EBIA Weekly Archives - ERISA - Court Cases

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  1. Attorney's Letter Stating "Intention to Appeal" Was Not an Appeal
    From the November 19, 2009 EBIA Weekly
    The participant receiving long-term disability benefits in this case was notified by the insurer for her employer’s plan that benefits would be terminated because she was no longer disabled and that she had 180 days to appeal. ...
    [Swanson v. Hearst Corp. Long Term Disability Plan, 2009 WL 3582435 (5th Cir. 2009)]
  2. ERISA TPA That Is Not a Fiduciary Must Face State-Law Breach of Contract Claims by Plan Sponsor
    From the November 12, 2009 EBIA Weekly
    The employer in this case sued the former TPA of its two self-insured medical plans for claims processing errors that allegedly created millions of dollars in additional costs for the plans. Asking the court to enter judgment in its ...
    [W.E. Aubuchon Co. v. BeneFirst, LLC, 2009 WL 3272491 (D. Mass. 2009)]
  3. Insurer May Consider Relevant Nonmedical Information in Deciding Disability Claim
    From the October 22, 2009 EBIA Weekly
    The employee in this case argued that her claim for LTD benefits was improperly denied by the plan’s insurer. After her employer declined to renew her employment contract, the employee filed an LTD claim contending that she could ...
    [Black v. Long Term Disability Ins., 2009 WL 2972376 (7th Cir. 2009)]
  4. Court Holds That QDRO Controls Determination of Life Insurance Beneficiaries Because Welfare Plan QDROs Are Not Preempted by ERISA
    From the October 15, 2009 EBIA Weekly
    In this case, a deceased employee’s third wife and the children of his first wife all claimed a right to the employee’s group life insurance benefits. The claim of the children was based on a state ...
    [Metro. Life Ins. Co. v. Hanson, 2009 WL 3268640 (D.N.H. 2009)]
  5. Oral Statements Allegedly Changing Plan Terms Did Not Support Claim for Fiduciary Breach
    From the October 08, 2009 EBIA Weekly
    In this case, executives of a subsidiary group that merged with its parent company sued the parent (and plan sponsor) for alleged oral misrepresentations about how their pensions would be calculated. According to the executives, they were promised that their ...
    [Ladouceur v. Credit Lyonnais, 2009 WL 3104039 (2d Cir. 2009)]
  6. Health Plan May Not Sue Under ERISA for Benefits Paid to Ineligible Former Spouse (but State-Law Claims May Still Be Possible)
    From the October 08, 2009 EBIA Weekly
    In a familiar fact pattern, the employee in this case failed to notify his group health plan after he and his covered spouse divorced. In the interim, the ineligible former spouse incurred over $13,000 in medical expenses that were ...
    [N.Y. State Teamsters Council Health & Hosp. Fund v. Williams, 2009 WL 2515671 (N.D.N.Y. 2009)]
  7. Second Circuit Finds That Employer's Practice of Paying for Release Agreements Does Not Create an ERISA Plan
    From the October 08, 2009 EBIA Weekly
    In this case, a former employee argued that her employer’s ongoing practice of offering payments to certain terminating employees in exchange for signing release agreements was an ERISA plan. As background, ERISA applies only if there is a &#...
    [Kawski v. Johnson & Johnson, 2009 WL 2750691 (2d Cir. 2009)]
  8. Former Employees Have No Claim Against Bankrupt Employer for Unpaid Medical Bills, But Can Seek Unpaid Employee Health Premiums
    From the October 01, 2009 EBIA Weekly
    Just weeks before filing for bankruptcy, the employer in this case failed to pay the employer and employee portions of insurance premiums to the insurer of its health plan, and the insurer terminated coverage. Former employees who had regular or ...
    [Leslie v. Champion Parts, Inc., 2009 WL 2781675 (W.D. Ark. 2009)]
  9. SPD and Denial Letters Adequately Disclosed One-Year Limitations Period
    From the September 17, 2009 EBIA Weekly
    The employee in this case sued her employer’s self-funded short-term disability plan after her claim for benefits was denied. Her lawsuit was dismissed, however, because it was filed 20 days after the plan’s one-...
    [Scharff v. Raytheon Co. Short Term Disability Plan, 2009 WL 2871229 (9th Cir. 2009)]
  10. TPA's Fiduciary Liability Was Properly Limited to the Amount of Health Plan Assets Over Which It Exercised Control
    From the September 10, 2009 EBIA Weekly
    A company edging toward bankruptcy stopped contributing to its self-funded health plan. The plan’s TPA terminated its contract with the company, and then wrote three checks (totaling approximately $10,700) on the plan’s account: one ...
    [Briscoe v. Preferred Health Plan, Inc., 2009 WL 2589678 (6th Cir. 2009)]

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