By: Chris Busey and Ron Kramer
Even when a claims administrator approves a claim for disability benefits, its job is not done. That principle was again demonstrated in the recent case Owings v. United of Omaha Life Insurance Co., No. 16-3128 (10th Cir. Oct. 17, 2017). The plaintiff’s claim for long-term disability benefits had…
By Jonathan A. Braunstein and Michael W. Stevens
Seyfarth Synopsis: The Ninth Circuit Court of Appeals recently confirmed that ERISA preempts state insurance law bans on discretionary clauses for self-funded ERISA plans.
The Ninth Circuit has weighed into the national debate over discretionary clauses in ERISA plans, holding that ERISA preempts a state-law ban on…
By: Ian Morrison and Tom Horan
Seyfarth Synopsis: In a strong decision for insurers, the Eighth Circuit affirmed summary judgment for the administrator, rejected plaintiff’s conflict of interest argument, and found that it was not arbitrary for the administrator to require objective evidence of impairment when processing an LTD claim.
Cooper v. Metropolitan Life Insurance…
By: Sam Schwartz-Fenwick and Chris Busey
Seyfarth Synopsis: The Eighth Circuit upheld dismissal of Title VII claims challenging an employee benefit plan’s blanket transgender exclusion because the exclusion impacted the employee’s transgender son, not the employee. The Eight Circuit overturned the dismissal of the employee’s claim against the plan’s third-party administrator under the Affordable Care…
By: Sam Schwartz-Fenwick and Jules Levenson
Seyfarth Synopsis: In a decision with wide ranging implications, the Ninth Circuit has ruled that a discretionary clause in an employer drafted plan document is subject to, and invalidated by, California’s insurance regulation banning discretionary clauses in insured plans.
In recent years a number of states have passed…
By, Sam Schwartz-Fenwick and Jim Goodfellow
Seyfarth Synopsis: In an opinion that may result in increasingly complex ERISA benefits litigation, the Eighth Circuit has allowed a breach of fiduciary duty claim premised on alleged faulty claims handling practices to proceed in conjunction with a claim for benefits.
In a case that should catch the…
By: Jim Goodfellow and Ian Morrison
Seyfarth Synopsis: The Fifth Circuit has concluded that Texas’ ban on discretionary language in insurance policies does not alter the standard of review related factual determinations made by ERISA administrators. In so holding, the Court has suggested that Texas’ ban on discretionary language does not apply to non-insurance policy…
By: Michael Stevens and Ronald Kramer
Seyfarth Synopsis: The Sixth Circuit becomes the seventh circuit court to not require administrative exhaustion for statutory ERISA claims (as opposed to denial of benefit claims), while two circuit courts still do.
In a decision earlier this month, the Sixth Circuit joined six other circuit courts in holding that…
By: Alexius O’Malley and Sam Schwartz-Fenwick
Seyfarth Synopsis: A Court ruled that under the Affordable Care Act, an ERISA governed plan exclusion cannot unequivocally bar emergency medical care related to injuries sustained in a fireworks explosion.
Recently, a federal court in Minnesota addressed whether a participant in a self-funded ERISA-governed welfare plan, could recover $225,000…
By: Amanda Sonneborn and Thomas Horan
Be careful what you ask for. The Plaintiff in a recent case from the Central District of California learned that lesson when the Plan’s re-evaluation of her claim for benefits revealed that she was apparently working as a stunt coordinator and stunt actress, despite having received disability pension payments…
