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Employee Benefits Breach of Contract Employee Retirement Income Security Act (ERISA)

Polsinelli

Sixth Circuit Holds TPAs Do Not Get a Free Pass from ERISA’s Fiduciary Duties

Polsinelli on

In a decision about ERISA’s fiduciary duties and transparency, the Sixth Circuit in Tiara Yachts, Inc. v. Blue Cross Blue Shield of Michigan held that Blue Cross Blue Shield of Michigan (BCBSM), a third-party administrator...more

Holland & Knight LLP

Sixth Circuit Reverses Dismissal of ERISA Healthcare Fee Suit Against Third-Party Administrator

Holland & Knight LLP on

There has been a recent rise in Employee Retirement Income Security Act of 1974 (ERISA) litigation against third-party administrators (TPAs) and other service providers challenging their management of self-funded health...more

Keating Muething & Klekamp PLL

Benefits Monthly Minute - March 2025

The March Monthly Minute brings you three recent case updates addressing 401(k) forfeiture utilization, TPA responsibility for recovering self-insured plan’s fraudulently paid claims, and continued PBM litigation in the wake...more

Robinson+Cole ERISA Claim Defense Blog

Ninth and Second Circuit Courts of Appeals Rule that Preauthorization Process Does Not Impose Independent Contractual Liability on...

Within days of one another, the U.S. Court of Appeals for the Ninth and Second Circuits ruled—on issues of first impression for both—that ERISA expressly preempts state law breach of contract and promissory estoppel claims...more

Carlton Fields

Ringmaster’s Review: Fall 2023 Litigation on Parade

Carlton Fields on

In Ross v. Venerable Insurance & Annuity Co., a Missouri appellate court reversed judgment in favor of the named beneficiary of a flexible premium deferred annuity contract. Following the annuitant’s death, the beneficiary...more

Carlton Fields

Expect Focus - Volume III, September 2023

Carlton Fields on

Regulators Hit Jackpot: Off-Channel Communications - Several years before announcing the first “off-channel” communications enforcement action, the SEC and FINRA cautioned broker-dealers and investment advisers about...more

Saul Ewing LLP

The Friday Five: Five Current ERISA Litigation Highlights - April 2022

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This month’s Friday Five covers cases relating to: (1) whether claim administrators can recover overpayments through a breach of contract claim under state law; (2) whether claim administrators can rely solely on a claimant’s...more

Epstein Becker & Green

Third Circuit: Provider’s Out-of-Network Claims not Pre-empted by ERISA

Epstein Becker & Green on

In an important win for healthcare providers, on July 17, 2020, the Third Circuit determined in a published opinion that an out-of-network provider’s direct claims against in insurer for breach of contract and promissory...more

Rivkin Radler LLP

Employee Benefit Plan Review – From the Courts

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Second Circuit Affirms Decision Rejecting ERISA Claims for Retiree Health Benefits The U.S. Court of Appeals for the Second Circuit has affirmed a district court’s decision dismissing claims under the Employee Retirement...more

Proskauer - Employee Benefits & Executive...

Best Practices in Administering Benefit Claims #9 – Managing Litigation Utilizing a Plan’s Litigation Tools

As we shifted focus last week from a plan’s administrative claims procedures to defending against a claim for benefits in court, we explained how a well-documented administrative record can enhance the chances of getting a...more

Seyfarth Shaw LLP

Out Of Network Provider’s Claim Against Health Insurer Avoids ERISA Preemption

Seyfarth Shaw LLP on

Seyfarth Synopsis: A provider that is not seeking benefits based upon an assignment of a patient’s claims under ERISA but instead is pursuing state law claims based solely on agreements and representations made directly by...more

King & Spalding

Fifth Circuit Reverses District Court’s Ruling that Required Hospital to Plead Specific Plan Language to State a Claim For ERISA...

King & Spalding on

On June 12, 2018, the United States Court of Appeals for the Fifth Circuit issued a ruling in Innova Hospital San Antonio, L.P. v. Blue Cross and Blue Shield of Georgia, Inc., et al. that clarified the scope of what a...more

Seyfarth Shaw LLP

Central District Of California Finds No ERISA Preemption Where Determination Of Benefits At Termination Is Non-Discretionary

Seyfarth Shaw LLP on

Seyfarth Synopsis: Claims for benefits at termination may proceed as a breach of contract claim in state court, and avoid ERISA preemption, where the calculations are individualized, straightforward and do not implicate an...more

Holland & Knight LLP

Religious Institutions Update: January 2018 - Lex Est Sanctio Sancta

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Timely Topics - By Shannon B. Hartsfield - The U.S. Department of Health and Human Services (HHS) announced on Jan. 18, 2018, the creation of a new division within its Office for Civil Rights (OCR). OCR is described as...more

Hogan Lovells

District Court Case Highlights Advantages of ERISA Severance Plans

Hogan Lovells on

Specialists have long touted certain significant advantages to employers that come along with maintaining ERISA severance plans, and a recent district court case highlights some of these advantages....more

Carlton Fields

Court Finds That Reinsurance Transaction Did Not Breach Investment Contract Underlying An ERISA Plan

Carlton Fields on

MetLife acquired the rights to a fixed investment option contract with Midco, a trust established to administer a retirement plan for the employees of Midco International, Inc. Midco plan participants received interest each...more

Bowditch & Dewey

Court Allows Retired President to Pursue Claim of Contract for Lifetime Pay and Benefits Against University

Bowditch & Dewey on

On February 7, 2017, the U.S. District Court for the Eastern District of Kentucky ordered that the former President of the University of the Cumberlands, Dr. James Taylor, may proceed on his claims that the University failed...more

Holland & Knight LLP

Religious Institutions Update: August 2016

Holland & Knight LLP on

When was the last time your organization reviewed your insurance policies? Not all policies are equal. Many religious organizations are underinsured. Most should have general liability, property, professional liability,...more

Carlton Fields

A Summary of Predicted Litigation Under the DOL’s Proposed Fiduciary Rule

Carlton Fields on

The Department of Labor’s recent Proposed Rule, which defines the term "fiduciary" as it applies to persons who provide "investment advice" to ERISA plans and IRAs, will impact the likelihood and severity of fiduciary...more

Franczek P.C.

Employee Benefits Alert - August 2015

Franczek P.C. on

Retirement Plans - IRS Issues Guidance on Benefit Suspension Voting under MPRA - As we have written in prior alerts, the Multiemployer Pension Reform Act of 2014 (MPRA) permits trustees of financially troubled...more

Burr & Forman

DOL Hearings Debate “Fiduciary Duty” not “Suitability” Standard for Retirement Accounts

Burr & Forman on

The U.S. Department of Labor (“DOL“) recently heard public comment to its proposed regulatory changes implementing a fiduciary duty on any individual receiving compensation for advice tailored to a plan sponsor, participant...more

Jackson Walker

Davidson v. Henkel — What’s Going On With Nonqualified Deferred Compensation Plans and FICA

Jackson Walker on

In This Presentation: - Davidson v. Henkel Corp. - The Parties - NQ Plan - The Plan’s Tax Clauses - Davidson’s Pre-Retirement Counseling - 2011 Compliance Review and Letter - Henkel’s Tax...more

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