EBIA Weekly Archives - ERISA - Court Cases
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Results (848 articles found)
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- 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 ...
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- 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, ...
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- 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 ...
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- 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 ...
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- 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. ...
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- 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 ...
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- 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 ...
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- 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” ...
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- 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. ...
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- 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 ...
