By: Amanda Sonneborn and Jules Levenson
Seyfarth Synopsis: Court excludes evidence of Social Security disability award issued after the final decision issued on plaintiff’s claim for plan disability benefits. The decision accentuates the importance of fighting to limit the evidence before a Court on review of a plan administrator’s decision.
Just like football is a…
By: Jules Levenson, Meg Troy and Ian H. Morrison
Knowingly spending money that isn’t yours sounds like a no-no, but depending on how the Supreme Court rules in Montanile v. Board of Trustees of the National Elevator Industry Health Benefit Plan (No. 14-723), certain ERISA plan participants may well have that perverse incentive, owing…
By Ward Kallstrom and Andrew Scroggins
Claims by providers seeking to assert the rights of ERISA plan participants have been percolating in courts throughout the country.[1] The Seventh Circuit has now weighed in, rejecting the notion that providers who have payment disputes with ERISA plans are entitled to utilize a plan’s ERISA-mandated claims appeal…
By: Amanda Sonneborn and Christopher Busey
In Mirza v. Insurance Administrator of America, Inc., No. 13-3535 (3d Cir. August 26, 2015), the Third Circuit became the latest Court to require benefit denial letters to include a notification of the plan’s limitations period for bringing suit. In reaching this conclusion, it joined the First and…
By: Jon Braunstein and Nabeel Ahmad
In a recent decision, the Ninth Circuit Court of Appeals rejected a Plan participant’s attempt to extend California insurance law’s notice-prejudice rule to self-insured ERISA plans. Zagon v. Am. Airlines, Inc., 2015 BL 160778, 9th Cir., No. 13-55866 (5/21/15) (unpublished).
The pertinent case facts are these: Zagon, a…
By: Sam Schwartz-Fenwick and Amanda Sonneborn
In last week’s oral argument on the constitutionality of same-sex marriage bans, Chief Justice Roberts asked the following question:
Counsel, I’m I’m not sure it’s necessary to get into sexual orientation to resolve the case. I mean, if Sue loves Joe and Tom loves Joe, Sue can marry…
By: Amanda Sonneborn and Meg Troy
The Fifth Circuit recently addressed an out-of-network provider’s right to sue and whether coverage may be conditioned on collections of patient’s out of pocket costs. North Cypress Medical Ctr. Operating Co., et al. v. Cigna Healthcare, et al., No. 12-20695.
North Cypress owns and operates a hospital in…
By: Sam Schwartz-Fenwick, Nick Clements and Ian H. Morrison
The EEOC issued an internal memo entitled an “Update on Intake and Charge Processing of Title VII Claims of Sex Discrimination Related to LGBT Status” on February 3, 2015. The memo, sent to the EEOC’s District Directors, seeks to “reiterate the importance of proper handling of…
By, Amanda Sonneborn and James Goodfellow
Following up on a post we wrote back in January 2014, the Sixth Circuit en banc reversed its prior decision affirming an award of disgorgement as an equitable remedy for an insurer’s allegedly improper failure to pay benefits. By way of reminder, the issue before the Court was whether…
By: Ada Dolph and Jim Goodfellow
In Becker v. Mays-Williams, No. No. 13–35069 (9th Cir. Jan. 28, 2015), the Ninth Circuit was confronted with the issue of determining whether decedent Asa Williams, a long-time participant in his employer’s ERISA governed retirement savings plans, effectively changed his beneficiary designation from his ex-wife to his son…
