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It May Be Time to Start Thinking About Equitable Claims Again

A recent decision by the Eighth  Circuit Court of Appeals, Jones v. Aetna Life Ins. Co., No. 16-1714, 2017 U.S. App. LEXIS 8112 (8th Cir. May 8, 2017), provides another signal that those of us defending against benefit claims increasingly may have to contend with simultaneous equitable claims for breach of fiduciary duty. Though the law … Continue Reading

“Probate Exception” Bars Federal Jurisdiction over ERISA Dispute

The U.S. District Court for the Northern District of New York has ruled that the so-called “probate exception” to federal jurisdiction precludes federal courts from adjudicating cases implicating federal question jurisdiction, including cases arising under ERISA. In so doing, the N.D.N.Y. joins ranks with a small but growing number of federal district and circuit courts … Continue Reading

ERISA governs plans established by church-related organizations

It is well-established that ERISA contains what is commonly referred to as a “church-plan exemption” which provides that plans established by churches are not required to abide by ERISA’s many rules and regulations. For many years, a number of courts have held that this exemption also applied to plans that were established by organizations that … Continue Reading

Preferred provider agreements do not support ERISA claim

In Penn. Chiro. Assoc. v. Independence Hosp. Indem. Plan, Inc., — F.3d –, 2015 WL 5853690 (7th Cir., Oct. 1, 2015), two chiropractors who had signed preferred provider agreements with an insurer claimed that the insurer violated ERISA in determining payments to them. In particular, plaintiffs claimed that the insurer had improperly recouped overpayments without … Continue Reading

When does ERISA govern a severance plan?

Typically, ERISA litigation starts with a concrete plan, whether it is a retirement plan or an insurance plan. It is much more unusual to have an ERISA dispute turn on whether there is a plan at all. It is still more unusual to have the employee arguing that ERISA governs, and the employer arguing that … Continue Reading

Third Circuit Rules That Assignment of Plan Benefits Confers Standing to Sue

In North Jersey Brain & Spine Ctr. v. Aetna, Inc., — F.3d –, 2015 WL 5295125 (3d Cir. Sep. 11, 2015), the court addressed the question “whether a patient’s explicit assignment of payment of insurance benefits to her healthcare provider, without direct reference to the right to file suit, is sufficient to give the provider … Continue Reading

Claim of ERISA Exemption Does Not Impact Subject Matter Jurisdiction

In Smith v. Regional Transit Auth., 756 F.3d 340 (5th Cir. 2014), the Fifth Circuit  rejected its prior precedent, and held that the governmental plan exemption (and presumably other, similar exemptions) does not impact subject matter jurisdiction. The court noted that the “Supreme Court has repeatedly instructed that we must avoid conflating the question of … Continue Reading

Supreme Court Emphasizes that ERISA Plans Are Not Always Pre-Eminent

In a recent decision involving fiduciary duties in Employee Stock Ownership Plans (ESOPs), the Supreme Court emphasized an important limit on the pre-eminence of the plan document. Recent Supreme Court decisions, primarily in the welfare benefit plan context, have emphasized the primary importance of the plan document in establishing a fiduciary’s obligations and a participant’s … Continue Reading

Heimeshoff v. Hartford Life: Supreme Court Holds that Plan Can Start Limitation Clock Before Benefit Claim Accrues

In Heimeshoff v. Hartford Life & Acc. Ins. Co., 571 U.S. __ (Dec. 16, 2013) , the Supreme Court held that a contractual limitation provision under which the clock begins to run before administrative remedies are exhausted  is enforceable under ERISA, as long as a reasonable time is left after exhaustion is expected to occur. … Continue Reading

Heimeshoff v. Hartford – Supreme Court Briefing

In petitioning for certiorari, Heimeshoff asked the Supreme Court to consider three questions: 1.         When should a statute of limitations accrue for judicial review of an ERISA disability adverse benefit determination? 2.         What notice regarding time limits for judicial review of an adverse benefit determination should an ERISA plan or its fiduciary give the claimant … Continue Reading

Heimeshoff v. Hartford – Motion to Dismiss

Hartford moved to dismiss the action because it was filed after the expiration of the policy’s contractual limitation period. The plain language of the Policy gave her until December 8, 2005 to submit proof of loss: she alleged that her disability began on June 6, 2005; the ninety-day Elimination Period would ordinarily end on September … Continue Reading

Social Security Statute Aids Interpretation of Ambiguous Plan Offset Provision

In Lipker v. AK Steel Corp., 2012 WL 5346325 (6th Cir. Oct. 31, 2012), the plaintiff applied for surviving spouse benefits under the pension benefits plan administered by her husband’s former employer. The administrator approved her claim, but she disputed the amount of the benefit. The discrepancy between her expectation and the actual award hinged … Continue Reading

Using Congressional Policy – Part 6 – Conclusion

There is no question that ERISA provides many litigation benefits. But it doesn’t provide them as a boon to employers, administrators and their lawyers. Instead, the preemption of state laws, limited litigation, flexible plan design, and (especially) the availability of deferential review, are direct results of the careful balancing act that Congress engaged in when … Continue Reading

Using Congressional Policy – Part 2 – What Policies Did Congress Have?

In the 1950s, Congress began studying welfare and pension funds covered by collective bargaining agreements. After years of hearings, it concluded its studies and investigations with the following: The most serious single weakness in this private social insurance complex is … the too frequent practice of withholding from those most directly affected, the employee-beneficiaries, information … Continue Reading

Using Congressional Policy – Part 1 – Introduction

You’re standing in a room, holding a book in your hands. Another person walks in, and shouts, “Put that book down immediately!” You turn and ask the reason for the demand. Which reason would you find more persuasive: “Because I said so!” or “It’s a rare first edition and you must wear gloves when handling … Continue Reading

Litigating a “comprehensive and reticulated” statute

The United States Supreme Court, which issues a major ERISA decision every couple of years, has described ERISA as “a comprehensive and reticulated statute.” To those of you, like me, who thought “reticulated” had something to do with snakes, I can tell you that it means “constructed, arranged, or marked like a net or network.” … Continue Reading
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