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Benefits in the News > By Subject >Disability plans |
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[Guidance Overview] Fourth Circuit Splits With Sixth Circuit On Procedural Violation Remedy The Fourth Circuit opinion stated, 'The district court's reliance on the Sixth Circuit's decision in Wenner was misplaced, both because it is contrary to the law of this circuit and because that decision's rationale is flawed. In Wenner, a claimant's ERISA benefits were ordered reinstated, a substantive remedy, even though the only ERISA violation was a 29 U.S.C. ? 1133 procedural violation and the merits of the claim had not been decided." (Health Plan Law Blog by attorney Roy F. Harmon III) [Guidance Overview] Thorny Issues Presented In Grants Of Discretion To Third-Party Benefit Administrators Excerpt: "Employers and TPA's should give careful thought to these case authorities in drafting claims administration agreements. At a minimum, the agreements and the plan language should be coordinated on grants of authority. Obviously, explicit grants of authority are preferred and may in some jurisdictions be required to gain deferential review of claims denials. Administrative practices should conform to the agreement terms with attention to documentation of decisions as responsibility is allocated by plan terms." (Health Plan Law Blog) [Guidance Overview] Dual-Role Benefit Plan Administrator Conflicts: Proceed with Caution (PDF) 6 pages. Excerpt: "The Supreme Court's ruling in Metropolitan Life Ins. Co. v. Glenn increases the likelihood of the courts overturning certain benefits decisions. Understanding the ruling and what steps to take in its wake can help companies limit that risk." (Thompson Publishing Group via Vedder Price P.C.) [Guidance Overview] 'Unexplained Gap' in Reviewing Physician's Opinion Results in Decision for ERISA Plaintiff Excerpt: "The Fifth Circuit carefully noted that the reviewing physician, though finding the claimant not disabled, failed to engage the opinion of the treating physician on the key points offered in justification of the disability claim. . . . The 'unexplained gap' resulted in a substantial defect in the reasoning of the plan administrator's benefit denial. The Court reversed the decision of the district court and remanded for entry of judgment in favor of the claimant." (Health Plan Law blog by Attorney Roy F. Harmon III) Doctors Eased Path for L.I.R.R. Disability Claims Excerpt: "In the years before the investigators arrived, the Long Island office of the Railroad Retirement Board had been a beacon to employees of the Long Island Rail Road, offering the prospect of a comfortable retirement, complete with a pension and disability payments -- all at an age when people in other industries were still working. . . . Of particular interest to investigators is a small group of disability consultants and physicians who have helped the L.I.R.R. attain the dubious distinction of having the nation's highest rate of disabled retirees even while it was earning awards for employee safety." (The New York Times; free registration required) Special Laws Skirt Pension System as Massachusetts Legislature Boosts Benefits for Some Police, Firefighters Excerpt: "It was about 3 a.m. in the Theatre District when Boston police Officer William I. Griffiths wrenched his back during a struggle with a gun-wielding drug suspect who fired a bullet that zipped past the officer's head. The injuries he said he suffered during the July 2001 arrest, a herniated disc and traumatic stress, were so disabling that Griffiths decided he could not return to the force. But rather than applying for a disability pension, Griffiths went another route. He went to City Hall and Beacon Hill and persuaded local and state elected leaders to back a special state law granting him a much larger pension - 100 percent of his salary, tax free - than most disabled retirees receive." (The Boston Globe) How Do Disabilities Affect Future Retirement Benefits? Excerpt: "One-quarter of workers ages 51 to 55 develop work disabilities before age 62. Disabilities often force people to curtail their work hours, derailing retirement preparations. However, protections built into Social Security, including disability and spouse benefits and the system's tilt toward workers with low lifetime earnings, cushion the impact of midlife health problems. After other factors are controlled for, the onset of health-related work limitations between ages 51 and 61 reduces Social Security retirement benefits at ages 63 to 67 by only about 2 percent, much less than the impact on other retirement savings." (The