Government View Sought By High Court In ERISA Case

WASHINGTON, D.C. - The U.S. Supreme Court on Oct. 7 invited the solicitor general to file a brief expressing the views of the United States on whether to grant review of a Second Circuit U.S. Court of Appeals ruling regarding the appropriate standard of review and the enforcement of an equitable lien...

N.J. Federal Judge Remands Health Care Reimbursement Suit To State Court

NEWARK, N.J. - A New Jersey federal judge on Oct.7 remanded a health care reimbursement suit to state court, finding that the defendant failed to show that federal preemption existed under the Employee Retirement Income Security Act (Medwell v. CIGNA Healthcare of New Jersey Inc., No. 13-3998, D. N.J...

ERISA Plaintiffs May Join 27 Individual Defendants In Fiduciary Breach Suit

KANSAS CITY, Kan. - A pro se plaintiff alleging breach of fiduciary duty under the Employee Retirement Income Security Act may join 27 individual defendants, including partners of the plan's sponsor and directors and officers of the plan's insurer, a federal magistrate judge in Kansas ruled Oct...

High Court Hears Arguments On Limitations Period In ERISA Benefits Denial Case

WASHINGTON, D.C. - A beneficiary's claim for wrongful denial of disability benefits under the Employee Retirement Income Security Act does not accrue for limitations purposes until the plan's internal benefits resolution process has been exhausted, notwithstanding a plan provision providing that...

ERISA Preempts Claim To Proceeds Under Community Property Law, 9th Circuit Says

SAN FRANCISCO - A surviving spouse's state law claim to proceeds of a life insurance policy pursuant to community property law is preempted by the Employee Retirement Income Security Act, the Ninth Circuit U.S. Court of Appeals affirmed Oct. 15 in an unpublished opinion (Devon Larie Orr v. Michelle...

Symptoms Reflect Mental Illness; Plan Properly Capped Benefits, 2nd Circuit Rules

NEW YORK - A disability plan governed by the Employee Retirement Income Security Act did not act arbitrarily or capriciously in classifying a participant's disability as a mental illness, the Second Circuit U.S. Court of Appeals affirmed Oct. 23 (Robert Veryzer, Ph.D., v. American International Life...

Providers Fail To Allege Assignments; Federal Judge Dismisses Claims For Benefits

NEWARK, N.J. - Health care providers seeking payment for services provided to plan participants failed to allege with specificity the assignments on which they asserted derivative standing under the Employee Retirement Income Security Act, a federal judge in New Jersey ruled Oct. 24 (NJSR Surgical Center...

Insurance Broker's Former Employee Did Not Violate Injunction, Judge Concludes

NEW YORK - An insurance broker's former employee did not violate a preliminary injunction prohibiting future violations of an employee agreement with regard to the confidentiality and nonsolicitation provisions, a New York federal judge held Oct. 29, denying the insurance broker's motion for...

Benefits Claim Properly Dismissed Based On Res Judicata, 5th Circuit Holds

NEW ORLEANS - A federal district court properly granted summary judgment to an insurer on a participant's denial of disability benefits claim under the Employee Retirement Income Security Act because the lawsuit was barred by res judicata, the Fifth Circuit U.S. Court of Appeals ruled Oct. 29 in...

High Court Denies Review Of Denial Of Disability Claim Under ERISA

WASHINGTON, D.C. - The U.S. Supreme Court on Nov. 4 declined to review an 11th Circuit U.S. Court of Appeals unpublished ruling that an action under the Employee Retirement Income Security Act to recover disability benefits is time-barred because the claimant failed to file a claim within the plan's...

R.I. Federal Judge Grants Health Insurer Judgment In Denial Of Benefits Suit

PROVIDENCE, R.I. - A Rhode Island federal judge on Oct. 31 granted summary judgment in favor of a health maintenance organization in a wrongful denial of benefits dispute, saying that the plan clearly did not cover the services sought (Jean Ho Rath, et al. v. Tufts Associated Health Maintenance Organization...

Divided En Banc 7th Circuit: Breach Of Fiduciary Duty Claim Continues

CHICAGO - A divided en banc Seventh Circuit U.S. Court of Appeals on Nov. 7 ruled that the husband of a health plan participant may proceed with his claims that the plan sponsor and insurer breached their fiduciary duties under the Employee Retirement Income Security Act by failing to inform him during...

Illinois Federal Judge Denies Summary Judgment Motions In Reimbursement Suit

CHICAGO - An Illinois federal judge on Nov. 7 declined to grant summary judgment motions brought by both sides in a reimbursement dispute between chiropractors and a group of insurance companies (Pennsylvania Chiropractic Association, et al. v. Blue Cross Blue Shield Association, et al., No. 09-5619...

