Photo of Brian Neulander

The Sixth Circuit recently concluded that a disability plan participant was entitled to relief consisting of benefits under the plan and disgorgement of defendant’s profits for delaying payment. In so ruling, the Court found that this case presented a “a logical extension” of its precedent allowing a plaintiff to pursue in limited circumstances both a

The Supreme Court will review two of the numerous lawsuits challenging the Affordable Care Act’s (ACA) requirement that group health plans and insurers cover, without cost-sharing, contraceptives and/or abortifacients (the “Contraceptive Mandate”). The plaintiffs in these suits are secular, for-profit corporations and their owners, and they assert that being forced to comply with the Contraceptive

A federal court in New York appears to have issued the first published decision addressing alleged violations of the enhanced benefit claim procedures arising out of the Affordable Care Act (ACA). The new procedures contain various participant-friendly provisions, such as the right to external review, that alter ERISA’s existing benefit claim procedures for non-grandfathered welfare

The Affordable Care Act (ACA) requires non-grandfathered health plans to cover certain preventative health services. In a case seeking an injunction to bar enforcement of ACA’s so-called “contraception mandate” on the ground that it infringed plaintiffs’ deeply held religious beliefs, the Sixth Circuit held that secular, closely held for-profit corporations were not “persons” protected by

A federal district court recently ruled that, at the pleadings stage, Oklahoma established standing to pursue its suit to bar enforcement of the Affordable Care Act’s (“ACA”) shared responsibility penalty provisions. Oklahoma ex rel. Pruitt v. Sebelius, No. CIV-11-30, 2013 WL 4052610 (E.D. Okla. Aug. 12, 2013).

ACA contains a shared responsibility provision (also known as the “Employer Mandate”) under which, effective for 2015, large employers (those that employ 50 or more full-time equivalent employees) have to pay a shared responsibility payment if they do not offer minimum value, affordable coverage to their full-time employees. 26 U.S.C. § 4980H. As discussed in our May 31, 2013, blog post, there are two different penalties that could apply depending on whether an employer either (a) offers no health care coverage to at least 95% of its full-time employees or (b) offers full-time employees coverage that is unaffordable or does not provide minimum value. In either case, at least one full-time employee must qualify for a premium tax credit subsidy to purchase health insurance through a health care exchange before penalties apply.

The Third Circuit affirmed dismissal of plaintiff Nicholas Danza’s claims that Fidelity breached its fiduciary duties and engaged in prohibited transactions by charging excessive service fees for reviewing and qualifying Domestic Relations Orders (DROs) for a 401(k) plan. Danza v. Fidelity Management Trust Co., 2013 WL 3872118 (3d Cir. July 29, 2013) (unpublished). 

John Hancock Life Insurance Company is the most recent 401(k) plan service provider to prevail in a case by the plaintiffs’ bar asserting ERISA fiduciary breach claims based on allegations that it charged excessive 401(k) plan fees and received excessive revenue sharing payments.  Santomenno v. John Hancock Life Ins. Co., No. 2:10-cv-01655 (WJM), 2013

The Affordable Care Act (ACA) is significantly changing employer health care obligations under the Employee Retirement Income Security Act (ERISA).  Prior to ACA, the Supreme Court held that ERISA did not require employers to offer any level or type of welfare benefits, such as health care benefits. Now that ACA has passed constitutional muster, effective 2014, employers with more than 50 full-time employees will be required to provide “affordable” health care coverage to their full-time employees or face financial penalties.  Because the penalties are calculated based on the number of full-time employees, employers should carefully examine the legal risks of realigning their workforces to minimize the use of full-time employees in favor of employees whose status would not trigger ACA’s coverage mandate.  This article discusses the ACA whistleblower and ERISA Section 510 claims that might arise from such workforce restructurings or other attempts by employers to avoid ACA’s coverage requirements and corresponding tax penalties.

In Weaver Bros. Ins. Assoc., Inc. v. Braunstein, No. 11-5407, 2013 WL 1195529 (E.D. Pa. Mar. 25, 2013), a district court denied the plan administrator’s motion for judgment on the pleadings, ruling that monetary relief may be available for ERISA violations associated with the plan administrator’s failure to properly communicate the participant’s benefit rights