Urban Institute) An Overview of the Railroad Retirement Program (PDF) 11 pages. Excerpt: "The Railroad Retirement program was established in the 1930s. It provides retirement, survivor, unemployment, and sickness benefits to individuals who have spent a substantial portion of their career in railroad employment, as well as to these workers' families. This article describes the history, benefit structure, and funding of the Railroad Retirement program." (U.S. Social Security Administration) Labor Supply Effects of the Interaction between the Social Security Disability and Retirement Programs at Full Retirement Age Excerpt: "The Social Security Disability Insurance (DI) program imposes strong work restrictions on beneficiaries; however, the causal effect of the work disincentives on labor supply has been difficult to estimate. We take a new look at this question by exploiting the fact that DI benefits are payable only until full retirement age (FRA), at which point they are converted to retired worker benefits, and the program's implicit high marginal tax rate on earnings is abruptly relaxed." (University of Michigan Retirement Research Center) [Guidance Overview] Claims Denial Faces Stricter Review Because Sponsor Failed to Meet DOL Electronic Delivery Requirements Excerpt: "A ruling by the 9th U.S. Circuit Court of Appeals emphasizes the importance of compliance with the U.S. Department of Labor's regulations on delivering plan documents electronically. In Gertjejansen v. Kemper Insurance Companies, Inc., the court applied a stricter standard of review to a claims denial because the employer's delivery of the summary plan description (SPD) did not meet DOL requirements." (Watson Wyatt Worldwide) [Guidance Overview] Procedural Crossroads After Remand of Case to Plan Administrator Excerpt: "This dispute over long term disability benefits illustrates the exacting procedural requirements that must be observed in protecting a claim for benefits for appellate review. In this instance, the district court applied Sixth Circuit authority to hold that a motion to reopen the case after a remand to the plan administrator was the proper procedural course." (Health Plan Law blog by Attorney Roy F. Harmon III) [Guidance Overview] No Penalties for Claims Administrator That Failed to Furnish Requested Plan Document Excerpt: "EBIA Comment: The court's ruling is consistent with that of most courts on this issue . . . . As the court explained, the DOL claims procedure regulations broaden the plan administrator's duties but they do nothing to broaden the meaning of the term plan administrator." (Employee Benefits Institute of America) [Guidance Overview] Employer Was Not Required to Provide a COBRA Election Notice for Its Long-Term Disability Plan Excerpt: "EBIA Comment: As this court pointed out, COBRA does not apply to welfare benefit plans, such as typical long-term disability plans, that do not provide medical care. But employers should carefully examine their long-term disability plans to ensure that no ancillary benefits for medical care are present -- if benefits for medical care are provided, COBRA would apply to that part of the plan (assuming, of course, that the plan otherwise satisfies the conditions that cause a group health plan to be subject to COBRA)." (Employee Benefits Institute of America) 2nd Disability Exam Advised for L.I.R.R. Workers Excerpt: "The federal Railroad Retirement Board, which approves disability payments for just about every railroad employee who requests them, should first require that workers undergo independent physical exams -- something that infrequently happens now -- to prove that they are actually disabled, federal investigators said in a new report." (The New York Times; free registration required) [Guidance Overview] Internal Appeals Processes Require Strict Compliance By Claimants Excerpt: "Two important judicial doctrines converge in this case, both to the detriment of the plaintiff. First, the court finds that the plan administrator 'substantially complied' with the claims regulations; second, the court applied the failure to exhaust administrative remedies defense, rebuffing the plaintiff's justification based upon futility. The caselaw continues to demonstrate that claimants must carefully attend to all requirements of internal appeals processes and resolve any close cases with further application to the appeals avenues offered under the plan." (Health Plan Law blog by Attorney Roy F. Harmon III) [Guidance Overview] Chart of 415, Etc., Limits Updated for News Release IR-2008-118 The chart of maximum limits subject to inflation indexing at Carol V. Calhoun's employee benefits site