Uncategorized

:: Exhaustion Of Administrative Remedies Defense Precludes Judicial Review

Defendant seeks dismissal of the action. As the Third Circuit has noted, this should not be a “surprising result” for ERISA plaintiffs who “decide to bring a federal suit rather than pursuing administrative remedies.” D’Amico v. CBS Corp., 297 F.3d 287, 293 (3d Cir.2002). Accordingly, I grant Defendant’s motion for judgment on the pleadings dismissing …

:: Exhaustion Of Administrative Remedies Defense Precludes Judicial Review Read More »

:: Update To ERISA Toolkit

On the standard of review – a new checklist. This is added to the ERISA Toolkit page. _____________________________________________________________________The proper standard of review to be applied in judicial review of a plan administrator’s decision varies depending on venue. Nor are the Courts all persuaded that the issues have been well decided. As noted by a panel …

:: Update To ERISA Toolkit Read More »

:: Additional Class Certifications In Fed Ex Employment Practices Litigation

18. In Cause No. 3:05-CV-668 [South Carolina], the court GRANTS IN PART the plaintiffs’ motion for class certification [doc. # 578] and certifies the following class under Federal Rule of Civil Procedure 23(b)(2) for purposes of the plaintiffs’claims for unlawful wage deductions, S.C. CODE ANN. § 41-10-40, rescission and unjust enrichment, and declaratory relief: All …

:: Additional Class Certifications In Fed Ex Employment Practices Litigation Read More »

:: The Myth Of the “Partially Self-Insured” Group Health Plan

Dewitt and her husband, Anthony, were covered under Proctor’s health insurance plan. Throughout Dewitt’s tenure at Proctor, Anthony suffered from prostate cancer and received expensive medical care. His covered medical expenses were paid by Proctor, which was partially self-insured. It paid for members’ covered medical costs up to $250,000 per year. Anything above this “stop-loss” …

:: The Myth Of the “Partially Self-Insured” Group Health Plan Read More »

:: The Shank Case In Retrospect

The issue lit up the blogosphere as commentators denounced Wal-Mart. Earlier this week, Wal-Mart announced it would drop its effort to collect and would change its policy regarding subrogation to allow for exceptions. Tara Parker-Pope notes the public relations punishment that can be delivered via the blogosphere. The fact is, the major media outlets keep …

:: The Shank Case In Retrospect Read More »

:: Stop Loss Carrier Averts ERISA Preemption In Dispute Over “Fronted” Claims Reimbursement

More specifically, the sole issue we decide in this appeal is whether ERISA preempts a state law breach of contract claim and an alternatively pled state law unjust enrichment claim brought by a third-party company hired to perform only non-discretionary administrative services, under the self-funded portion of an employee health care benefit plan covered by …

:: Stop Loss Carrier Averts ERISA Preemption In Dispute Over “Fronted” Claims Reimbursement Read More »

:: No Statutory Penalty For Failure To Supply Requested Benefit Claims Forms

he administrator shall, upon written request of any participant or beneficiary, furnish a copy of the latest updated summary plan description, plan description, and the latest annual report, any terminal report, the bargaining agreement, trust agreement, contract, or other instruments under which the plan is established or operated. 29 U.S.C. § 1024(b)(4) Ejusdem generis – …

:: No Statutory Penalty For Failure To Supply Requested Benefit Claims Forms Read More »

:: OIG Announces Changes In Health Care Provider Self-Disclosure Protocol

o improve the disclosure process, we have concluded that the initial submission must contain the following information: (1) a complete description ofthe conduct being disclosed; (2) a description ofthe provider’s internal investigation or a commitment regarding when it wil be completed; (3) an estimate of the damages to the Federal health care programs ànd the …

:: OIG Announces Changes In Health Care Provider Self-Disclosure Protocol Read More »