This week in our blog series on best practices in administering benefit claims, we discuss the importance of knowing and, importantly, understanding the laws governing benefit claim administration.
Section 503 of ERISA...more
Our blog series on best practices in administering benefit claims has thus far stressed the importance of knowing and reading the plan document and summary plan description. This week, we take a look at a plan term that has...more
Last week, we kicked off our blog series on the fundamentals of benefit claim administration with an explanation of how important it is to know and read your plan document. The plan document is the legally binding contract...more
In this edition of our Newsletter, we take a look at a pair of cases that, while unrelated, together remind us of the importance of having clear plan rules in place that reflect the plan sponsor’s intention. The first article...more
10/11/2019
/ 401k ,
403(b) Plans ,
Affordable Care Act ,
Benefit Plan Sponsors ,
Breach of Duty ,
Class Action ,
Employee Benefits ,
Employee Retirement Income Security Act (ERISA) ,
Employer Group Health Plans ,
Fiduciary Duty ,
Foreign Nationals ,
Hardship Distributions ,
Health Insurance ,
IRS ,
Mental Health Parity Rule ,
Multiemployer Pension Plan Amendments Act (MPPAA) ,
Pensions ,
Retirement Plan ,
Safe Harbors ,
Standing ,
Statute of Limitations ,
Withdrawal Liability
Our ERISA Practice Center blog posts often discuss many complex, and sometimes esoteric, substantive and procedural ERISA issues, as well as related agency guidance and case law. In this new ten-part blog series, however, we...more
ERISA health care plans typically include reimbursement and subrogation clauses, which give plans a right to reimbursement of medical expenses paid on behalf of a beneficiary where the injury is caused by a third party. While...more
10/2/2019
/ Benefit Plan Sponsors ,
Employee Benefits ,
Employee Retirement Income Security Act (ERISA) ,
Employer Group Health Plans ,
Employer Liability Issues ,
Insurance Risk Pool ,
Jurisdiction ,
Medical Expenses ,
Medical Reimbursement ,
Preemption ,
Savings Clause ,
State Law Claims ,
Subrogation
The Third Circuit recently held that anti-assignment clauses in ERISA-governed healthcare plans are enforceable as long as they are unambiguous. The Court concluded that the anti-assignment clause clearly stated that...more
Over the past several years, the ERISA plaintiffs’ bar has targeted university-sponsored 403(b) plans, arguing that the plan fiduciaries breached their fiduciary duties and engaged in prohibited transactions in connection...more
Editor's Overview -
We often talk about the importance of evaluating whether there are any procedural obstacles to plaintiffs pursuing their ERISA claims, particularly in complex, class actions where it may not be...more
4/3/2019
/ Administrative Remedies ,
Article III ,
Breach of Duty ,
Defined Contribution Plans ,
Discovery ,
Electronically Stored Information ,
Employee Benefits ,
Employee Retirement Income Security Act (ERISA) ,
Fiduciary Duty ,
Financial Harm ,
Injury-in-Fact ,
IRS ,
Notice Requirements ,
Standard of Review ,
Standing
As we closed the door on 2018, we were met by two surprising decisions—one from a panel of the Second Circuit addressing employer stock drop litigation, and one from a federal district court in Texas declaring the entire...more
1/11/2019
/ 403(b) Plans ,
Affordable Care Act ,
Amgen v Harris ,
Breach of Duty ,
Constitutional Challenges ,
Disclosure Requirements ,
Employee Benefits ,
Employee Retirement Income Security Act (ERISA) ,
FIfth Third Bancorp v Dudenhoeffer ,
Hardship Distributions ,
Health Insurance ,
IRS ,
Plan Administrators ,
Proposed Regulation ,
Section 409A ,
Securities and Exchange Commission (SEC) ,
Stock Drop Litigation ,
Tax Cuts and Jobs Act
Editor's Overview -
