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20 Matching News Items

1.  DOL's Final Rule Modifies ERISA Disability Claim Regulations
Womble Carlyle Link to more items from this source
Jan. 17, 2017
"Addressing conflicts of interest, the final rule requires decisions regarding hiring, compensation, termination, or promotion of persons involved in making claim decisions not be based on the likelihood the individual will support denial of benefits.... The final rule expanded the definition of 'adverse benefit determination' to include 'any rescission of disability coverage,' including 'cancellation or discontinuance of coverage that has a retroactive effect.' "
2.  Federal District Court Deems Claim for Equitable Relief Appropriate
Womble Carlyle Link to more items from this source
Oct. 13, 2014
"The Court noted that the key to the Varity analysis was whether both theories of recovery were based upon the same alleged conduct; if so, the claim for equitable relief under ERISA 502(a)(3) was not appropriate. But here, Judge Story found, the alleged wrongful conduct was not Prudential's benefit determination, but rather the employer's failure to provide the conversion application in a timely manner. In fact, as a direct result of the employer's alleged breach, plaintiffs had no a claim for benefits pursuant to ERISA 502(a)(1)(B) under the policy terms; they had a claim under ERISA 502(a)(3) or nothing." [Biller v. Prudential Ins. Co. of America and Six Continents Hotels, Inc., No. 1:13-CV-03495 (N.D. Ga. Aug. 26, 2014)]
3.  Employee Benefit Plan is Governmental Plan, Even Though Employees are Not
Womble Carlyle Link to more items from this source
June 8, 2014
"While there was not much question that the Hospital was a governmental entity, the fact that Staffing, Inc.'s employees were not state employees made for a trickier question as to whether Staffing, Inc.'s plan was governed by ERISA.... [The Magistrate Court] found five of the six factors weighing in favor of deeming Staffing, Inc. an 'agency or instrumentality' of the government."
4.  Eleventh Circuit Joins Fourth Circuit in Rejecting Continuing Breach Approach to ERISA's Statute of Limitation
Womble Carlyle Link to more items from this source
Mar. 11, 2014
"The Court found that the plaintiff's allegations in the Complaint concerning the SunTrust plan fiduciaries' failure to remove the funds from the 401(k) options were 'in all relevant respects identical to the allegations concerning the [initial] selection process.' ... As the Fourth Circuit Court of Appeals was careful to do in Alphin, the Fuller Court declared that it was declining to decide 'whether a fiduciary had an ongoing duty to remove imprudent investment options from a Plan in the absence of a material change in circumstances.' Rather, it described its ruling as limited to the prevention of a 'continuing violation theory,' which could thwart the purpose of ERISA's six-year statute of repose." [Fuller v. SunTrust Banks, Inc., No. 12-16217 (11th Cir. Feb. 26, 2014)]
5.  11th Circuit Mandates Proactive Gathering and Review of SSA Information in LTD Claim Review
Womble Carlyle Link to more items from this source
Feb. 12, 2014
"Without asking Plaintiff for the information generated during the SSA investigation, LINA upheld its denial on the second appeal, explaining in the letter that the SSA decision was independent of its decision.... While the Court recognized that Plaintiff had the burden of establishing her entitlement to benefits, and that LINA was not required to 'ferret out evidence in [Plaintiff's] or the SSA's possession,' it found it 'troubling' that LINA 'treated the SSA process and the evidence generated by it as irrelevant and unavailable' once it had denied Plaintiff's claim at the initial level." [Melech v. Life Insurance Co. of North America (LINA), No. 12-14999 (11th Cir. Jan. 6, 2014)]
6.  Supreme Court Overturns 4th and 11th Circuit Rule Governing Finality of Judgment
Womble Carlyle Link to more items from this source
Jan. 21, 2014
"When a United States District Court judge enters judgment in a case, but postpones for a later date determination of a party's motion for attorneys' fees, when is the Court's decision 'final' ... particularly when counting the 30 days by which to appeal under the Federal Rules of Appellate Procedure? Until last week, the answer in the Fourth and Eleventh Circuit was: 'It depends.' ... [T]he U.S. Supreme Court resolved the split, unanimously holding that a District Court's decision on the merits was 'final' and started the clock running for the appeal deadline, even if an attorneys' fees award had not yet been determined, regardless of whether attorneys' fees were sought pursuant to statute or by contract." [Ray Haluch Gravel Co. v. Central Pension Fund of Int'l Union of Operating Engineers and Participating Employers, No. 12-992, 2014 WL 127952 (U.S. Jan. 15, 2014)]
7.  District Court in Florida Further Defines Parameters of Medical Provider's Standing to Sue under ERISA
Womble Carlyle Link to more items from this source
Oct. 30, 2013
"The boundaries of the medical provider's standing under ERISA were recently tested in the United States District Court for the Southern District of Florida. In MRI Scan Center v. MedSolutions/CIGNA ... the Plaintiff, MSC, provided imaging services to patients, including participants of employee health benefit plans insured by CIGNA.... Plaintiff alleged that CIGNA had improperly inflated the cost of services by adding its own administrative fees, in order to charge higher premiums. MSC alleged that this practice was a breach of CIGNA's fiduciary duty ... [The court disagreed]."
