ERISA Archives - The Insurance & Reinsurance Report

February 5, 2015 Life, Health, Disability & ERISA

Abuse of Discretion Where Insurer Failed to Consider “Similar Income” Requirement

George v. Reliance Std. Life Ins. Co.
5th Cir., Jan. 15, 2015

In the appeal of an ERISA disability benefits denial, the Fifth Circuit found an abuse of discretion where the insurer failed to consider the “similar income” provision. The insurer had found in its investigation that the claimant was not totally disabled under the policy as there were sedentary jobs for which the insured was able to perform. What the court found lacking, was any discussion of whether the sedentary jobs the insurer found …

September 16, 2014 Life, Health, Disability & ERISA

Cigna Has Continued its Battle for Coverage of ERISA Class Action

Cigna has continued its fight for coverage again urging the Pennsylvania Superior Court to overturn a decision that let its excess insurers off the hook over an ERISA class action brought by the company’s employees. The dispute centers on changes to the benefit plan, which U.S. District Judge Janet Arterton’s 2012 decision found had been fraudulently altered. Cigna argues that this finding does not qualify as a fact finding, and that the fraud exemption was inaccurately applied.

Cigna’s argument has been that the finding relied …

July 2, 2014 Life, Health, Disability & ERISA

Second Circuit: ERISA Claims Raise Reasonable Possibility of Negligence, Trigger Duty to Defend Under EBL Coverage

The plaintiff’s complaint in the underlying action alleged that she had been sexually harassed by a senior executive of the insured and that, when she confronted him about his conduct, she had been wrongfully terminated and coerced into accepting an independent contractor position that disqualified her from receiving certain employee benefits. The insured tendered the defense of the underlying action to the CGL carrier who disclaimed coverage. The underlying action was subsequently settled and the insured then filed a declaratory judgment action seeking defense and …

April 2, 2014 Life, Health, Disability & ERISA

First Circuit: Statute Of Limitations Does Not Apply Separately For Each LTD Benefit Payment

In a recent ERISA disability benefits case, the First Circuit answered the following questions involving a claim for the underpayment of monthly benefits: 1) when does the underpayment claim accrue?; and 2) does each new monthly underpayment give rise to a new claim?

In this case, the LTD claim was approved, but the insurer denied the claimant’s assertion that the benefits amount was inaccurate. Ordinarily, a cause of action for ERISA benefits accrues when a fiduciary denies a participant benefits. In this case, benefits were …

October 28, 2013 Life, Health, Disability & ERISA

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 …

July 31, 2013 Life, Health, Disability & ERISA

7th Circuit Affirms Dismissal of Chiropractic Care Copay Suit

Larson v. United Healthcare Ins. Co.
U.S. Ct. Apps. for the 7^th 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), …

June 19, 2013 Life, Health, Disability & ERISA

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 …