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
Benefit Claim Procedures
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 son as his beneficiary under the various plans in which he was a participant, rather than his ex-wife.
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,…
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…
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…