Practical HR Tips, News & Advice. Updated Daily.
A plan participant cannot pick definitions from various state or federal statutes and impose them on an employer-sponsored health plan where the plan left terms undefined, if the plan applies a common and ordinary meaning to those terms when asked to justify a claims denial. Applying this rule, a Michigan appeals court affirmed a lower […]
I’ve read how, due to the cost of administering long-term care (LTC) insurance, some private-sector vendors are either revisiting that benefit or jacking up premiums — partly because not enough people are signing up to sufficiently spread the risk, and costs, around. Well, the federal health reform law included a lofty goal of establishing a […]
It’s like the Hollywood movie Groundhog Day all over again. The Self Insurance Institute of America (SIIA) wakes up and has to face the same “anti-self-funding” arguments about adverse selection, insolvency and inferior benefits that it refuted last year … the year before … and the year before that. Again in damage-control mode, this time the […]
It’s important to disclose information through ERISA-required documents properly: it can be a plan administrator’s last line of defense if participants allege that they suffered losses because they didn’t know their rights or important plan terms. That obligation has grown in response to the financial scandals of the last decade (Enron, WorldCom, mortgage-leveraged bonds, etc.). […]
It has now been almost a year since health care reform was first enacted. The first year involved many compliance challenges, not the least of which was keeping up with the many pieces of guidance issued by DOL, IRS and HHS. Plans had to expand coverage (more dependents, fewer dollar limits, no more questions about […]
Although the COBRA statute never defined gross misconduct — leaving it up to the courts — no dictionary is needed when an “out-of-control” employee screams profanities at and makes seemingly threatening hand gestures toward another employee, saying she would “get” hers. This behavior was “so manifestly so outrageous and extreme as to constitute gross misconduct,” […]
Using independent contractors is a way to avoid paying unemployment, Social Security and Medicare taxes, overtime and benefits. However, if an employer is found liable of misclassifying an employee in tandem with committing wage and hour violations, DOL may fine the employer, and the employer may be assessed back wages and taxes. The U.S. Department of Labor (DOL) […]
Jan. 1, 2014, sounds far away, but some plan sponsors may be hoping that day never comes. That’s the day the “shared responsibility provisions” of the Patient Protection and Affordable Care Act (PPACA) kick in; and it’s the time plan sponsors become subject to health reform’s “unaffordable coverage trigger.” Under the law, if an employee’s […]
The warning “Beware of the Dog” is making employers fearful in a new way. One downside of offering telecommuting privileges is injuries that occur while an employee is working from home. If an employee is injured at home while he or she is on a work-related task, he or she may be entitled to workers’ comp benefits. This raises […]
Retirement plan administrators do not have the authority to conclude that a domestic relations order (DRO) is not qualified because it is based on a “sham” divorce, the 5th U.S. Circuit Court of Appeals decided July 18, 2011. The 5th Circuit stated that a key ERISA section “does not authorize an administrator to consider or […]