Practical HR Tips, News & Advice. Updated Daily.
A former employee left with more than $13,000 in unpaid medical bills after his employer retroactively terminated his employment and health benefits can sue for state-law claims, a federal district court ruled. The individual alleged that while he was hospitalized, the employer said his expenses would be covered. Thus, he did not elect COBRA coverage. […]
An insurer won recovery of health expenses paid from a member’s $255,000 settlement after said member refused to reimburse the insurer for medical payments it made. It did so in spite of an affidavit from the company plan administrator saying the insurer was not authorized to collect the funds from the member’s settlement proceeds. It […]
So you thought you were all caught up on annual-report tasks when you filed your Delinquent Filer Voluntary Compliance Program form with the U.S. Department of Labor? Well … not exactly. Some plan sponsors that filed under the DFVCP may still find themselves with tasks to complete before Dec. 1. Bottom line: Avoiding Form 5500 […]
The ruling in Penn. Chiropractic Ass’n v. BCBSA threatens to make recoveries more difficult for all insurers and may complicate the claims administration of self-funded plans. It also may necessitate self-insured plan sponsors reviewing network contracts with providers. Here’s what happened: a federal district court gave providers ERISA beneficiary status instead of following the language in […]
On May 22, CMS issued guidance (registration required) describing how plans, third-party administrators and insurers will pay reinsurance contributions required under health care reform for the next three years. The guidance says a contributing entity can complete all required steps for the reinsurance contributions process on Pay.gov, including registration, submission of the annual enrollment count and remittance of […]
A self-insured employer that explicitly excludes same-gender spouses from health plan coverage did not violate ERISA’s benefit interference or fiduciary breach provisions by having such exclusionary language, a federal district court in New York ruled. A same-gender couple had argued that, in light of U.S. v. Windsor, because the plan declined to cover the spouse, the employer interfered […]
A federal appeals court agreed with a retirement plan plaintiff that he did not have to show “actual harm” to seek a retirement plan reformation after alleged inadequate communication about a change in his former employer’s defined benefit plan. The 2nd U.S. Circuit Court of Appeals sided with Geoffrey Osberg and other plaintiffs in Osberg […]
Do not include the following in your documentation, says Wobst: Personal opinions. Rumors or speculation about the employee’s personal life. Theories about why the employee behaves a certain way. (Don’t practice psychiatry without a license.) For example, don’t call an employee “crazy.” Instead, document behaviors. Legal conclusions. (Don’t practice law without a license.) For example, […]
The claims administrator of an employer-sponsored health plan abused its discretion when it rejected a health benefits claim because it: (1) denied it without an explanation or plausible support; (2) had a structural conflict of interest because it was also the insurer; and (3) violated ERISA regulations by merely reciting its policy without refuting the […]
For the third time in eight years, a federal district court decision endorsing Xerox’s pension plan interpretation has been reversed, setting aside judicial deference usually granted to these interpretations under ERISA and moving Xerox retirees closer to winning final benefits. The issue in the case is how an earlier lump-sum distribution to some employees affects […]