The Sixth Circuit recently held that a venue selection clause in an ERISA-governed pension plan was enforceable and, in so ruling, refused to give deference to the DOL’s contrary position.
Mental Health Parity Act: A Litigation Update
The Federal Mental Health Parity and Addiction Equity Act (the “Federal Parity Act”), like many similar state parity laws, mandates that financial requirements (e.g., copayments, coinsurance, or deductibles) and treatment limitations (e.g., limitations on the frequency of treatment, number of out-patient visits, or amount of days covered for in-patient stays) applicable to mental health benefits generally can be no more restrictive than the requirements and limitations applied to medical benefits. These parity laws, which are enforceable under ERISA, have been at issue in an increasing number of cases. Three district courts, all of which are located within the Ninth Circuit, have released rulings over the past few weeks.
Fourth Circuit Rejects Widow’s Claim for Equitable Relief
The Fourth Circuit recently rejected fiduciary breach and equitable estoppel claims for life insurance coverage by Leslie Moon, the widow of a deceased employee, who claimed that the employer’s actions resulted in Mr. Moon’s failure to convert his life insurance to an individual policy following the onset of his disability. In so ruling, the Court
Sixth Circuit: ERISA’s Whistleblower Provision Doesn’t Protect Giving Information
The Sixth Circuit (in a 2-1 decision) recently held that ERISA Section 510 does not protect unsolicited employee complaints. See Sexton v. Panel Processing, Inc., 2014 U.S. App. LEXIS 8752 (6th Cir. May 9, 2014). Plaintiff Brian Sexton worked as a general manager for defendant Panel Processing and also served as a trustee for
Transgender Woman Seeks Coverage Under ACA
A transgender woman recently filed a complaint in the U.S. District Court for the Central District of Illinois against her primary care physician, as well as the not-for-profit health-care clinic with which her physician is affiliated, for alleged violation of the anti-discrimination provision of the Affordable Care Act (ACA). Taylor v. Lystila, No. 14-cv-2072
Courts Continue to Apply Presumption of Prudence While Awaiting the USSC’s Views
As the employee benefits world awaits the U.S. Supreme Court’s decision in Dudenhoeffer v. Fifth Third Bancorp, two federal courts recently dismissed employer stock-drop cases brought under ERISA on the ground that plaintiffs failed to overcome the presumption that a fiduciary’s decision to remain invested in employer stock was prudent. See Smith v. Delta
Court Rejects Plaintiff’s Attempt to Prevent Plan from Recouping $250,000 Overpayment
A federal district court in the Northern District of California dismissed an equitable estoppel claim brought by a pension-plan participant seeking to prevent the plan from recouping an overpayment. See Groves v. Kaiser Found. Health Plan, Inc., No. 13-cv-2259, 2014 U.S. Dist. LEXIS 38755 (N.D. Cal. Mar. 24, 2014). Relying on defendants’ representations that
Defendants See Success With Limitations Defenses Post Heimeshoff
Defendants have recently received three favorable decisions involving contractual and statutory limitations defenses. In each case, a federal court held that claims for benefits under ERISA plans were time-barred. Costa v. Astoria Fed. Sav. and Loan Ass’n, 2014 U.S. Dist. LEXIS 14292 (E.D.N.Y. Feb. 4, 2014); Paulus v. Isola USA Corp. Ret. Plan,
U.S. Supreme Court: A Decision on the Merits Triggers the Time to Appeal Irrespective of a Pending Contractual or Statutory Attorneys’ Fee Application
The U.S. Supreme Court ruled in a unanimous opinion that an unresolved claim for attorney’s fees does not prevent a decision on the merits of an ERISA suit from becoming final for purposes of the deadline to file a notice of appeal to a federal appellate court. Ray Haluch Gravel Co. v. Cent. Pension Fund
District Court Upholds Validity of IRS Rule Authorizing Premium Tax Credits to Individuals Who Enroll in Health-Care Coverage through Federally-Facilitated Exchanges
A district court in the District of Columbia recently held that the Internal Revenue Service’s (“IRS”) rule authorizing premium tax credits to individuals who enroll in health-care coverage through federal exchanges was unambiguously consistent with the “text, structure, and purpose” of the Affordable Care Act (“ACA”). Halbig v. Sebelius, No. 13-cv-0623, 2014 U.S. Dist. LEXIS 4853 (D.D.C. Jan. 15, 2014).
The Exchanges, Premium Tax Credits, and Challenged IRS Rule
To facilitate the purchase of “minimum essential” health-insurance coverage (which the ACA requires that most Americans either obtain or pay a tax penalty for failing to do so (the “Individual Mandate”)), the ACA provides for the establishment of American Health Benefit Exchanges (“Exchanges”). As explained by the U.S. Department of Health and Human Services (“HHS”), the Exchanges act as “a mechanism for organizing the health insurance marketplace to help consumers and small businesses shop for coverage . . . .” Currently, sixteen states and the District of Columbia have elected to establish Exchanges (“State-run Exchanges”). Because the remaining thirty-four states have currently declined to do so, HHS has (pursuant to its authority under the ACA) stepped-in and created Exchanges on their behalf (“Federally-facilitated Exchanges”).