Life, Health, Disability, and ERISA Newsletter is Now Available

Life, Health, Disability, and ERISA provides a summary of decisions from across the country concerning life, health, and disability policies, including those governed by ERISA. Following your review of Life, Health, Disability, and ERISA kindly feel free to contact attorneys and co-editors with any comments you may have, or with any topics you would like to see in upcoming newsletters.

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D.C. Circuit Deals Latest Blow to ACA Contraception Mandate

The court started its opinion by stating “we are asked to revisit the behemoth known as the Affordable Care Act … we must determine whether the contraceptive mandate imposed by the Act trammels the right of free exercise — a right that lies at the core of our constitutional liberties — as protected by the Religious Freedom Restoration Act. We conclude it does.”

“The query is simple: do corporations enjoy the shelter of the Free Exercise Clause? Or is the free-exercise right a ‘purely personal’ …

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Supreme Court Wonders if ERISA Decision in Heimeshoff v. Hartford Will Matter

Oral argument was heard on October 15 in the case of Heimeshoff v. Hartford Life & Acc. Ins. Co.. Briefly, the relevant background of this case is as follows: In August 2005, Heimeshoff filed a claim with Hartford Life & Accident Insurance Co. (Hartford) for long term disability benefits and Hartford denied her claim in December 2005. After retaining counsel and several evaluations by other doctors, Hartford denied Heimeshoff’s claim again in November 2006. Heimeshoff appealed the decision, but Hartford upheld its denial in …

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Caveat Emptor – Let the Buyer Beware of Health Care Phish

Caveat emptor — “Let the buyer beware” is a good rule of thumb for people to keep in mind as they begin to sign up for health insurance under the new exchanges established in accordance with the Affordable Care Act. Law enforcement and security professionals are warning consumers to beware of phishing schemes associated with the new health care exchanges. Insurers and employers alike can assist in this effort by educating consumers and employees on this danger and provide practical suggestions for ensuring that they …

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7th Circuit Affirms Dismissal of Chiropractic Care Copay Suit

Larson v. United Healthcare Ins. Co.
U.S. Ct. Apps. for the 7th Cir.,July 26, 2013
The plaintiffs filed a proposed class action alleging that health insurance companies violated Wisconsin law by requiring copayments for chiropractic care. The insurance code prohibits insurers from excluding coverage for chiropractic services if their policies cover the diagnosis and treatment of the same condition by a physician or osteopath. The complaint cited violations of Employee Retirement Income Security Act for recovery of benefits due, 29 U.S.C. 1132(a)(1)(B) & 502(a)(3), …

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It’s Only Temporary: Employee Hired to Meet Short-Term Workload Conditions on Indefinite Basis Is “Temporary Worker” Under Policy

Central Mut. Ins. Co. v. True Plastics, Inc.
(Mass. Ct. App. July 10, 2013)

A Massachusetts appellate court recently held that the phrase “short-term workload conditions” as used in a liability policy’s definition of “temporary worker” was unambiguous and could include workers hired on an indefinite basis.

The claimant was injured while operating a molding machine at the insured’s plant. The claimant was not an employee of the insured company (a manufacturer of plastic components), but rather had been assigned to work at the insured …

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California Cuts To Rural Healthcare Services Violate Medicaid Act

California Ass’n of Rural Health Clinica; Avenal Community Health Center v. Douglas et al.
United States Court of Appeals for the Ninth Circuit, July 5, 2013

California recently enacted legislation that eliminates coverage for certain healthcare services in under-served rural areas to help curb the State’s budgetary woes. Specifically, the legislation cut coverage for adult dental, podiatry, optometry and chiropractic services in rural areas. The court ruled that eliminating coverage for such programs would be in conflict with the Medicaid Act and that the legislation …

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U.S. Supreme Court Grants Petition to Clarify ERISA Technicality

Ray Haluch Gravel Co., et al., v. Cent. Pension Fund of the Int’l Union of Oper. Eng’rs & Participating Emp’rs, et al., case No. 12-992
Petition Granted June 17, 2013

According to the petition, “[t]he question presented in this case, on which there is an acknowledged conflict among nine circuits, is whether a district court’s decision on the merits that leaves unresolved a request for contractual attorney’s fees is a “final decision” under 28 U.S.C. § 1291.”

The U.S. Supreme Court agreed to hear …

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Seventh Circuit Rules 401K Provider Not a Fiduciary Under ERISA

Leimkuehler v. American United Life Ins. Co.
7th Cir. Apr. 16, 2013

In this case, the practice involved plan participants who invested in mutual funds through a service provider. The use of the service provider allowed the plan participants to indirectly invest in mutual funds by placing their investment into a separate account that was controlled by the service provider. The service provider received revenue sharing payments from the selected mutual funds, for its administrative services.

The plan trustee sued the service provider alleging that …

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