Calif. Federal Judge Denies Temporary Restraining Order In Denial Of Benefits Suit

OAKLAND, Calif. - A California federal judge on Nov. 8 denied a plaintiff's motion for a temporary restraining order to keep her health insurance company from allegedly wrongfully denying benefits for her continued residential treatment for eating disorders (Alison O. v. Anthem Blue Cross Life and...

New York Federal Judge Partially Dismisses Health Care Reimbursement Suit

WHITE PLAINS, N.Y. - A New York federal judge on Nov. 14 partially granted the defendants' motion to dismiss a health care reimbursement dispute (Bridget M. Curran v. Aetna Life Insurance Co., et al., No. 13-289, S.D. N.Y.; 2013 U.S. Dist. LEXIS 163162).

Divided 6th Circuit Awards Actual Damages And Disgorgement In ERISA Case

CINCINNATI - The Sixth Circuit U.S. Court of Appeals ruled 2-1 on Dec. 6 that a disability plan participant who was awarded benefits under Employee Retirement Income Security Act Section 502(a)(1)(b) was also entitled to an equitable award of $3.79 million in disgorged profits under Section 502(a)(3...

New Jersey High Court Won't Review Ruling That ERISA Preempts Hospital's Claims

TRENTON - The New Jersey Supreme Court on Dec. 6 denied a petition for certification of a Superior Court ruling that Employee Retirement Income Security Act Section 514(a) expressly preempts a medical provider's claims against the ERISA plan for payment of the provider's customary fees for the...

Judge: Failure To Exhaust Administrative Remedies Dooms Breach, Bad Faith Claims

BOSTON - Because a short-term disability (STD) benefits recipient did not pursue the review process available after her insurer terminated benefits payments, a Massachusetts federal judge on Dec. 9 found that her claims against her insurer and employer must be dismissed per the Employee Retirement Income...

Supreme Court Rules On Limitations Period In ERISA Denial Case

WASHINGTON, D.C. - The U.S. Supreme Court ruled Dec. 16 that the contractual limitations provision of a disability benefits plan that requires participants to bring suit within three years after "proof of loss" is due is enforceable under the Employee Retirement Income Security Act, even if...

California Federal Judge Remands Reimbursement Suit, Finds No Preemption Exists

SAN JOSE, Calif. - A California federal judge on Dec. 16 remanded a reimbursement dispute to state court, holding that the Employee Retirement Income Security Act did not preempt the state law claims (Bay Area Surgical Management v. United Healthcare Insurance Co., et al., No. 13-2512, N.D. Calif.; 2013...

Supreme Court Justice Halts Birth Control Mandate For Catholic Group

WASHINGTON, D.C. - U.S. Supreme Court Justice Sonia Sotomayor on Dec. 31 temporarily blocked the federal government from enforcing the birth control mandate contained in the Patient Protection and Affordable Care Act (PPACA) against an order of Catholic nuns at the request of the group after a lower...

Government Opposes Supreme Court's Halt Of Birth Control Mandate

WASHINGTON, D.C. - The federal government on Jan. 3 filed a brief with the U.S. Supreme Court opposing an emergency injunction pending appellate review or, in the alternative, a petition for a writ of certiorari before judgment and injunction pending resolution following a Dec. 31 order by Justice Sonia...

ERISA Benefit Termination Proper Despite Social Security Award, 5th Circuit Rules

NEW ORLEANS - A federal district court properly ruled that a disability insurer did not abuse its discretion under the Employee Retirement Income Security Act by terminating benefits based on medical evidence that post-dated a Social Security Administration (SSA) determination that the claimant was disabled...

High Court Will Not Review ERISA Benefit And Disclosure Claims

WASHINGTON, D.C. - The U.S. Supreme Court on Jan. 13 denied a plan participant's petition for a writ of certiorari seeking review of an 11th Circuit U.S. Court of Appeals ruling that a health plan insurer did not abuse its discretion in calculating benefits and that the insurer was not liable for...

N.J. Federal Judge Remands Reimbursement Dispute; No Federal Jurisdiction Exists

NEWARK, N.J. - In an unpublished opinion, a New Jersey federal judge on Jan. 21 granted a plaintiffs' motion to remand its health care reimbursement suit, saying neither complete preemption nor an embedded federal question of jurisdiction existed (MHA d/b/a Meadowlands Hospital Medical Center v....