Steven A. Sutro
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On April 23, 2018, the Departments of Labor (DOL), Health and Human Services (HHS) and Treasury (together, the “Agencies”) released proposed frequently asked questions (“FAQs”) related to nonquantitative treatment limitations (“NQTLs”) under the Mental Health Parity and Addiction Equity Act (“MHPAEA”). The Agencies also provided guidance on new disclosure requirements (which were described in our … Continue Reading
On May 7, 2018, the DOL issued a Field Assistance Bulletin (“FAB”) addressing the Department’s enforcement policy on the fiduciary rule that was recently vacated by the Fifth Circuit. Although the DOL has elected not to continue defending the rule before the Fifth Circuit, the FAB leaves the rule’s status in a holding pattern. Rather … Continue Reading
A federal district court in Indiana recently granted preliminary approval of a settlement between Anthem and a class seeking coverage of Applied Behavior Analysis (“ABA”) treatment for autism disorders. The three-year old litigation involved claims that Anthem violated the federal Mental Health Parity and Addiction Equity Act (“MHPAEA”) by limiting the hours of ABA therapy that … Continue Reading
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 Circuit. NAFA had appealed a district court decision that dismissed NAFA’s challenge to the fiduciary rule. The decision to drop that … Continue Reading
In a 2-1 decision, the U.S. Court of Appeals for the Fifth Circuit vacated the Department of Labor’s fiduciary rule, including the expanded definition of “investment advice fiduciary” and the associated exemptions. The decision nullifies the Department’s 2016 regulation—at least in the Fifth Circuit, which includes Texas, Louisiana, and Mississippi, and arguably nationwide—but is not … Continue Reading
The Tenth Circuit recently affirmed the Department of Labor’s authority to impose new conditions for exemption from prohibited transaction rules with respect to the sale of annuity contracts. The case related to the Department’s decision, as part of the 2016 “fiduciary rule,” to make sales of fixed indexed annuities ineligible for Prohibited Transaction Exemption 84-24, … Continue Reading
The Eighth Circuit held that defined benefit pension plan participants who alleged breach of fiduciary duty and prohibited transaction claims under ERISA lacked standing to assert their claims because, during the course of the litigation, the plan became overfunded. Plaintiffs brought suit after the plan lost $1.1 billion, which plaintiffs claimed arose from imprudent investments and … Continue Reading
Banner Health and the Kaiser Foundation were recently hit with separate class action lawsuits challenging their denials of certain mental health care coverage. In the case against Banner Health, plaintiffs challenge Banner Health’s exclusion of applied behavior analysis therapy from coverage for autism spectrum disorder as “experimental or investigational.” Plaintiffs allege that the failure to … Continue Reading
The Ninth Circuit affirmed two district court decisions that concluded medical providers were not “beneficiaries” under Section 502(a) of ERISA and therefore lacked standing to bring an ERISA claim. The Court explained that, in one case, the provider had an assignment from the participants, but the assignment was invalid because the plan contained a non-assignment clause … Continue Reading
The Sixth Circuit held that retirement plan participants were not required to exhaust their administrative remedies prior to bringing a claim alleging that a plan amendment violated ERISA. In so holding, the Court agreed with the opinions of the Third, Fourth, Fifth, Ninth, Tenth, and D.C. Circuits and disagreed with the opinions of the Seventh … Continue Reading
A federal district court in the Western District of Kentucky certified a class of participants and beneficiaries in plans sponsored by Anthem Health Plans of Kentucky, Inc. who had been denied coverage or reimbursement for Applied Behavior Analysis (ABA) for Autism Spectrum Disorder (ASD). Plaintiff claimed that the time and dollar limitations violated ERISA and … Continue Reading
A federal magistrate judge in Pennsylvania recommended that a class action complaint claiming that AlliedBarton terminated certain employees to prevent them from reaching eligibility for vacation benefits be dismissed as untimely. Observing that ERISA section 510 does not provide a specific statute of limitations, the court determined that the most analogous state-law cause of action … Continue Reading
A federal district court in California held that a complaint filed by members of the International Union of Operating Engineers that challenged pension plan trustees’ decision to make certain investments was filed five days too late and thus barred by ERISA’s six-year statute of limitations. In so holding, the court ruled that the limitations period … Continue Reading
The Tenth Circuit held that a pension plan consultant, who misstated the amount of monthly pension payments that a pension plan participant would receive in retirement, was not a fiduciary under ERISA. Plaintiffs Trent and Wendy Lebahn, who were participants in the National Farmers Union Uniform Pension Plan, claimed that the Plan, its Pension Committee … Continue Reading
Proposed Mental Health Parity Guidance Focuses on Nonquantitative Treatment Limitations
By Damian A. Myers and Steven A. Sutro on Posted in Mental Health Parity
New DOL FAB Further Delays Enforcement of Fiduciary Rule, But Does Not Undo The Rule In Its Entirety
By Seth Safra, Russell Hirschhorn and Steven A. Sutro on Posted in Department of Labor, Fiduciary
Anthem Settles Mental Health Parity Litigation Involving Autism Treatment
By Steven A. Sutro on Posted in Mental Health Parity
Confusion Ensues After Appeal Over Fiduciary Rule in D.C. Circuit Dropped
By Seth Safra, Russell Hirschhorn and Steven A. Sutro on Posted in Department of Labor, Fiduciary
Fifth Circuit Vacates DOL Fiduciary Rule
By Seth Safra, Russell Hirschhorn and Steven A. Sutro on Posted in Department of Labor, Fiduciary
Tenth Circuit Upholds DOL’s Authority to Impose New Conditions for PTEs and Leaves Door Open for Changes to Fiduciary Rule
By Seth Safra, Russell Hirschhorn and Steven A. Sutro on Posted in Department of Labor, Fiduciary
No Standing To Pursue Fiduciary-Breach Claim Where Plan Became Overfunded During Litigation
By Steven A. Sutro on Posted in Standing
New Class Action Lawsuits Asserting Violations of the MHPAEA
By Steven A. Sutro on Posted in Mental Health Parity
Ninth Circuit: Medical Providers Lack ERISA Standing
By Steven A. Sutro on Posted in Standing
Sixth Circuit: ERISA Exhaustion Not Required in Plan Amendment Suit
By Steven A. Sutro on Posted in Benefit Claim Procedures
Class Certified in Claims for Autism Treatment Coverage
By Steven A. Sutro on Posted in Class Certification, Mental Health Parity
ERISA Section 510 Interference Claim Time Barred
By Steven A. Sutro on Posted in ERISA § 510
Challenge to Pension Fund Investment Decision Time Barred
By Steven A. Sutro on Posted in Statute of Limitations
Pension Consultant Found Not to be an ERISA Fiduciary
By Steven A. Sutro on Posted in Fiduciary