has now been amended to include the newly announced 2009 limits. Among other things, the chart shows limits under sections 415, 403(b), 401(k), and 457, as well as the Social Security wage base and Social Security and Medicare tax rates, for 1996-2009. (Calhoun Law Group, P.C.) Congressional Lawmakers Seek Oversight of Railroad Retirees Excerpt: "Members of the New York Congressional delegation summoned officials of the federal Railroad Retirement Board to a meeting in New York City on Friday, emerging with what the lawmakers said was an agreement that could lead to the re-evaluation of disability payments awarded to hundreds of retired Long Island Rail Road workers." (The New York Times; free registration required) [Guidance Overview] Second Circuit Vacates Judgment for Plan, Suggests Appointment of Counsel Excerpt: "The federal courts have continued to adapt the MetLife v. Glenn decision into their approach in an ad hoc and unpredictable fashion. To be sure, several courts have seen the case as requiring little change. Others, such as the Second Circuit in Douglas, reached conclusions that reveal a new approach to old issues. In this unpublished decision, the Second Circuit reversed and vacated a district court judgment for the disability carrier where the claimant had failed to submit her claim within the time required by the policy." (Health Plan Law blog by Attorney Roy F. Harmon III) Retirees May Be Abusing Disability Insurance, Long Island Rail Road Says Excerpt: "On Tuesday the railroad gave the state attorney general, Andrew M. Cuomo, and the inspector general of the Metropolitan Transportation Authority evidence raising the possibility that hundreds of its employees were buying private disability insurance policies knowing that the federal railroad board would declare them disabled." (The New York Times; free registration required) [Guidance Overview] Conflicts of Interest Under ERISA -- A Review of the Recent U.S. Supreme Court Decision Excerpt: "In Metropolitan Life v. Glenn, 554 U.S. ___ (2008), a divided Court decided that a plan administrator has a conflict of interest when it decides whether to grant or deny claims that the plan will be required to pay. The Court found the conflict to be clear since '[t]he employer's fiduciary interest may counsel in favor of granting a borderline claim while its immediate financial interest counsels to the contrary.'" (Anderson Kill & Olick, P.C. via Mondaq; free registration required) [Guidance Overview] Three Federal Circuit Courts Consider the Impact of Supreme Court's Glenn Decision on Standard of Review Analysis Excerpt: "Here is a summary of three post-Glenn circuit court decisions, each of which involved a denial of long-term disability benefits." (Employee Benefits Institute of America) [Guidance Overview] Reinstatements Revisited: Tate v. Long Term Disability Plan for Salaried Employees, Excerpt: "After just reviewing the 7th Circuit decision in Hackett v. Xerox Corp. Long-Term Disability Income Plan, 315 F.3d 771 (7th Cir. 2003), so influential in Pannebecker v. Liberty Life Assur. Co., 2008 U.S. App. LEXIS 19753 (9th Cir. Ariz. Sept. 18, 2008), I find this recent decision from the 7th Circuit curious. This appears to be a case where the plan decision should fall in Category #2, as benefits were previously approved, but later terminated without a principled decision. Therefore, under Hackett,benefits should be reinstated." (Health Plan Law blog by Attorney Roy F. Harmon III) New York Governor Wants Congress to Investigate Long Island Rail Road Disability Plan Excerpt: "Gov. David A. Paterson Tuesday asked Congress to launch an investigation into possible abuses of a federal disability compensation plan by employees of the Long Island Rail Road. Paterson's call came on the same day that a member of the obscure federal agency that has been recently criticized for rubberstamping LIRR disability claims spoke out against 'an outdated ... system that desperately needs fixing.'" (Newsday) [Guidance Overview] The Conundrum of ERISA Remands & Reinstatements Excerpt: "Pannebecker provides helpful analysis on the point of what should follow should the circumstances of a benefit denial necessitate 'remand' to the plan administrator. In Pannebecker, the Ninth Circuit agreed with the district court that the plan administrator was justified in denying disability benefits on the view that the claimant could perform sedentary job duties. In other words, the plan administrator 'won'." (Health Plan Law blog by Attorney Roy F. Harmon III) New York's Governor Seeks Study of Benefits at Long Island Rail Road Excerpt: "Gov. David A. Paterson said on Sunday that he would