Coordination-of-Benefits Claim Is Not Equitable
In Central States, Southeast & Southwest Areas Health & Welfare Fund v. Gerber Life Ins. Co., 771 F.3d 150 (2d Cir 2014), the Second Circuit joined the Fifth Circuit in ruling that an ERISA...
View ArticleCourt Provides Narrow Interpretation for Mental Illness Limitation
In George v. Reliance Standard Life Ins. Co., 776 F.3d 349 (5th Cir. 2015), a case of first impression, a divided Fifth Circuit panel decided when a disability is “caused by or contributed to by” a...
View ArticleInsurer Reasonably Denied AD&D Claim Following “Suicide By Cop”
In Rice v. ReliaStar Life Ins. Co., 770 F.3d 1122 (5th Cir. 2014), the police responded to a 911 call about the decedent, Rice, sitting in his car, in his garage, with a gun to his head, threatening...
View ArticleEighth Circuit Leaves Open Possibility That Procedural Irregularities Can...
In Johnson v. United of Omaha Life Ins. Co., 775 F.3d 983 (8th Cir. 2014), the court determined that the district court erroneously reviewed the administrator’s determination under the de novo...
View ArticleEighth Circuit Enforces Choice of Law Clause; Discusses Test for Evaluating...
In Brake v. Hutchinson Tech. Inc. Grp. Disability Income Ins. Plan, 774 F.3d 1193 (8th Cir. 2014), the court determined that, where a policy insuring a South Dakota resident was issued in Minnesota to...
View ArticleNinth Circuit Replaces Gabriel Decision On Equitable Remedies; Modifies...
We previously reported on Gabriel v. Alaska Electrical Pension Fund, 755 F.3d 647 (9th Cir. 2014), which addressed limits on make-whole relief under 1132(a)(3), and affirmed judgment for the plan...
View ArticleBeneficiary Designation Forms Are not Plan Documents; Change of Beneficiary...
In Becker v. Williams, — F.3d –, 2015 WL 348872 (9th Cir. Jan. 28, 2015), the plan participant called the plan administrator to change the beneficiary of his pension plans from his ex-wife to his son....
View ArticleERISA Claim Accrues Upon Clear Repudiation of Claim, Even if There is No...
In Witt v. Metro. Life Ins. Co., 772 F.3d 1269 (11th Cir. 2014), the court answered the question: “what happens when the defendant says it issued a formal denial letter and the plaintiff says he never...
View ArticleSixth Circuit At it Again: Orders Make-Whole Relief in Disability Benefit Claim
In Stiso v. Intl. Steel Group, 2015 WL 3555917 (6th Cir. June 9, 2015), the court reversed a ruling by the district court that dismissed a claim for make-whole relief, and directed the district court...
View ArticleSixth Circuit Rules Plan Terms are “Irrelevant” When Considering Equitable Claim
The Sixth Circuit is fast making itself the center of case law on equitable remedies under ERISA. In Pearce v. Chrysler Group LLC Pension Plan, 2015 WL 3797385 (6th Cir. June 18, 2015), the court held...
View ArticleState Law Is Not A “Controlling Statute” Overriding Contractual Limitation
Heimeshoff v. Hartford Life & Acc. Ins. Co., 134 S. Ct. 529 (2013), held that a contractual limitation period in an ERISA plan is enforceable as written unless the period is unreasonably short, or...
View ArticleEvidence Supporting a Claim Can Be Insufficient, Even if Undisputed
Roganti v. Met. Life Ins. Co., 786 F.3d 201 (2d Cir. 2015), involved a dispute over the effect an arbitral award for improper employment practices had on pension benefits. The opinion is useful for...
View ArticlePlan Manager Was Not a Fiduciary For Purposes of Subrogation Claim Standing
In Humana Health Plan, Inc. v. Nguyen, 785 F.3d 1023 (5th Cir. 2015), Humana entered into a Plan Management Agreement (“PMA”) with the API Enterprises Employee Benefits Plan. The PMA stated that API...
View ArticleFailure to Understand Exhaustion Requirement Does Not Excuse Compliance
Orr v. Assurant Employee Benefits, 786 F.3d 596 (7th Cir. 2015), concerned the failure to exhaust administrative remedies following the denial of a claim for AD&D benefits. The plan in question...
View ArticleDeath Resulting From DVT Caused By Long Flights Not Covered Under AD&D Policy
Williams v. Natl. Union Fire Ins. Co. of Pitt., 2015 WL 4080909 (9th Cir. July 7, 2015) involved the death of “an acclaimed horticulturist” from pulmonary embolism triggered by deep vein thrombosis...
View ArticleWhere Administrative Appeal Deadline Ends on Saturday, Monday Appeal Is Timely
In LeGras v. Aetna Life Ins. Co., 786 F.3d 1233 (9th Cir. 2015), plaintiff’s 180-day period to administratively appeal ended on a Saturday, and he mailed his appeal the following Monday. Aetna denied...
View ArticleThird 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...
View ArticleWhen 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....
View ArticleUpcoming Amendments to Federal Rules Will Impact ERISA Litigation
On December 1, 2015, barring action by Congress, amendments to the Federal Rules of Civil Procedure, will take effect. A number of these amendments are intended to fine-tune the discovery process, and...
View ArticleFirst Circuit Applies Younger abstention doctrine to ERISA preemption claim
In Sirva Relocation, LLC v. Richie, 794 F.3d 185 (1st Cir. 2015), ERISA preemption met federal abstention, and lost. Knight was an employee of Sirva, which had a disability plan insured by Aetna....
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