Life, Health, Disability & ERISA Archives - Page 2 of 10

Logical Construction: Federal Court Relies on Practical Considerations in Finding No Coverage for Lost Future Earnings

In 3M Co. v. National Union Fire Insurance Co., 2015 U.S. Dist. LEXIS 131197 (D. Minn., September 28, 2015) a federal judge for the District of Minnesota determined that a policyholder was not entitled to coverage for earnings on its investment in a trading company engaged in a Ponzi scheme because it did not own the earnings.

The policyholder invested its employee-benefit plan assets in the trading company. The investment took the form of a limited partnership in the trading company. In 2009, …

October 20, 2015 Life, Health, Disability & ERISA

Recent Court Decisions Show Fight Over ACA is Alive and Well

The battle over the Affordable Care Act (ACA) is heating up again with two recent high-profile decisions. In the first case, the U.S. House of Representatives as an institution sued the executive branch over actions taken by the executive during the implementation of the ACA. This case is unique because it addresses the broader question of whether the legislative branch has the authority to sue the executive branch over how the executive implements statutes.

In U.S. House of Representatives v. Burwell, the U.S. House …

October 7, 2015 Life, Health, Disability & ERISA

Emotions Set Aside: Widow Denied Husband’s Life Insurance Benefits For Failure to Report Change in Health After Application

The case of Yafei Huang v. Life Insurance Co. of North America, in the U.S. Court of Appeals for the Eighth Circuit dealt with the denial of life insurance benefits — and is a strong reminder to consumers to read the fine print.

On November 12, 2009, Ping Liu elected basic life insurance coverage from Life Insurance Company of North America (LINA) through his employers ERISA plan in the amount of his yearly salary. Liu also elected to get supplemental coverage in the amount …

September 8, 2015 Life, Health, Disability & ERISA

Sixth Circuit: SPD is Binding Plan Document, Subrogation Clause Enforceable

The central question in this appeal before the Sixth Circuit was whether the summary plan description (SPD) — the only document in the record that contained a subrogation provision — was a binding plan document with enforceable terms.

In this case, Bd. of Trs. v. Moore, U.S. Ct. Apps., Sixth Cir., Aug. 25, 2015, there was a Trust Agreement that authorized the Board of Trustees to adopt a written welfare benefits plan, to administer the plan, and to act as plan fiduciary. Central to the …

September 2, 2015 Life, Health, Disability & ERISA

Money Trouble: Some Health Insurance CO-OPs in Financial Trouble

Much of the focus on health insurers under the Affordable Care Act (ACA) has centered on larger health insurance companies. In an effort to expand the number of health plans available to the public, the ACA also created the Consumer Operated and Oriented Plan (CO-OP) Program. The program is administered by the Centers for Medicare and Medicaid Services (CMS) at the Department of Health and Human Services (HHS). The ACA further directed HHS to make loans to these CO-OPs to assist with their establishment and …

August 4, 2015 Life, Health, Disability & ERISA / Regulatory

GAO Statement Highlights Deficiencies in Federal Exchange Enrollment Process

On July 16, 2015, the Government Accountability Office issued a written statement entitled “Patient Protection and Affordable Care Act: Observations of 18 Undercover Tests of Enrollment Controls for Health-Care Coverage and Consumer Subsidies Provided under the Act.” This statement contained the findings of “undercover testing of the [Exchange] application, enrollment, and eligibility verification controls using 18 fictitious identities” that GAO submitted or attempted to submit through the Exchange in several states in a variety of ways.

Testing began in January 2014 before the …

July 23, 2015 Life, Health, Disability & ERISA

Accommodations for Contraception Coverage Exemptions Replace Subsidies As The ACA Story of the Week

In recent months, the main event in the challenges against the Affordable Care Act centered on the subsidies provisions in the ACA. The Supreme Court decided this matter in King v. Burwell. In July 2015, there were two additional key developments related to the provision requiring employers to provide contraception coverage.

On July 14, 2015, the 10^th Circuit Court of Appeals in Little Sisters of the Poor Home v. Burwell held that the self-certifying procedure in place for religious not-for-profits to take advantage …

July 8, 2015 Life, Health, Disability & ERISA

Timing is Everything: Beneficiary Change Made During Divorce Action in Violation of NY’s Automatic Orders Ineffective

Reliastar Life Ins. Co. of New York v. Cristando, N.Y. App. Div., 2d Dept., June 3, 2015

Under New York law, while the designation of an ex-spouse beneficiary will be subject to automatic revocation in most circumstances, that same change cannot be made during the pendency of the divorce proceeding. The New York Appellate Division affirmed a trial court’s decision, finding such that a wife’s decision to change the beneficiary of her life insurance policy while her divorce was pending violated the “automatic orders” …

June 29, 2015 Life, Health, Disability & ERISA

Eleventh Circuit: Failure to Give Notice of Time Limit to File Action Does Not Render Contractual Limitations Period Unenforceable

In Wilson v. Standard Ins. Co. (U.S. Ct. Apps., 11th Cir.) the claimant filed her lawsuit claiming long term disability benefits thirty-four months after the three-year contractual limitations period. The claimant argued that equitable tolling should apply because the insurer’s denial letter did not give notice of the time limit and therefore was in violation of the ERISA regulations. The Eleventh Circuit found that the “claims procedure” regulation, 29 CFR 2560.503-1(g)(1)(iv), clearly required notice of the administrative review procedures and those time limits, as …

June 25, 2015 Life, Health, Disability & ERISA / Regulatory

SCOTUS: Affordable Care Act Subsidies Apply to Federal Exchanges

On June 25, 2015, in a 6-3 opinion written by Chief Justice John Roberts, the United States Supreme Court held that the subsidies available in the Affordable Care Act apply to participants in both state and federal healthcare exchanges. A key component of the Affordable Care Act (i.e., the part that helps make this insurance affordable) is tax subsidies for those who qualify under the income requirements stated in the Act. Language in this provision, according to the petitioners and the dissent, appeared to limit …