district court in Washington concluded that the denial of benefits for gender-affirming care by a third-party administrator (“TPA”)...more

Mintz - Employment Viewpoints

Health Plan Transparency and the Case for Welfare Plan Fiduciary Committees

The Consolidated Appropriations Act, 2021 (the “Act”) adopted a series of transparency requirements that apply to employer-sponsored group health plans. These transparency rules impose a series of new and complex obligations...more

Foley & Lardner LLP

CAA Compensation Disclosures: DOL’s New FAB Confirms the Scope is Broad

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The Consolidated Appropriations Act, 2021, Public Law 116-260 (CAA) set forth new compensation disclosure requirements that apply to service providers who provide “brokerage services” or “consulting” to group health plans...more

Wiley Rein LLP

Sixth Circuit Holds E&O Policy’s ERISA Exclusion Bars Coverage for Claims Against Trustee of Employee Stock Ownership Program

Wiley Rein LLP on

Applying Ohio law, the United States Court of Appeals for the Sixth Circuit has concluded that an ERISA exclusion in a professional services liability insurance policy barred coverage for all ERISA-related Claims made against...more

Dentons

Even the DOL is Issuing Cybersecurity Instructions

Dentons on

In April, the Department of Labor, specifically the Employee Benefits Security Administration, issued cybersecurity guidance to assist in protecting “the retirement benefits of America’s workers.”  This guidance falls neatly...more

Jackson Lewis P.C.

COVID-19 Deadline Extensions—No More Time Outs But No Single Deadline Either!!

Jackson Lewis P.C. on

We recently provided an update on the looming end date for COBRA and other deadline extensions and the uncertainty that continues to add to the administrative burdens without more clarity from the DOL and IRS. Message...more

Jackson Lewis P.C.

COVID-19 Deadline Extensions—Still Relevant To Plan Sponsors?

Jackson Lewis P.C. on

In May of 2020, the Department of Labor (DOL) and Internal Revenue Service (IRS) released joint-agency guidance that extended several important deadlines for employees, including COBRA election and payment deadlines, HIPAA...more

Littler

“Medical Necessity” Isn’t Well-Defined Unless It Is Well-Defined

Littler on

A U.S. District Court in Connecticut recently issued an order that highlights the importance of understanding exactly what the term “medically necessary” means in an ERISA health plan....more

Seyfarth Shaw LLP

ERISA Preemption — The Courts of Appeal Continue to Rule As They Await Further Supreme Court Attempts To Define, Once and for All,...

Seyfarth Shaw LLP on

Synopsis: Two Courts of Appeal reach opposite results on ERISA preemption, thus continuing the judicial quest for a definitive meaning of ERISA preemption. Stay tuned for more such decisions, and yet more Supreme Court...more

BakerHostetler

Ohio Federal Court Rejects Attempt to Certify Class Against Third-Party Plan Administrator Under ERISA § 502(a)(3)

BakerHostetler on

Employee Retirement Income Security Act (ERISA) claims can potentially involve significant amounts in controversy, and in an effort to broaden the pool of potential defendants, ERISA plaintiffs are often fond of arguing that...more

Robinson & Cole LLP

How Secure is Your Retirement Plan?

Robinson & Cole LLP on

Most employers are generally aware of their fiduciary status as a “plan sponsor” of an ERISA-governed retirement plan (e.g., 401(k) and 403(b) plans). In fact, the employer’s hiring of a service provider is in and of itself a...more

Ary Rosenbaum - The Rosenbaum Law Firm P.C.

I’m not interested in making $$$$ off referrals

Maybe I’m like Larry David, but I have a lot of pet peeves. I hate when people whistle or sing in public. I hate when people talk on the phone in line. I also don’t deal well with working with, working for, and being related...more

Pullman & Comley, LLC

May Vermont Apply Its Health Care Database Law to the Third-Party Administrator for a Self-Insured ERISA Plan?

Pullman & Comley, LLC on

Vermont requires all public and private entities that pay for health care services provided to its residents to supply data to its "all-payer database." The requirements apply to insurers and third-party administrators, among...more

Proskauer - Employee Benefits & Executive...

U.S. Supreme Court Holds ERISA Plan Cannot Enforce Equitable Lien Against Participant’s General Assets

On January 20, 2016, the U.S. Supreme Court reversed a decision by the Eleventh Circuit and held that when a ERISA plan participant obtains a third-party settlement subject to a plan’s subrogation provision, and then...more

Proskauer Rose LLP

The ERISA Litigation Newsletter - October 2015

Proskauer Rose LLP on

Editor's Overview - This month, we review the Second Circuit's ruling in New York State Psychiatric Ass'n, Inc. v. UnitedHealth Grp. wherein the Second Circuit ruled that: (i) a provider association has associational...more

Foley & Lardner LLP

Second Circuit Reinstates Mental Health Parity Case Against UnitedHealth

Foley & Lardner LLP on

In late August the U.S. Court of Appeals for the Second Circuit reinstated a lawsuit by a physician association against a third-party plan administrator. The case against UnitedHealth Group and related entities (United) had...more

Proskauer - Employee Benefits & Executive...

Agencies Issue Final Regulations on the Summary of Benefits and Coverage (SBC) Requirements

As promised in the FAQ issued on March 30, 2015, the U.S. Departments of the Treasury, Labor and Health and Human Services (the Departments) have issued final regulations regarding the summary of benefits and coverage (SBC)...more

Ary Rosenbaum - The Rosenbaum Law Firm P.C.

Advisors Advantage - July 2015

In This Issue: - How Retirement Plan Advisors Can Benefit From Any New DOL Fiduciary Rule - Avoid Other Providers Who Are The Sticks in the Wheels of Progress - Sometimes It's Just Words - Never...more

Ary Rosenbaum - The Rosenbaum Law Firm P.C.

Sometimes it’s just words

So much of any industry is dedicated to marketing, because marketing can help a company sell a product or service just based on how it’s marketed. Whoever sold the pet rock is still probably laughing all the way to the bank. ...more

Ary Rosenbaum - The Rosenbaum Law Firm P.C.

Advisors Advantage - June 2015

In This Issue: - For Retirement Plan Providers, It's All About Making A Connection - DOL Comment Period Extended - Supreme Trouble with Tibbles - My Referrals Aren't For Sale And Neither Should Yours ...more

Ary Rosenbaum - The Rosenbaum Law Firm P.C.

Advisors Advantage - August 2014

Dealing with adversity. It's about how you deal with it. I'm a huge Aerosmith fan since high school and it's because the music resonates with me because it reminds me of the experiences that I have gone through...more

Proskauer - Employee Benefits & Executive...

Express Plan Terms Allow Self-Insured Plan to Recover Medical Benefits Paid to Employee Post-McCutchen

In Quest Diagnostics v. Bomani, et al., 11-CV-00951 (D. Conn., June 19, 2013), the court granted Quest Diagnostic’s (“Quest”) motion for summary judgment, ruling that Quest, as the fiduciary to its self-insured medical plan,...more

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