8.  District Court Judge Invites the 11th Circuit Court of Appeals to Reverse Him on Benefit Claim Review
Womble Carlyle Link to more items from this source
Aug. 20, 2013
"The Honorable William Acker, sitting in the United States District Court for the Northern District of Alabama, was not shy in letting his opinion be known, when he lambasted the entire ERISA benefits review process -- from the fiduciary's administrative claims handling to the 11th Circuit's unique six-step methodology in reviewing the fiduciary's decision -- even while ruling in favor of the defendants.... Judge Acker gave Plaintiff the 'unsolicited advice' to forego an appeal, citing insurmountable odds. Nevertheless, Judge Acker made it known that, in the event Plaintiff appealed, 'his feelings would not be hurt' if he were reversed."
9.  Fourth Circuit Reverses District Court and Trend, Says Death from Driving While Intoxicated Is an 'Accident'
Womble Carlyle Link to more items from this source
June 9, 2013
"The reversal at the Fourth Circuit illustrates again the struggle to define the word 'accident,' in a situation involving a driver who intentionally becomes highly intoxicated and intentionally drives, knowing the inherent dangers, yet probably does not intend to crash, sustain injury and/or perish.... As did ... the District Court below, the Fourth Circuit Court of Appeals explored a spectrum of interpretations of the word 'accident.'"
10.  Supreme Court Decision in Mccutchen Leaves 11th Circuit Precedent Unscathed
Womble Carlyle Link to more items from this source
Apr. 17, 2013
"In its decision ..., the United States Supreme Court said what the Eleventh Circuit has been saying all along: Recovery through (and defenses to) ERISA Sec. 502(a)(3) are limited to enforcement of the terms of the plan, and cannot be crafted in contradiction of clear plan terms."
11.  Creditors Can Reach Benefits under Top Hat Plan, District Court Rules
Womble Carlyle Link to more items from this source
Apr. 11, 2013
"After recognizing that the Plan was exempt from ERISA's anti-alienation provision mandate, the [federal district court in Maryland] went on to address whether the terms of the Plan controlled over Maryland's garnishment laws by virtue of ERISA's preemption section 514. In holding in favor of the creditor, the Court ... [ruled] that ERISA did not preempt state garnishment laws that simply provided a procedural device for enforcing a judgment. As to the Participant's argument that garnishment would violate the terms of the Plan, the Court held that the creditor's rights were not subject to the terms of the Plan[.]" [Sposato v. First Mariner Bank, 2013 WL 1308582 (D. Md. Mar. 29, 2013)]
12.  District Court Applies Presumption against Suicide When Interpreting AD&D Policy
Womble Carlyle Link to more items from this source
Mar. 28, 2013
"[T]he Court held that federal common law 'firmly established a negative presumption against suicide.' Under this rule, 'the presumption[] never drop[s] out of the case until the fact finder, [i.e., the Court] becomes convinced, given all the evidence, that it is more likely than not that the insured committed suicide'.... Implicit in the Court's ruling was its sense that the 'official' reports did nothing more than rule out a homicide." [Acree v. Hartford Life & Accident Ins. Co., 2013 WL 140097 (M.D. Ga. 2013)]
13.  ERISA Does Not Preempt State Court Order Requiring Beneficiary to Renounce Right to Employee's Plan Benefits
Womble Carlyle Link to more items from this source
Mar. 15, 2013
"The lesson: An estate can sue the employee benefit plan beneficiary before the plan distribution is made, putting in place the threat of a court's contempt powers by the time the distribution is made." [Adrochick v. Byrd, No. 12-1728 (4th Cir. Mar. 4, 2013)]
14.  Courts in the Fourth Circuit Continue Trend: Death from Driving While Intoxicated Is Not an 'Accident' (PDF)
Womble Carlyle Link to more items from this source
May 29, 2012
"Magistrate Judge Patrick Auld, sitting in the Middle District of North Carolina, found in favor of an ERISA plan fiduciary who determined that a death resulting from driving while intoxicated was not an 'Accident' for purposes of an Accidental Death & Disability benefit under an ERISA-qualified employee benefit plan. Johnson v. American United Life Ins. Co., 2012 U.S. Dist. Lexis 32718 (M.D. N.C. 2012)."