In last quarter's Newsletter, we commented that all eyes were on President Trump's nomination to the U.S. Supreme Court, as the outcome of the appointment process can have a significant impact on the...more
10/3/2018
/ 401k ,
403(b) Plans ,
Attorney's Fees ,
Discovery ,
Electronically Stored Information ,
Employee Benefits ,
Employee Retirement Income Security Act (ERISA) ,
Federal Rules of Civil Procedure ,
Fiduciary Duty ,
Fiduciary Rule ,
FRCP 26(b)(1) ,
Preemption ,
Recordkeeping Requirements ,
Retirement Plan ,
Standing
As we head into the thick of summer, all eyes are on President Trump's nomination to the U.S. Supreme Court to replace retiring Justice Anthony Kennedy and the impact the new Justice will have on shaping the law for...more
7/11/2018
/ 21st Century Cures Act ,
401k ,
403(b) Plans ,
Beneficiaries ,
Bi-Partison Balanced Budget Act (BBA) ,
Breach of Duty ,
Clawbacks ,
Department of Labor (DOL) ,
Employee Benefits ,
Employee Retirement Income Security Act (ERISA) ,
Fiduciary Duty ,
Fiduciary Rule ,
HDHP ,
Health Care Providers ,
Health Savings Accounts ,
Investment Adviser ,
Investment Management ,
IRS ,
MHPAEA ,
Murder ,
Plan Administrators ,
Preemption ,
Prescription Drugs ,
Retirement Plan ,
Slayer Statutes
Despite the change in seasons, there appears to be no change in the pace of complex and class action ERISA litigation. Investments in defined contribution plans—both 401(k) and 403(b) plans—continue to be the leading target...more
4/11/2018
/ 401k ,
Affordable Care Act ,
Benefit Plan Sponsors ,
Bi-Partison Balanced Budget Act (BBA) ,
Books & Records ,
Breach of Duty ,
Cadillac Tax ,
Department of Labor (DOL) ,
Disability Benefits ,
Employee Benefits ,
Employee Retirement Income Security Act (ERISA) ,
Excessive Fees ,
Executive Compensation ,
Fiduciary Duty ,
Fiduciary Rule ,
Hardship Distributions ,
Investment Adviser ,
IRS ,
Multiemployer Pension Plan Amendments Act (MPPAA) ,
Mutual Funds ,
National Association for Fixed Annuities (NAFA) ,
Retirement Plan ,
Self-Dealing ,
Standing
On March 23, 2018, the National Association for Fixed Annuities (“NAFA”) and the Department of Labor filed a Joint Stipulation of Dismissal of litigation involving the Department’s fiduciary rule in the District of Columbia...more
In an opinion released yesterday, the Supreme Court reaffirmed that collective bargaining agreements (CBAs) must be interpreted according to “ordinary principles of contract law.” CNH Industrial N.V. v. Reese, No. 17-515,...more
Editor's Overview -
For over two decades, federal law has required covered health plans and insurers to ensure that certain mental health benefits are in parity with offered medical/surgical benefits. The meaning of...more
1/9/2018
/ 401k ,
Affordable Care Act ,
Attorney's Fees ,
Benefit Plan Sponsors ,
Claim Procedures ,
Compensation & Benefits ,
Cost-Sharing ,
Deferred Compensation ,
Department of Health and Human Services (HHS) ,
Department of Labor (DOL) ,
Disability ,
Disability Benefits ,
Employee Benefits ,
Employee Retirement Income Security Act (ERISA) ,
Enforcement Actions ,
Fiduciary Duty ,
Health Savings Accounts ,
Healthcare Facilities ,
Healthcare Reform ,
Income Taxes ,
Individual Retirement Account (IRA) ,
Mental Health ,
Mental Health Parity Rule ,
MHPAEA ,
Public Health Service Act ,
QMAC ,
QNEC ,
Securities and Exchange Commission (SEC) ,
Sexual Harassment ,
Shared Responsibility Rule ,
Statute of Repose ,
Tax Deductions ,
Tax Reform ,
User Fees
Editor's Overview - As we have observed on other occasions, the ERISA class action plaintiffs' bar has, for several years now, honed in on 401(k) plan fiduciaries and their decisions to select and retain investment options...more
10/4/2017
/ 401k ,
403(b) Plans ,
AARP ,
Affordable Care Act ,
Breach of Duty ,
Class Action ,
Delays ,
Department of Labor (DOL) ,
Disability Benefits ,
Disclosure Requirements ,
Employee Benefits ,
Employee Retirement Income Security Act (ERISA) ,
Employer Mandates ,
Equal Employment Opportunity Commission (EEOC) ,
Excessive Fees ,
Executive Orders ,
