On April 16, 2013, the U.S. Supreme Court issued its opinion in U.S. Airways, Inc. v. McCutchen http://www.supremecourt.gov/opinions/12pdf/11-1285_i4dk.pdf finding in favor of U.S. Airways in its quest to recover $66,866 in medical expenses incurred by its employee as a result of a traffic accident. McCutchen was a participant in the... Read More
ERISA requires that plans contain a reasonable claims procedure. Courts have generally required claimants to exhaust that claims procedure before filing a lawsuit. In addition, if the plan gives the plan administrator discretion to interpret the plan and decide claims, a court will often give deference to the plan administrator’s... Read More
Many employers know that one benefit to an ERISA plan is the standard of review available when the participant brings a lawsuit for benefits under the plan. If the plan documents give the plan administrator discretion to decide claims, then the court will review the exercise of the plan administrator’s... Read More
Pactiv Corporation sponsored a severance plan subject to ERISA. The plan required an employee to sign a separation agreement and release in a “form acceptable to the company” in order for the employee to be entitled to a payment under the plan. The severance plan itself did not contain a... Read More
I recently blogged about an employer who continued health insurance coverage for an employee on short term disability in contravention of the health plan document. The employer lost its stop-loss coverage for health claims incurred by the disabled employee because the health plan document did not specifically allow for continued... Read More
Last Thursday, June 28, in a 5-4 decision, the U.S. Supreme Court found that the Patient Protection and Affordable Care Act of 2010 (the “Affordable Care Act” or “Act”) is constitutional paving the way for final implementation of its provisions. http://www.supremecourt.gov/opinions/11pdf/11-393c3a2.pdf While the Administration argued that the Act was... Read More
There has been much discussion and blogging about different possible outcomes from the U.S. Supreme Court’s review of the Affordable Care Act (ACA). However, it is only recently that we are starting to see articles analyzing the effect that a complete repeal might have. If the Supreme Court strikes... Read More
I blogged recently about an Eighth Circuit decision where the court concluded that a deferred compensation agreement with a single employee did not constitute an ERISA plan. I warned employers that courts do not always accept an employer’s characterization of a plan or program as being covered by ERISA. Another... Read More
Blue Cross of Northeastern Pennsylvania (“Blue Cross”) insured New Life Homecare, Inc. (“New Life”) under a group health insurance contract. The insurance contract required New Life to enroll at least 75% of its eligible participants in the plan and provided that no more than 15% of the eligible employees could... Read More
Last week I received copies of the first new fiduciary fee disclosures required by final Department of Labor Regulations under ERISA Section 408(b) (2). Fee disclosures were received from Fidelity Investments and Prudential Financial, providers to two client retirement plans. The details of the required disclosures are described in my... Read More