15.  Many Health Care Reform Provisions Effective This Year: Employers Need to Take Action (PDF)
Womble Carlyle Link to more items from this source
Apr. 5, 2010
4 pages. Excerpt: The [target document] is an overview of some of the highlights of the Act that are of particular importance to employers and are effective this year or next year. We will issue subsequent alerts focusing on provisions that are effective later, as employers should consider those provisions when considering changes to plan design, its implementation and issues such as whether or not they wish to continue providing employee health coverage.
16.  Employers Must Make 2009 Required Minimum Distribution Decisions by November 30 (PDF)
Womble Carlyle Link to more items from this source
Nov. 3, 2009
Excerpt: Pursuant to Notice 2009-82, employers must decide by November 30, 2009, whether to: * Suspend all RMDs for 2009, unless the participant affirmatively requests the distribution; * Distribute all RMDs for 2009, unless the participant affirmatively requests the waiver; * Continue RMDs for 2009 in accordance with plan provisions without a choice participants. In addition, employers will need to decide by November 30, 2009, whether and to what direct rollovers of distributions containing 2009 RMDs will be offered to participants.
17.  Impact of the Emergency Economic Stabilization Act of 2008 on Executive Compensation Design (PDF)
Womble Carlyle Link to more items from this source
Oct. 8, 2008
2 pages. Excerpt: The EESA executive compensation restrictions are noteworthy in part because they restrict certain elements of executive compensation design, as opposed to just imposing federal tax consequences for certain types of compensation. The scope of the EESA executive compensation restrictions depends on how the troubled assets are sold to the Treasury: through market mechanisms such as auctions or reverse auctions, or via direct purchases. The remainder of this client alert summarizes EESA's executive compensation provisions.
18.  Important Deadline Under Section 409A Approaching for Nonqualified Deferred Compensation Plans and Faculty Members of Academic Institutions (PDF)
Womble Carlyle Link to more items from this source
July 8, 2008
3 pages. Excerpt: This is a reminder that the deadline for compliance with the Internal Revenue Code Section 409A rules is approaching quickly. In addition, this is an alert to all academic institutions to a potential Section 409A issue affecting their faculty members that must be addressed prior to the beginning of the next academic year. It is very unlikely that either of these deadlines will be extended further. Therefore, it is important that any necessary action be taken promptly.
19.  Fiduciaries Exposed to New Liability Under ERISA As Supreme Court Rules on Individual Accounts (PDF)
Womble Carlyle Link to more items from this source
Feb. 27, 2008
4 pages. Excerpt: This alert provides a brief summary of the LaRue case, as well as outlines the problems it may create for plan sponsors and fiduciaries and posits several actions that they may wish to take to help address those problems.
20.  June 30 Deadline for Deferrals under Calendar Year Performance Plans (PDF)
Womble Carlyle Link to more items from this source
June 13, 2005
2 pages. Excerpt: New Internal Revenue Code Section 409A ... generally requires that elections to defer compensation under a nonqualified deferred compensation plan be made in the year prior to the taxable year in which the underlying services are performed. However, there is an exception to this general rule for elections related to certain performance-based compensation.

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