Federal Rules of Civil Procedure ,
Fiduciary Duty ,
Fiduciary Rule ,
Form 5500 ,
GINA ,
Hardship Distributions ,
Health Insurance Portability and Accountability Act (HIPAA) ,
Healthcare Reform ,
Hurricane Harvey ,
Individual Retirement Account (IRA) ,
Investors ,
IRS ,
Motion to Dismiss ,
OMB ,
PBGC ,
Pensions ,
Preventive Health Care ,
Principal Transaction Exemption ,
Retirement Plan ,
Self-Dealing ,
Twombly/Iqbal Pleading Standard ,
Universities ,
Wellness Programs
On March 1, 2017, the U.S. Department of Labor proposed a 60-day delay of the conflict of interest rule and related exemptions (currently set to be applicable on April 10, 2017). The Department opened two comment periods...more
On March 1, 2017, the U.S. Department of Labor proposed a 60-day delay of the conflict of interest rule and related exemptions (currently set to be applicable on April 10, 2017). The Department opened two comment periods...more
On February 17, 2017, a federal district Court in Kansas upheld the U.S. Department of Labor’s conflict of interest rule and related exemptions in a suit brought by Market Synergy Group, Inc. This ruling on the merits follows...more
2/24/2017
/ Administrative Procedure Act ,
Best Interest Contract Exemptions ,
Conflicts of Interest ,
Department of Labor (DOL) ,
Employee Benefits ,
Employee Retirement Income Security Act (ERISA) ,
Fiduciary Duty ,
Fiduciary Rule ,
Financial Adviser ,
Investment Adviser ,
OMB ,
Retirement ,
Retirement Plan ,
Trump Administration
There were two key developments last week concerning the ongoing challenges to the U.S. Department of Labor (USDOL) conflict of interest rule and related exemptions: a Presidential Memorandum calling for a review of the...more
Editor’s Overview -
In 2016, we saw a considerable uptick in the number and variety of excessive fee lawsuits commenced against plan fiduciaries of defined contribution plans. We begin the year by taking a look at these...more
1/31/2017
/ 401k ,
403(b) Plans ,
AARP ,
Americans with Disabilities Act (ADA) ,
Benefit Plan Sponsors ,
Breach of Duty ,
Class Action ,
Collective Bargaining ,
Defined Contribution Plans ,
Dismissals ,
Employee Benefits ,
Employee Retirement Income Security Act (ERISA) ,
Employer Group Health Plans ,
Equal Employment Opportunity Commission (EEOC) ,
Excessive Fees ,
Fiduciary Duty ,
Financial Adviser ,
GINA ,
Investment Funds ,
Irreparable Harm ,
Lifetime Health Benefits ,
Preliminary Injunctions ,
Reservation of Rights ,
Retirement ,
Retirement Plan ,
Revenue Sharing ,
Self-Dealing ,
Unions ,
Vesting ,
Wellness Programs
This month Richard Zall, Chair of Proskauer's Health Care Department, explores developments likely to occur with respect to the Affordable Care Act as a result of the new administration. In our Rulings, Filings and...more
12/21/2016
/ 21st Century Cures Act ,
Affordable Care Act ,
CEOs ,
CMMI ,
Conflicts of Interest ,
Department of Labor (DOL) ,
Employee Benefits ,
Employee Retirement Income Security Act (ERISA) ,
Employer Group Health Plans ,
Fiduciary Rule ,
Flexible Spending Accounts ,
Food and Drug Administration (FDA) ,
Health Insurance ,
Health Insurance Exchanges ,
Health Savings Accounts ,
Individual Mandate ,
Local Ordinance ,
Medicaid ,
Medical Devices ,
Medicare ,
Medicare Advantage ,
Pay Ratio ,
Pay Ratio Tax ,
Payroll Taxes ,
Pharmaceutical Industry ,
Preliminary Injunctions ,
Qualified Small Employer Health Reimbursement Plan (QSEHRAs) ,
Repeal ,
Subsidies ,
Tax Credits ,
Trump Administration
On December 15, 2016, the U.S. Court of Appeals for the District of Columbia Circuit denied the emergency request from the National Association for Fixed Annuities (“NAFA”) for an injunction blocking the implementation of the...more
On November 28, 2016, Judge Crabtree in the U.S. District Court for the District of Kansas ruled in favor of the U.S. Department of Labor and denied the motion for a preliminary injunction filed by the Market Synergy Group,...more