give Andrew M. Cuomo, the state's attorney general, broad powers to investigate the Long Island Rail Road as part of a wide-ranging review his administration would seek of how disability and pension benefits were potentially manipulated by L.I.R.R. supervisors, workers and retirees." (The New York Times; free registration required) [Guidance Overview] Ninth Circuit Opinion Holds Structural Conflict Exists Where Employer Pays Benefits Out of a Trust Excerpt: "The Ninth Circuit, in the case of Burke v. Pitney Bowes Inc. Long-Term Disability Plan, weighed in on the interpretation of MetLife v. Glenn in another disability case, appearing to disagree (but not citing) one of the holdings in the recent Eleventh Circuit opinion of Frankie White v. Coca-Cola Bottling Co. . . . (Rather, the court stated it disagreed with the pre-MetLife decision of Gilley v. Monsanto Co., Inc., 490 F.3d 848, 856 (11th Cir. 2007) relied upon by the Eleventh Circuit in the White case.)" (Attorney B. Janell Grenier via Benefitsblog.com) Another Reason Not to Use Your Pension before Retirement: ERISA Offset Excerpt: "Every year thousands of people are wrongfully denied long-term disability benefits from their insurance company. Often, these individuals will take early withdrawal from their retirement plan in order to meet basic living expenses while appealing the denial of benefits. As a result, they are left with nothing to fund their retirement and because of the disability, no means of ever earning that income again. To add insult to injury, once the disability carrier decides that they were wrong and should not have denied benefits, they also take credit for the income received from the individual's pension, IRA or other retirement plan." (Florida Disability & LTD Weblog) Reduction of LTD Benefits Based on Receipt of Social Security Benefits Is Reasonable Excerpt: "The appellate court also agreed with a lower court ruling that Coca-Cola was right in trying to recoup overpayments of benefits. The court said the Coca-Cola's interpretation of both a provision in the Coca-Cola Long Term Disability Income Plan that permits an offset for the receipt of other disability benefits and one that allows the plan to recoup overpayments of benefits was correct." (PLANSPONSOR.com; free registration required) [Guidance Overview] In Important 11th Circuit Case After the Glenn Decision, Heightened Arbitrary and Capricious Review Is Questioned Excerpt: "This recent unpublished 11th Circuit opinion presents interesting comment, post-Glenn, on the appropriate standard of review in a benefits denial case. At issue was the plan administrator's reduction of benefits under a long-term-disability plan based on a participant's receipt of Social Security disability benefits." (Attorney Roy F Harmon III in the Health Plan Law blog) Workers' Compensation: Benefits, Coverage, and Costs, 2006 Excerpt: "[This 88-page report provides] the only comprehensive national data on this largely state-run program. The study provides estimates of workers' compensation payments -- cash and medical -- for all 50 states, the District of Columbia, and federal program providing workers' compensation." (National Academy of Social Insurance) Annual Statistical Report on the Social Security Disability Insurance Program, 2007 Excerpt: "Size and Scope of the Social Security Disability Program: Disability benefits were paid to more than 8.1 million people. Awards to disabled workers (804,787) accounted for about 90 percent of awards to all disabled beneficiaries (901,114). In December, payments to disabled beneficiaries totaled almost $7.8 billion. Benefits were terminated for 522,349 disabled workers. Supplemental Security Income payments were another source of income for about 1 out of 6 disabled beneficiaries." (U.S. Social Security Administration) [Guidance Overview] 'Metlife v. Glenn': The Court Addresses a Conflict Over Conflicts in ERISA Benefit Administration (PDF) 11 pages. Excerpt: "A case concerning disability benefits could have important ramifications for how health benefits are administered as well. . . . This paper analyzes the history of the conflict in the courts over this issue; the Supreme Court's resolution of it in MetLife; and the implications of this decision for plans, beneficiaries, and health policy." (Health Affairs) [Guidance Overview] The Supreme Court Strikes Twice (but Misses the Mark) (PDF) 4 pages. Excerpt: "In its recently completed term, the Supreme Court issued two ERISA-related opinions that address questions left unanswered by earlier Supreme Court decisions and that are of critical importance for plan administration (and litigation that may result from