WASHINGTON, D.C. — Arguing in a June 23 respondent brief that the circuit courts of appeal are not split on how to interpret the term “accident” under accidental death and dismemberment (AD&D) policies and “have uniformly answered the question that the law of the transferee court controls in non-diversity cases involving questions of federal law,” an insurer urges the U.S. Supreme Court to deny review of a First Circuit U.S. Court of Appeals decision.
WASHINGTON, D.C. — The U.S. Supreme Court on June 27 denied a multiemployer pension plan’s request to review a ruling regarding withdrawal liability under the Employee Retirement Income Security Act; the request had focused on the dismissal of the plan’s “evade or avoid” withdrawal liability theory and what was considered in “any substantial continuity” analysis.
WASHINGTON, D.C. — In a June 15 petition seeking review of a Colorado Court of Appeals ruling that preemption under the Employee Retirement Income Security Act “extends to post-distribution lawsuits,” the representative of an estate tells the U.S. Supreme Court that the dispute over life insurance plan proceeds represents an opportunity to resolve a circuit split over a question left open by Kennedy v. Plan Administrator for DuPont Savings & Investment Plan.
WASHINGTON, D.C. — The U.S. Supreme Court on June 27 denied a request to review a nonprecedential Second Circuit U.S. Court of Appeals ruling that a health benefits provider and a pharmacy benefits manager (PBM) were not acting as fiduciaries under the Employee Retirement Income Security Act when they set prescription drug prices.
ST. LOUIS — Providing no explanation, the Eighth Circuit U.S. Court of Appeals on June 21 denied a petition for rehearing by an insurer against which a panel upheld a grant of summary judgment in a suit over alleged mishandling of an enrollment for supplemental life insurance; in seeking rehearing, the insurer argued that the ruling is contrary to the circuit’s precedent in Kerns v. Benefit Trust Life Ins. Co.
NEW YORK — A disability insurer did not abuse its discretion in finding that a claimant was not physically disabled from performing the duties of any occupation because substantial medical evidence supports the insurer’s decision and the insurer was not obligated to defer to the opinions of the claimant’s treating physician regarding her ability to work, the Second Circuit U.S. Court of Appeals said June 21.
ST. LOUIS — Rejecting data from Investment Company Institute (ICI) and investment consulting firm NEPC as meaningful benchmarks and ruling that the complaint failed to state a claim, a Missouri federal judge on June 21 granted dismissal of putative class suit that alleged imprudence under the Employee Retirement Income Security Act regarding record-keeping and investment-management fees and one fund in a retirement plan.
CINCINNATI — A Sixth Circuit U.S. Court of Appeals panel on June 21 affirmed dismissal of a putative class suit over fees and actively managed target date funds (TDFs) in a retirement plan, ruling in part that a showing of imprudence does not “come down to simply pointing to a fund with better performance.”
WASHINGTON, D.C. — Reversing and remanding a Sixth Circuit U.S. Court of Appeals decision, a split U.S. Supreme Court on June 21 ruled that “a group health plan that provides limited benefits for outpatient dialysis — but does so uniformly for all plan participants” does not violate the Medicare Secondary Payer Act (MSPA), with a partial dissent by two justices based on outpatient dialysis being “an almost perfect proxy for end stage renal disease.”
CINCINNATI — A district court did not err in determining that a disability insurer was permitted to offset a claimant’s long-term disability (LTD) benefits by the amount of Social Security disability benefits received because the plan clearly allowed the benefits to be offset, the Sixth Circuit U.S. Court of Appeals said June 7.
NEW YORK — Denying a long-pending motion for sanctions or attorney fees in an Employee Retirement Income Security Act case that defendant New York University (NYU) School of Medicine argued was a duplicative lawsuit, a federal magistrate judge in New York on June 8 ruled that filing the suit “was not objectively unreasonable” and that the plaintiffs “did not act in bad faith.”
SAN FRANCISCO — With reprocessing of claims unavailable, a small class involving state-mandated guidelines for mental health coverage lacks remedy, and despite attempts to puff up its importance to Employee Retirement Income Security Act insureds, a panel ruling is largely unremarkable and does not warrant rehearing, an insurer told the Ninth Circuit U.S. Court of Appeals on June 16.
NEW ORLEANS — The Fifth Circuit U.S. Court of Appeals on June 15 affirmed a district court’s ruling that a disability insurer properly denied a claim for long-term disability (LTD) benefits based on the plan’s pre-existing condition exclusion and found no support for the claimant’s argument that the insurer waived its right to assert the pre-existing condition exclusion.
NEW YORK — The Second Circuit U.S. Court of Appeals on June 2 denied a petition by participants in a defined-benefit multiemployer pension plan for panel rehearing or rehearing en banc of a dispute over reinterpretation of “retires.”
CHIGAGO — Parties in a suit over an administrative subpoena by the secretary of Labor have largely agreed on a proposed confidentiality order but disagree on one paragraph pertaining to the secretary providing documents to other government agencies, they told an Illinois federal court in filings dated May 27 and June 13.
NEW YORK — Arguing in a June 10 amicus curiae brief that the appellee’s “right to pursue plan-wide relief may not be prospectively waived,” the U.S. secretary of Labor urges the Second Circuit U.S. Court of Appeals to uphold denial of a motion for individual arbitration in a retirement plan participant’s putative class suit that alleges violations of the Employee Retirement Income Security Act.
DENVER — Seven separate external reviewers explained denial of claims for residential mental health treatments, and allowing review of only a “slice” of the record would “radically change the approach to review of [Employee Retirement Income Security Act] health benefits decisions,” an insurer warns the 10th Circuit U.S. Court of Appeals in a June 10 reply brief.
SEATTLE — A district court did not err in granting judgment in favor of a disability insurer because the claimant failed to meet his burden of proving that he satisfied the disability policy’s 90-day elimination period, the Ninth Circuit U.S. Court of Appeals said June 13.
WASHINGTON, D.C. — The U.S. Supreme Court on June 13 denied a certiorari petition filed by a man who asserted that the case “expands the question” examined in Montanile v. Board of Trustees of Nat. Elevator Industry Health Benefit Plan; the ruling for which he sought review held that a health plan is entitled to seek reimbursement of medical expenses from any recovery he obtains regarding an incident that happened when he was a minor.
BALTIMORE — After a Maryland federal judge cited recent Fourth Circuit U.S. Court of Appeals decision McAdams v. Robinson as cause for concern about the scope of released claims in a proposed settlement agreement, he asked if the parties in the class action over a retirement plan’s hardwiring amendment are willing to alter the terms to clarify that scope; they said yes in a joint June 9 notice including a proposed modified release.