Administrators

:: Thorny Issues Presented In Grants Of Discretion To Benefit Administrators

“As an independent, non-fiduciary, third-party administrator, Everest might still be liable . . . if the Geddesses had made claims against Everest individually, distinct from its role as United’s agent. But they did not. Nor did the district court find any basis for personal liability against Everest. For these reasons, the money judgment [on the …

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:: Fourth Circuit Splits With Sixth Circuit On Procedural Violation Remedy

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 …

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:: Disclaimer Shields Claims Administrator From Mispresentation Claims

Tenet alleges that it provided approximately $ 241,000 worth of medical services to Sylvester based on UniCare’s representation that Sylvester was covered under the Plan. . . .  Pursuant to the Managed Care Agreement, UniCare paid Tenet $ 132,827.34, the negotiated payment under the agreement, on July 27, 2005.  On August 5, 2005, Sheltering Arms …

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:: Court Imposes Personal Liability And Attorney Fees On Plan Fiduciary For Breach

Derived from these components, the Sixth Circuit has held that an ERISA fiduciary has a duty to “give complete and accurate information in response to participants’ questions.” Drennan v. Gen. Motors Corp., 977 F.2d 246, 251 (6th Cir. 1992). Furthermore, “misleading communications to plan participants regarding plan administration . . . will support a claim …

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:: Class Actions Suits Alleged Improper Reimbursement Of Out Of Network Providers

I have been reporting the highlights of the Ingenix database controversy which has been at the center of investigation by the New York Attorney General and several significant lawsuits. According to the allegations, the use of a database operated by Ingenix, a subsidiary of United Health Group, has resulted in improper reimbursements of out of …

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