fiduciary missteps). . . . If the Court's intention was to entertain us with a series of interesting (but not that interesting) and thought-provoking essays . . ., then it hit the target both times. If, on the other hand, the Court's goal was to supply clear and sensible guidance in an area that is generating more (not less) litigation, its aim was not true." (Adams and Reese LLP) [Opinion] On Estoppel and Equitable Remedies Under ERISA: It Should Be a Two-Way Street Excerpt: "I've complained at times in the past that too many federal Circuit and District courts view ERISA's equitable remedies as a one way street. Plan fiduciaries chasing subrogation or overpayment claims have free rein to recover money from plan participants under the guise of 'appropriate equitable relief.' Yet those some courts often deny the participants any monetary recovery for violations of ERISA because recovery of money supposedly falls outside the scope of 'appropriate equitable relief.'" (Brian S. King's ERISA Law Blog) [Guidance Overview] Employee Benefits Developments, August 2008 Issue Includes ESOP Dividends -- New Tax Reporting Rules; Mere Posting of SPD on Intranet Does Not Ensure Actual Receipt; Trilogy of IRS Guidance Regarding Health Savings Accounts; Service by Director as Interim CEO Results in Loss of Tax Deduction for Corporation; IRS Proposes Regulations Regarding 'Greater of' DB Plan Formulas; and No FICA Tax Refund On Nonqualified Deferred Comp Plan Benefits Never Received; Kentucky Retirement System Does Not Violate the ADEA. (Hodgson Russ) Total Incapacitation Not Only Proof of Disability in Wyoming Excerpt: "The Wyoming State Supreme Court has decided that an employee's education and training level, and not just total incapacitation, can cause the worker to be eligible for permanent and total disability." (PLANSPONSOR.com; free registration required) Beach Erosion on the ERISA Waterfront Excerpt: "These are interesting times for those who contend for clients along the Maginot Line of ERISA's preemption provisions. Never a particularly easy line to follow, the perimeter has become increasingly uneven on several fronts. [These include provider reimbursement cases, equitable or promissory estoppel, state prohibitions on discretionary clauses, and state law actions against service providers.]" (Health Plan Law blog by Attorney Roy F. Harmon III) Employer Was Not Off Base in Disability Cutoff Excerpt: "A federal appellate court has cleared an employer of wrongdoing in the firing of an employee who returned to work while receiving disability benefits. The 1st U.S. Circuit Court of Appeals upheld a lower court decision that found Parametric Technology Corp. (PTC) did not run afoul of the Employee Retirement Income Security Act (ERISA) by carrying out the termination while Alexei Kouvchinov was receiving short-term disability benefits. Circuit Judge Bruce M. Seyla found there was no evidence of discriminatory intent by PTC." (PLANSPONSOR.com; free registration required) [Guidance Overview] Seventh Circuit Holds for Insurance Carrier Denying Claims Under 'Arbitrary and Capricious' Standard Excerpt: "Fibromyalgia claims face long odds in federal court, and this Seventh Circuit decision fits the typical pattern. As a post MetLife v. Glenn decision, the case does nonetheless present some surprise in that it does not address the standard of review in more than a passing manner." (Health Plan Law blog by Attorney Roy F. Harmon III) Getting Social Security Disability Payments Can Be a Fight to The Death Excerpt: "The crest of baby boomers has reached prime age for disabilities and now slams Social Security offices." (AARP) Worker's Positive Drug Test While on FMLA Leave not Grounds for Benefits Denial Excerpt: "A state of Ohio appellate court has thrown out a decision by the Industrial Commission of Ohio denying an employee who tested positive for cocaine temporary total disability compensation." (PLANSPONSOR.com; free registration required) [Guidance Overview] MetLife v. Glenn Decision Wedges Open Discovery on Use of Outside Consultants Excerpt: "It was just a matter of time before we saw a case where the district court judge took a fresh view of discovery limitations in view of the Supreme Court's decision in MetLife v. Glenn. In Hogan-Cross, Judge Kaplan rejected MetLife's position that discovery should be limited to the 'administrative' record simply because the policy language contained a discretionary clause. The opinion will likely receive ample use in ERISA discovery disputes on a wide range of issues." (Health Plan Law blog by Attorney Roy F. Harmon III) [Guidance Overview] Harsh Consequences of Shoddy Claim Denials