Sarah J. Delaney, Author at The Insurance & Reinsurance Report

Several thousand New Yorkers are receiving unexpected checks in the mail due to an investigation by the New York State Department of Financial Services (DFS) into life insurance claims practices. According to a DFS press release, regulators started investigating these practices in July 2011. Regulators found that insurers did not pay out life insurance benefits unless the beneficiary made a claim on the policy. The problem is this practice only works if the beneficiary actually knows that he, she, (or it) is a beneficiary. …

January 22, 2013 Life, Health, Disability & ERISA

Federal Government’s 95 Percent Rule Relaxes ACA Requirements

Federal Register, Proposed Rulemaking, 26 CFR Parts 1, 54 and 301
In a proposed rulemaking, the Department of the Treasury and the Internal Revenue Service (IRS) recognized a “margin of error” in proposing a 95 percent mandate for large employers in providing medical benefits to employees. The intention is to create leeway for oversights, inadvertent errors, and unique circumstances allowing the employer protection from financial penalties in these instances. In order to extend this flexibility to the smaller “large employers” (those with 50 or more …

January 7, 2013 Life, Health, Disability & ERISA

Doctor’s Loss of License Qualifies as Disability Resulting From Sickness

Jacobs v. Northwestern Mutual Life Ins. Co.

N.Y. App. Div., 2d Dept. (Dec. 19, 2012)

The insured, a plastic surgeon, had his medical license suspended on the grounds that his continued practice constituted an imminent danger to the health of the people of this state. Shortly thereafter, the insured filed claims under his disability insurance policies claiming that mental illness and drug addition before the suspension rendered him unable to perform his duties. The insurer denied the claims citing the plaintiff’s continued practice until the

January 3, 2013 Life, Health, Disability & ERISA

Federal Judge Remands Prudential Suit Against JP Morgan to New Jersey State Court

The Prudential Insurance Company Of America ET AL. v. J.P. Morgan Securities LLC et al.;
(2:12-cv-03489 U.S. District Court for the District of New Jersey)
In April of 2012, the Prudential Insurance Company of America (the plaintiffs) filed suit against the J.P Morgan Securities, LLC, (the defendants) in New Jersey state court, claiming that the defendants made false statements and other misrepresentations in connection with $523 million in Residential Mortgage-Backed Securities (RMBS) purchased by Prudential between 2005 and 2007. The defendants moved to remove the …

November 26, 2012 Life, Health, Disability & ERISA

Supreme Court Wont Hear Employee’s ERISA Claims Over ‘Prudent’ Investments in Company Stock

Fisher v. JP Morgan Chase & Co.
U.S.Sup.Ct.(2d Cir.) Nov. 13, 2012

The plaintiff’s ERISA claims in this action involved allegations that (1) the employer and director defendants negligently permitted plan participants to purchase and hold shares of JP Morgan common stock when it was imprudent to do so; (2) defendants failed to disclose and negligently misrepresented material facts to Plan participants; and (3) JP Morgan and the director defendants failed to appoint appropriate fiduciaries, monitor those fiduciaries, and supply them with the information necessary …

October 30, 2012 Life, Health, Disability & ERISA

Blue Shield California Seeks Supreme Court Review on ERISA Waiver

Blue Shield of California v. Harlick
Petition for Writ of Cert from U.S. Ct. Apps. 9th Cir., (filed Oct. 10, 2012)

The Petition for Cert comes after the Ninth Circuits ruling that barred Blue Shield from considering on remand whether the plaintiff’s services were medically necessary. The court held that the ERISA plan had waived its right to conduct an investigation and to potentially make the medically necessary determination because it did not identify those specific grounds in its initial denial. Under this ruling, the …

July 3, 2012 Uncategorized