Employee Benefits & Executive Compensation Blog

The View from Proskauer on Developments in the World of Employee Benefits, Executive Compensation & ERISA Litigation

Tag Archives: Benefit Claim Procedures

Third Circuit Says ERISA Administrative Appeal Denial Letters Must State Plan-Imposed Time Limits

The Third Circuit recently held that ERISA administrative appeal denial letters must include plan-imposed time limits for commencing a lawsuit challenging the claim denial, and the failure to provide such notice warranted setting aside the plan’s limitation period.  Mirza v. Ins. Adm’r. of Am., Inc., 2015 WL 5024159 (3d Cir. Aug. 26, 2015). The ERISA … Continue Reading

Ninth Circuit Rules Beneficiary Designation Forms Are Not Documents and Instruments Governing the Plan

In Becker v. Mays-Williams, 13-35069-cv, 2015 WL 348872 (9th Cir. Jan 28, 2015), the Ninth Circuit – in a matter of first impression – concluded that beneficiary designation forms were not “documents and instruments governing” an ERISA plan, as described in Section 404(a)(1)(d) of ERISA.  A participant called the plan office and telephonically re-designated his … Continue Reading

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, 2014 U.S. … Continue Reading

Claims Administrator Not Liable Under ERISA For Alleged Failure to Follow ACA’s Enhanced Benefit Claim Procedures

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 … Continue Reading

Fifth Circuit Rules that Changed Basis for Denying Claim Violated ERISA § 503

In Rossi v. Precision Drilling Oilfield Services Corp. Employee Benefit Plan, 2013 WL 85910 (5th Cir. Jan. 8, 2013), the Fifth Circuit held that defendant violated ERISA § 503 by changing its basis for denying plaintiff medical coverage, because doing so prevented plaintiff from having a meaningful review of the denial of benefits. The court thus … Continue Reading
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