and Explanations of Benefits Excerpt: "Two recent district court decisions highlight the fact that administrators issuing unclear or incomplete claim denial letters do so at their own peril. In both Tinker v. Versata, Inc. Group Disability Income Insurance Plan, No. 2:06-CV-02906 (E.D. Cal. July 13, 2008) and O'Connell v. Northland Lutheran Retirement Community Employee Benefit Plan, No. 07-C-637 (E.D. Wis. July 15, 2008), judges imposed significant penalties on plans for failing to live up to ERISA's standards in their explanations of claim denials." (McGuireWoods LLP) [Guidance Overview] U.S. Supreme Court Rules on How ERISA Benefit-Claim Fiduciaries Should Handle Conflicts of Interest Excerpt: "The United States Supreme Court recently decided Metropolitan Life Insurance Co. v. Glenn ('MetLife'), giving critical guidance to ERISA fiduciaries who consider and decide benefit claims. The Court held that a conflict of interest inherently exists when a fiduciary both makes benefit eligibility decisions under a plan and funds those benefits (referred to by the Court as the 'evaluator/payor conflict'); that courts should consider this conflict as a factor when determining whether the fiduciary abused its discretion in denying benefits; and that the significance of the factor will depend upon the circumstances of the particular case." (Blank Rome LLP) [Guidance Overview] Benefit Claims Procedures Should Be Reviewed to Address Potential Conflict of Interest Issues Raised in Supreme Court Glenn Decision Excerpt: "If an employer has any benefit plans where the persons responsible for deciding claims for benefits are also responsible for paying for those benefits, consideration should be given to revising those plans to eliminate those potential conflicts of interest. Steps that employers can take now to address these potential conflicts of interest include the following . . . ." (Bond, Schoeneck & King, PLLC) [Guidance Overview] COBRA Was Required for Former Employee Receiving Social Security Disability Benefits Excerpt: "Medicare entitlement can affect an individual's COBRA rights in several different ways, and keeping all the rules straight is not an easy task. This case illustrates that one source of confusion can be the various benefit programs that the SSA operates. As this court explains, receipt of Social Security disability benefits does not justify a failure to provide COBRA." (Employee Benefits Institute of America) [Guidance Overview] Audio of Webinar: Recent ERISA Litigation - What's the Verdict? Excerpt: "On July 23, David Levin with Gallagher Benefit Services hosting presented a webinar on recent ERISA litigation and the various issues for sponsors of ERISA plans. This webinar provided an overview of these recent cases and their impact on ERISA plans . . . ." (Drinker Biddle & Reath LLP) [Guidance Overview] Ninth Circuit Sees Broader Discovery Rights for ERISA Claimants in Conflict of Interest Cases Excerpt: "The open-ended nature of the inquiry into the existence and effect of structural conflicts of interest in MetLife v. Glenn suggests the possibility, if not the probability, that judges disinclined to give existing precedent hostile to broad discovery ample room to fall back upon the status quo." (Health Plan Law blog by Attorney Roy F. Harmon III) More Players Call Foul on National Football League's Pension System Excerpt: "The National Football League's pension system continues to pay players less than they are entitled to for disabilities caused by on-field injuries, a lawsuit filed in U.S. District Court in Baltimore claims. The pension suit against the league is the third one filed by attorney Cyril V. Smith, who won a verdict of more than $1.5 million for the family of the late 'Iron Mike' Webster in 2005. The decision was affirmed by the 4th U.S. Circuit Court of Appeals." (The Daily Record) [Guidance Overview] Court Rebuffs Fiduciary Breach Claim As Redundant in Claim for Benefits Case Excerpt: "The Crider opinion offers several interesting insights. First, the case addresses an attempt to incorporate state law into an ERISA long term disability policy. Second, the case raises the nettlesome issue of when a fiduciary breach claim can be heard along side a claim for benefits." (Health Plan Law blog by Attorney Roy F. Harmon III) [Guidance Overview] Plan Without 'Discretion' Language Loses Appeal in Benefits Case Excerpt: "Two recent federal appeals court cases demonstrate that having the right language in the plan document often determines whether the plan wins or loses a benefits-denial case. In each case, the plan administrator denied a claim for disability benefits, the trial court upheld