By: Mark Casciari and Michael Cederoth
Seyfarth Synopsis: The Court of Appeals for the Ninth Circuit recently rejected the application of the doctrine of equitable estoppel to prevent a plan trustee from enforcing the clear terms of the plan. So, it bears repeating that drafters of ERISA plans are well advised to draft as clearly…
By: Rebecca K. Bryant, Sam M. Schwartz-Fenwick, and Ian H. Morrison
Seyfarth Synopsis: A recent 10th Circuit decision holding that in order for the abuse of discretion standard to apply in litigation the claims administrator must provide participants with actual notice of discretionary authority or notice of a document affecting standard of review…
By: Jon Karelitz and Mark Casciari
Synopsis: A recent 4th Circuit decision reiterates the importance of aligning a plan fiduciary’s administrative claim and appeal review process with the standards for a “full and fair review” under U.S. Department of Labor regulations, including disclosing all documents considered in the course of determining a claim (absent compelling…
By: Mark Casciari and Ian Morrison
Synopsis: A recent decision of the federal district court for the Southern District of New York warns ERISA fiduciaries that even innocent mistakes that do not misuse plan assets or unjustly enrich the fiduciaries can cause an unexpected and substantial expense to the plan, at least in the context…
Seyfarth Synopsis: In an unpublished yet fascinating decision, the California Court of Appeal held that ERISA § 514 preempts state law causes of action premised on wrongful disclosure of protected private health information. Although not-binding as precedent, the decision is noteworthy to Plan sponsors and administrators because it demonstrates the expansive preclusive effect of federal…
Seyfarth Synopsis: A recent case from the Western District of North Carolina contains a helpful example of how the standards applicable to an employee’s request for accommodation of a disability differ from those for determining whether the same employee is eligible for benefits under a short-term disability plan. At the same time, it demonstrates the…
By, James Goodfellow and Amanda Sonneborn
Seyfarth Synopsis: The Fifth Circuit adds to the growing body of case law requiring more detailed reviews of claims for life insurance or accidental death and dismemberment benefits following accidents resulting from drunk driving.
In White v. LINA, No. 17-30356, __F.3d__, 2018 WL 2978641 (5th Cir. June 13,…
By: Chris Busey, Tom Horan and Sam Schwartz-Fenwick
Seyfarth Synopsis: The Fourth Circuit found in favor of an insurer on a claim for life insurance benefits, finding the insured’s failure to submit the required evidence of insurability was not excused by his employer having wrongly deducted premiums for that coverage from his pay.
By, Jim Goodfellow and Sam Schwartz-Fenwick
Seyfarth Synopsis: In a win for ERISA plan and claims administrators, the Third Circuit has affirmed the broad enforcement of a long-term disability plan’s mental or nervous limitation period.
In Krash v. Reliance Standard Life Insurance Group, No. 17-1814, the Third Circuit affirmed the judgment of the…
By Ronald Kramer and Michael W. Stevens
Seyfarth Synopsis: Claims for benefits at termination may proceed as a breach of contract claim in state court, and avoid ERISA preemption, where the calculations are individualized, straightforward and do not implicate an ongoing administrative scheme.
Under a recent decision from the Central District of California, employers may…
