EBIA Weekly Archives - ERISA - Court Cases

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  1. Insurance Company Not a Proper Defendant in ERISA Benefit Claim Lawsuit
    From the March 11, 2010 EBIA Weekly
    The employee in this case sued her employer’s insured disability benefit plan and its disability insurance company to recover disability benefits. The insurance company asked the court to dismiss the employee’s claims against it because the ...
    [Turnipseed v. Educ. Mgmt. LLC's Employee Disability Plan, 2010 WL 140384 (N.D. Cal. 2010)]
  2. TPA Was an ERISA Fiduciary Despite Contractual Disclaimer of Fiduciary Status
    From the February 25, 2010 EBIA Weekly
    The third-party administrator (TPA) in this case made payments on infertility and mental health claims in excess of the applicable caps and lifetime maximum limits imposed under the employer’s group health plan. The employer, as plan sponsor, ...
    [Hartsfield, Titus & Donnelly LLC v. Loomis Co., 2010 WL 596466 (D.N.J. 2010)]
  3. Administrative Law Judge Upholds Assessment of $86,500 in Penalties for Plan's Failure to File Complete Form 5500
    From the January 28, 2010 EBIA Weekly
    This DOL administrative law judge decision involves a 401(k) plan that was assessed an $86,500 penalty after it failed to include an acceptable accountant’s report with its Form 5500 for the 2004 plan year. After repeatedly ...
    [U.S. Dep't of Labor v. Airport Hospitality, Ltd., 2007-RIS-00048 (ALJ 2009)]
  4. Benefit Claim Survives Claimant's Failure to Exhaust Administrative Remedies Due to Insurer's Failure to Provide Requested Documents
    From the December 10, 2009 EBIA Weekly
    The insurer for the ERISA long-term disability plan in this case terminated a plan participant’s benefits (for failure to satisfy the applicable disability definition), providing a denial notice that cited the findings of medical and vocational experts ...
    [Brown v. J.B. Hunt Transport Services, Inc., 2009 WL 3818374 (8th Cir. 2009)]
  5. Employer's Hand-Delivery Process for Distributing SPDs Was Sufficient Under ERISA
    From the December 03, 2009 EBIA Weekly
    The trial court in this case found that an employer’s SPD hand-delivery process satisfied DOL regulations, which require that the process be reasonably calculated to ensure that recipients receive SPDs and likely to result in full distribution. ...
    [Davis v. AK Steel Corp., 2009 WL 3853608 (W.D. Pa. 2009)]
  6. Disability Plan's Interpretation of Earnings to Exclude Commissions Upheld as Reasonable
    From the December 03, 2009 EBIA Weekly
    This case involved a dispute about the amount of long-term disability benefits payable to a disabled employee who had transferred from a management to a nonmanagement sales position before her disability began. Under the plan, benefits for management salespeople ...
    [Wallace v. Johnson & Johnson, 2009 WL 3294841 (1st Cir. 2009)]
  7. Cancer Insurance Policy Endorsed by Employer and Offered Through Cafeteria Plan Was an ERISA Plan
    From the November 24, 2009 EBIA Weekly
    An employee’s spouse sued the insurer of her cancer insurance policy in state court after it refused to pay for medical treatment she had received. The insurer removed the case to federal court, arguing that her claim was ...
    [Lee v. Liberty Nat'l Life Ins. Co., 2009 WL 3316371 (S.D. Ga. 2009)]
  8. State's Practice of Preventing Insurers From Including Discretionary Clauses in Insurance Policies Not Preempted by ERISA
    From the November 24, 2009 EBIA Weekly
    As we previously reported, an insurer challenged the Montana Insurance Commissioner’s interpretation of a state law requiring the Commissioner to disapprove insurance contracts with inconsistent, ambiguous or misleading clauses or conditions that “deceptively affect the risk” ...
    [Standard Ins. Co. v. Morrison, 2009 WL 3429501 (9th Cir. 2009)]
  9. 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)]
  10. 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)]

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