Preemption

: : Seventh Circuit Uses “Dual Hat” Versus “Single Hat” Analysis To Decide State Law Preemption Issues

“The exclusive benefit rule is a cornerstone of ERISA that state law cannot dilute. While ERISA narrowly contemplates parallel liability against the dual-hat director and officer defendants, it preempts further aiding and abetting liability that would impose additional duties on Argent and Stout beyond their exclusive ERISA obligations.” Halperin v. Richards No. 20-2793 (July 28, …

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: : State Law Banning Discretionary Language Saved from ERISA Preemption

Research revealed no relevant case law addressing Oregon’s specific regulation. However, several circuits, including the Ninth, Seventh, and Sixth Circuit Courts of Appeals, have held that similar state bans on discretionary language in ERISA plans are not preempted. See Standard Ins. Co. v. Morrison, 584 F.3d 837, 846-47 (9th Cir. 2009)…Adams v. United of Omaha …

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: : Disability Policy Offered By Employer Determined To Be Governed By State Law

ERISA preempts state law that “relate[s] to any employee benefit plan.”[2] 29 U.S.C. § 1144(a). Plaintiff asserts his claims under a disability policy that, according to Plaintiff, is not subject to ERISA regulation. . . . The undisputed facts establish that DLL&R requested the removal of Plaintiff’s policy from the FlexBill, Defendant sent Plaintiff a …

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: : Nationwide Class Action Discovery Permitted Against LTD Carrier In Recoupment Dispute

“[T]he only issue before the Court is whether discovery regarding potential class members outside of the state of Pennsylvania is relevant to Plaintiff’s claims under ERISA. Aetna argues that this discovery is irrelevant because Plaintiff’s asserts claims only under state law.  But Aetna misconstrues the allegations in the second amended complaint, which clearly assert that …

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: : Court Remands Insurer’s Recoupment Claims Against Provider to State Court Applying Davila Test

Here, plaintiff seeks damages in the amount of $226,562.62, which it contends make up the unpaid balance of overpayments to Dr. Gupta. BCBSLA’s complaint does not seek a constructive trust or an equitable lien on particular funds. Rather, it seeks to recover from Dr. Gupta’s assets generally. Thus, the Court finds that plaintiff’s claims are …

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:: 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” …

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:: Sixth Circuit Applies Trilogy Of Supreme Court ERISA Cases In Upholding State Law

Far from announcing a brave new line for ascertaining ERISA preemption, the post-1997 cases show only a willingness to place more emphasis on the presumption against preemption and on the underlying purposes of the ERISA statute–both of which give the States wider, but hardly unreviewable, berth in regulating the area. The last thing, indeed, that …

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:: District Court Adopts Agency Principles Deeming Employer Agent Of Insurance Carrier

n Ward v. Management Analysis Co. Employee Disability Benefit Plan, the Ninth Circuit cited with approval a decision under California law finding an agency relationship where an employer administers a group insurance policy while under the control and direction of the insurer. According to the Elfstrom rule, a dispositive factor is proof that the employer …

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:: ERISA Plan Stands Down In “Overpayments” Dispute With Providers

ollowing an outcry from physicians and discussions with the Medical Assn. of Georgia, one of Atlanta’s largest employers has temporarily halted work by a company it hired to seek supposed overpayments from doctors. Earlier this year, Georgia-Pacific authorized Franklin, Tenn.-based Health Research Insights to send 1,100 letters to doctors in Atlanta, Savannah, Ga., and Brunswick, …

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