ERISA

Another Bad Erisa Case, Deferential Standard for Sedgwick and Sun Trust

In the recent decision of Foster v. Sedgwick Claims Management Services, the Circuit Court of the District of Columbia recently affirmed a finding that Sedgwick, the plan administrator for a Sun Trust plan, had complete and sole discretion in determining whether or not an employee’s medical evidence qualifies as disabling as defined by the plan.…

Read More

Reliance Standard’s Denial Found Arbitrary and Capricious

The Sixth Circuit recently reversed a twelve month mental disorder limitation against Reliance Standard adopting the “but-for” approach for Mental and Nervous Disorder Limitations of the Fifth, Ninth, and Third circuits. Okuno v. Reliance Standard Life Ins.Co. Ms. Okuno was approved solely for mental disorder benefits for her auto-immune disease and narcolepsy due to the…

Read More

Supreme Court Issues ERISA subrogation Opinion

In a surprising bit of good news for plaintiffs, on January 20, 2016, the Supreme Court issued Montanile v. Board of Trustees of National Elevator, 577 U.S.  (2016).  In this action, the plaintiff was seriously injured by a drunk driver, which required payments from his ERISA plan of more than $120,000 for his medical expenses.…

Read More

Sixth Circuit Allows Lawsuit to Continue Despite ERISA Requirment

On October 2, 2015, in Waskiewicz v. UniCare Life & Health Ins. Co., the Sixth Circuit reversed a district court’s granting of summary judgment in favor of Ford’s ERISA Plan because the insured, who suffered from major depression and gender identity disorder, failed to provide notice of her disability to the Plan after she suffered…

Read More

Sixth Circuit Continues to Give Meaning to “Equitable Relief”

On June 18, 2015, the Sixth Circuit in Pearce v. Chrysler Group LLC Pension Plan, 2015 WL 3797385, found that a retirement plan participant could state an equitable claim under ERISA for supplemental pension benefits until he became eligible for Social Security benefits, notwithstanding the fact he was terminated prior to receiving the benefits and the…

Read More

Eleventh Circuit Vacates Prior Decision on ERISA Fiduciary

The Eleventh Circuit revisited its holding in Pruitt v. SunTrust Banks, Inc., No. 14-13207 (11th Cir. June 30, 2015), a putative ERISA class action brought against ERISA fiduciaries by plan participants, concerning certain investments in the plan.  The district court had dismissed the case based on ERISA’s borrowed six-year statute of limitations.  In related proceedings,…

Read More

Seventh Circuit Reaffirms Requirement to Exhaust Administrative Remedies

In Orr v. Assurant Employee Benefits (7th Cir. May 19, 2015) the district court dismissed a lawsuit for life insurance benefits because the plaintiffs did not first exhaust their administrative remedies.  On appeal, the Seventh Circuit affirmed noting that the denial letter plaintiffs received informed them of their right to seek review and included a copy of USIC’s Life…

Read More

Second Circuit Finds That New York’s Anti-Subrogation Statute Is Not Preempted By ERISA

Recently, the Second Circuit held in Wurtz v. The Rawlings Company, — F.3d—, 2014 WL 3746801, that New York’s anti-subrogation, Section 5-335, is “saved” by ERISA’s “saving clause” and applies to health insurers providing coverage through ERISA plans. This will provide some significant relief to New York ERISA participants and beneficiaries. Plaintiffs filed a class action…

Read More