Search the News Archive

What Personal Injury Lawyers Need to Know About ERISA Liens

"It is critical for the personal injury lawyer to obtain the benefit plan and not just rely on the summary plan description (SPD).... It is just as important for personal injury lawyers to attempt to negotiate with the benefit plans as early as possible.... Any leverage to negotiate a lower reimbursement is lost if the attorney waits too long."

Ninth Circuit Accidental Death Ruling Raises Critical ERISA Issue: Raising Defenses at Trial

"In addition to concluding the decedent's death was due to an accident despite the insured's reckless behavior, the court discussed a bedrock [ERISA] principle that precludes benefit plans from raising new issues for the first time in litigation. The absence of a policy exclusion was also critical to the outcome of the case." [Wolf v. Life Ins. Co. of North America, No. 21-35485 (9th Cir. Aug. 25, 2022)]

What Employment Lawyers Should Know About ERISA

"This article will endeavor to provide a practical overview of ERISA, followed by some pointers for how to spot and address ERISA problems that commonly arise in the employment law context.... [1] ERISA: A brief overview ... [2] ERISA's requirement of a 'full and fair review' ... [3] Common ERISA mistakes employment lawyers make."

What Employers Should Consider When Purchasing Group Disability Insurance

"[1] What is the reputation of the carrier? ... [2] Does the policy contain discretionary language? ... [3] Are the benefits taxable? ... [4] What is the definition of disability? ... [5] What is the elimination period? ... [6] What are the limitations and exclusions?"

ERISA Ruling Rightly Addresses Civil Procedure Hurdle

"[I]nstead of plenary hearings, ERISA claims are mostly conducted as record review proceedings. That means courts generally disallow the introduction of any evidence not previously introduced during the claim process. On July 29, a federal appellate court ruled that a district court's preclusion of additional evidence proffered by the plaintiff in an ERISA benefits case was erroneous." [Harris v. The Lincoln National Life Ins. Co., No. 21-13186 (11th Cir. Jul. 29, 2022)]

District Court Judge Rebukes Administrators of NFL Players' Disability Plan After De Novo Trial

"A federal judge ... issued in June a stinging indictment of the disability benefit plan that covers both active and former football players who become permanently and totally disabled due to injuries sustained during their professional football playing careers.... The court's opinion cited other decisions involving the plan and former football players, which the court maintained showed a pattern as to how players are treated by the plan." [Cloud v. The Bert Bell/Pete Rozelle NFL Player Retirement Plan, No. 20-1277 (N.D. Tex. Jun. 21, 2022)]

Claiming Disability Benefits for Fibromyalgia

"[It] is common for severe pain, fatigue, and/or fibro fog to prevent an individual with fibromyalgia from working on a consistent basis. You should submit a claim for long-term disability benefits if you are unable to perform the duties of your job due to any combination of those symptoms. However, it can be an uphill battle proving that your fibromyalgia symptoms prevent you from performing your job."

Second Circuit Ruling Highlights ERISA Claim Procedure Deadlines

"While the court ... acknowledged that administrators are entitled to flexibility in administering benefits, the Second Circuit concluded the need for flexibility cannot outweigh the purpose of the regulation to limit the number of appeals a claimant must pursue. Hence, the court determined that Hartford was obligated to decide McQuillin's entitlement to benefits within 45 days of his appeal submission, and the failure to do so rendered the duty to appeal exhausted after 45 days elapsed without a benefit determination." [McQuillin v. Hartford Life and Accident Ins. Co., No. 21-1514 (2d Cir. Jun. 7, 2022)]

Eighth Circuit Ruling Shows Lax Enrollment Practices Can Be Costly

"The court expressed concern about the legal consequence of Reliance's acceptance of Skelton's premium payments, pointing out that it had told Skelton she would not have to pay premiums until the coverage was approved, yet Reliance 'then took her premiums without approving her application -- profiting on its broken promise.' ... [T]he Eighth Circuit sent a powerful message to ERISA fiduciaries that they need to maintain strict procedures and guidelines in administering benefits, and that sloppiness or negligence will be punished." [Skelton v. Radisson Hotel Bloomington, No. 21-2641 (8th Cir. May 6, 2022)]

Fourth Circuit ERISA Ruling Shows Plan Discretion Is Not Limitless

"A doctor's opinion relied on by the plan that was not based on a full review of the relevant evidence was viewed by the court as neither principled nor reasoned.... [T]he plan's imposition of an absolute requirement that all conservative treatments must be exhausted before approving surgery was also considered an abuse of discretion.... Finally, ... [an] abuse of discretion may exist when the benefit determination is inconsistent with the purpose of the plan." [Garner v. Cent. States, SE & SW Areas Health & Welfare Fund Active Plan, No. 21-1602 (4th Cir. Apr. 20, 2022)]