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The claims administrator of an employer-sponsored health plan abused its discretion when it rejected a health benefits claim because it: (1) denied it without an explanation or plausible support; (2) had a structural conflict of interest because it was also the insurer; and (3) violated ERISA regulations by merely reciting its policy without refuting the […]
For the third time in eight years, a federal district court decision endorsing Xerox’s pension plan interpretation has been reversed, setting aside judicial deference usually granted to these interpretations under ERISA and moving Xerox retirees closer to winning final benefits. The issue in the case is how an earlier lump-sum distribution to some employees affects […]
Rather than merely finding that an individual was entitled to benefits due, a federal appeals court ordered an insurer to pay a large monetary award under ERISA based on the equitable theories of unjust enrichment and disgorgement of ill-gotten profits. The 6th U.S. Circuit Court of Appeals held that the insurer used money it should […]
A brief from the U.S. Solicitor General recommending that the U.S. Supreme Court hear a “stock-drop” class-action case could make it the most important ERISA litigation of the High Court’s current term. Employee benefits attorneys watching the case’s progress say a High Court decision could deter employers from offering employer stock as a 401(k) plan […]
With difficult, loud people, ask, Why is he or she so difficult? Maybe my thought is that this person is insecure, so I change my behavior, things change for the better, and the other person takes the credit. But there’s the beginning of a relationship. Four Ts of Crucial Connections To work on difficult relationships, […]
A third-party claims administrator may not be sued for violating the Mental Health Parity and Addiction Equity Act because the law by its terms applies only to group health plans and their insurers, a federal district court ruled. Related ERISA claims against the TPA were also dismissed because the company was not the “plan administrator” […]
Many hoped that the U.S. Supreme Court’s ruling in U.S. v. Windsor would clear up the confusion regarding what employers and plan administrators can and should do if they have employees with same-gender spouses. Alas, that was not to be. As 2014 approaches, employers face as many complications as ever. Rather than simplifying matters, the […]
Earlier this week, President Obama said the Affordable Care Act will not be repealed as long as he is in office, in spite of its turbulent implementation process. No mention was made of the great sacrifices and adjustments employers are being asked to make. For example, large employers will have to toil for thousands of […]
While most retirement plan sponsors and their vendors think being deemed a plan fiduciary is an “all-or-nothing” proposition, it is in fact becoming a growing continuum of service-provider job titles and responsibilities, one industry expert suggests. For example, a survey of 100 randomly selected, non-client plan sponsors conducted by retirement planning and wealth management firm […]
By Mary Jo Larson Nearly every 401(k) plan offers its participants some investment options that include revenue-sharing fee payments. For many years, employers were not even aware that their participants’ investments were generating these payments. Today, in the wake of new U.S. Department of Labor disclosure and reporting rules and well-publicized cases attacking employers for […]