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Author: Roy Harmon

Author: Roy Harmon

Home Articles posted by Roy Harmon

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

Roy Harmon Preemption / Stop Loss / Uncategorized March 10, 2021 July 9, 2021

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, …

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

:: Workers’ Compensation Settlements Vulnerable To Recoupment

Roy Harmon Uncategorized March 10, 2021 July 11, 2021

While the Court is not unsympathetic to Defendants, it recognizes that the Fund has a fiduciary responsibility to enforce its lien on the proceeds of Defendants’ workers’ compensation settlements in order maintain the solvency of …

Read more":: Workers’ Compensation Settlements Vulnerable To Recoupment"

:: Refund Requests Prove Shortest Route To Group Health Plan Reimbursement

Roy Harmon Uncategorized March 10, 2021 July 11, 2021

Plaintiff relies on a provision titled, “Third-Party Liability (Subrogation)” but Premera is not asserting subrogation rights. Premera might have asserted subrogation rights if Allied had not paid the PIP benefit, but Allied did so. Nor …

Read more":: Refund Requests Prove Shortest Route To Group Health Plan Reimbursement"

:: Fourth Circuit Rejects Argument That Plan Implicitly Conferred Discretionary Authority

Roy Harmon Uncategorized March 10, 2021 March 10, 2021

Firestone Tire & Rubber Co. v. Bruch, 489 U.S. 101 (1989), establishes the principle that courts review de novo an ERISA benefits determination unless the plan confers discretionary authority on its administrator. In this case …

Read more":: Fourth Circuit Rejects Argument That Plan Implicitly Conferred Discretionary Authority"

:: Assignment Of Benefits Does Not Preclude Provider From Suing On State Law Theories

Roy Harmon Uncategorized March 10, 2021 March 10, 2021

No case has been brought to the attention of this Court holding that a health care provider loses its ability to sue for damages in state court when they also request medical bill payment under …

Read more":: Assignment Of Benefits Does Not Preclude Provider From Suing On State Law Theories"

:: Arbitration Of ERISA Claims Proves Expensive Dispute Resolution Alternative

Roy Harmon Uncategorized March 10, 2021 March 10, 2021

The question before the court is whether the arbitration panel manifestly disregarded the law when it awarded Plaintiff almost $ 4 million in damages. Since the Panel provided no written findings on which it based …

Read more":: Arbitration Of ERISA Claims Proves Expensive Dispute Resolution Alternative"

:: Revisiting The Concept Of Standing As A Defense To ERISA Actions After LaRue

Roy Harmon Uncategorized March 10, 2021 March 10, 2021

Finally, we should note that while the LaRue Court only decided statutory standing in its opinion, it did not ignore constitutional standing, nor could it have ruled on statutory standing had the requirements of constitutional …

Read more":: Revisiting The Concept Of Standing As A Defense To ERISA Actions After LaRue"

:: MetLife Decision Handed Down – Supreme Court Affirms The Sixth Circuit

Roy Harmon Uncategorized March 10, 2021 March 10, 2021

SCOTUSBLOG has announced that the Supreme Court has released the opinion in MetLife v. Glenn(06-923).  The key issue before the Court in that case was whether the fact that a claim administrator of an ERISA …

Read more":: MetLife Decision Handed Down – Supreme Court Affirms The Sixth Circuit"

:: Active At Work Issue Resolved Against Health Insurer In $650,000 Benefit Dispute

Roy Harmon Uncategorized March 10, 2021 March 10, 2021

If a health insurer issues coverage to an employer group, stipulating that coverage is available to employees regularly working 30 hours per week, who may decide whether an employee meets the eligibility requirement – the …

Read more":: Active At Work Issue Resolved Against Health Insurer In $650,000 Benefit Dispute"

:: Seventh Circuit Holds That Sereboff Supports Disability Carrier’s Counterclaim

Roy Harmon Regulatory / Uncategorized March 10, 2021 March 10, 2021

Although Standard’s plan does not use the word “discretion,” it uses a variety of equivalent terms that convey the same meaning. See supra (”full and exclusive authority to control and manage, . . . to …

Read more":: Seventh Circuit Holds That Sereboff Supports Disability Carrier’s Counterclaim"

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