LexisNexis® Legal Newsroom
Judge Awards $13M Under ERISA To Beneficiaries Who Received Benefits Through RAA

PORTLAND, Maine - A federal judge in Maine on Sept. 11 awarded more than $13 million in damages and prejudgment interest to a class of life insurance beneficiaries who received benefits through retained asset accounts (RAAs) on their claims that Unum Life Insurance Company of America breached its fiduciary...

Louisiana Federal Judge Remands Reimbursement Suit, Says Jurisdiction Lacking

NEW ORLEANS - A Louisiana federal judge on Sept. 16 remanded a health care reimbursement suit to state court, finding that the court lacked subject matter jurisdiction (Omega Hospital v. Louisiana Health Service & Indemnity Co., et al., No. 13-21, E.D. La.; 2013 U.S. Dist. LEXIS 131988).

California Federal Judge Remands Health Care Payment Dispute; No ERISA Preemption

LOS ANGELES - A California federal judge on Sept. 18 remanded a breach of health care contract suit to state court, saying that the Employee Retirement Income Security Act did not preempt the claims (Port Medical Wellness Inc. v. Connecticut General Life Insurance Co., et al., No. 13-3604, C. D. Calif...

Federal Judge Declines To Dismiss Fraudulent Health Care Billing Claims

NEWARK, N.J. - A New Jersey federal judge on Sept. 24 declined to dismiss a fraudulent health care billing suit, finding that the plaintiff health insurer properly supported its claims against the health care provider (Connecticut General Life Insurance Co. v. Roseland Ambulatory, No. 12-5941, D. N.J...

La. Federal Judge Dismisses Denial Of Benefits Case, Allows Amendment

LAFAYETTE, La. - A Louisiana federal judge on Sept. 23 adopted the findings of a magistrate judge in dismissing a wrongful denial of health benefits case, but allowed the plaintiff time to amend her complaint to assert violations of the Employee Retirement Income Security Act (Amelia Simon v. Express...

High Court Denies Review Of ERISA Disability Case

WASHINGTON, D.C. - The U.S. Supreme Court on Oct. 7 denied a disability insurer's petition seeking review of a First Circuit U.S. Court of Appeals ruling that the insurer's decision to offset benefits was subject to a de novo standard of review because it depended on the insurer's interpretation...

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...

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...

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...

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...

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...

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....