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DOL's Final Rule Modifies ERISA Disability Claim Regulations

"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.' "

Federal District Court Deems Claim for Equitable Relief Appropriate

"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)]

Employee Benefit Plan is Governmental Plan, Even Though Employees are Not

"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."

Eleventh Circuit Joins Fourth Circuit in Rejecting Continuing Breach Approach to ERISA's Statute of Limitation

"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)]

11th Circuit Mandates Proactive Gathering and Review of SSA Information in LTD Claim Review

"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)]

Supreme Court Overturns 4th and 11th Circuit Rule Governing Finality of Judgment

"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)]

District Court in Florida Further Defines Parameters of Medical Provider's Standing to Sue under ERISA

"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]."

District Court Judge Invites the 11th Circuit Court of Appeals to Reverse Him on Benefit Claim Review

"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."

Fourth Circuit Reverses District Court and Trend, Says Death from Driving While Intoxicated Is an 'Accident'

"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.'"

Supreme Court Decision in Mccutchen Leaves 11th Circuit Precedent Unscathed

"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."