the plan's decision, and the participant appealed. In the Fourth Circuit case (Woods) the plan lost the appeal, while in the Seventh Circuit case (Gutta) the plan won." (Employee Benefits Institute of America) [Guidance Overview] What Effect Does MetLife v. Glenn Have on Discovery in Denial of Benefit Claims? Excerpt: "Apparently none, at least according to the first ruling on this question I have seen out of a court in the First Circuit. In a ruling by a magistrate judge, the United States District Court for the District of Maine has concluded that MetLife v. Glenn does not change the rules in the First Circuit governing the extent to which - if at all - a party is allowed to conduct discovery beyond the administrative record itself in a denied benefits case governed by the arbitrary and capricious standard of review." (Stephen Rosenberg of The McCormack Firm, LLC) [Guidance Overview] District Court Clarifies Standard for Providing Notice of Plan Limitations Provisions Excerpt: "A recent decision from the U.S. District Court for the District of Arizona raises important drafting and administrative issues for employers to consider when adding a plan-based statute of limitations provision to their benefit plans. In Solien v. Raytheon Long Term Disability Plan #590, the court refused to uphold a plan-based one-year limitations period for challenging benefit claims in court because the limitation period was not adequately disclosed in the summary plan description (SPD) and was not communicated to the participant as part of the plan's claim denial determination." (McDermott Will & Emery) [Guidance Overview] 10 Things the Supreme Court Did Not Do in Metlife v. Glenn Excerpt: "As we look at the disputes presented in the arena of benefit claims and denials through the murky lens held up in Breyer's MetLife opinion, we have reason to ask if legal pragmatism really is as workable as its adherents claim." (Health Plan Law blog by Attorney Roy F. Harmon III) Listing of Post-MetLife v. Glenn Decisions Excerpt: "The initial reception by the judiciary is the best indicator of what a Supreme Court decision really 'means'. To that end, here's what I have for decisions citing the case thus far . . . ." (Health Plan Law blog by Attorney Roy F. Harmon III) Human Resource Professionals Should Review Who Makes Health and Disability Benefit Determinations for Their Companies Excerpt: "In the employee-benefits case, MetLife vs. Glenn, the Court ruled that companies have a potential conflict of interest when they administer health and disability benefit plans, and decide claims filed under the plans. The justices ruled that courts should consider whether a conflict exists when employees challenge decisions by plan administrators." (Human Resource Executive Online) [Guidance Overview] Supreme Court Provides Further Guidance on Judicial Review of Benefit Claim Denials Excerpt: "Last month, in a case closely watched by those who sponsor and administer ERISA plans, the Supreme Court provided additional guidance regarding what constitutes a conflict of interest and how courts should weigh such conflicts. The Supreme Court 's decision potentially affects benefit claims under all types of retirement and welfare plans subject to ERISA." (Faegre & Benson LLP) A Concise ERISA Counterclaim Review Checklist Excerpt: "From a survey of the post-Sereboff counterclaim cases, here's a list of key recurring issues . . . ." (Health Plan Law blog by Attorney Roy F. Harmon III) [Guidance Overview] Supreme Court Issues Two Significant Employee Benefits Decisions, But Uncertainty Remains (PDF) 4 pages. Excerpt: "In its recent decisions in Kentucky Retirement Systems v. E.E.O.C. and Metropolitan Life Insurance Company v. Glenn, the United States Supreme Court addressed several important issues regarding the design of employee benefit plans and related litigation. Both decisions, however, have unfortunately left a number of significant issues undecided and may lead to confusion and uncertainty for litigants and courts alike." (Dechert LLP) [Guidance Overview] Conflict of Interest in Claims Decisions – A Critical Analysis of MetLife v. Glenn Excerpt: "As a result of the heightened scrutiny that conflicts of interest will be subject to, it is important to take notice of the Supreme Court's position that steps can be taken to minimize the potential adverse effect of financial conflicts of interest. Although these steps are not required, it is likely that employers or insurers who fail to take these steps will be at a distinct disadvantage when a claim denial is challenged in court." (Kilpatrick Stockton LLP) |
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