Statute requires that Plan Administrator reimburse for room and board at a mental health facility where a similar surgical or medical stay would be so reimbursed.
The court's reading does not conflict with agency interpretations.
http://cdn.ca9.uscourts.gov/datastore/opinions/2018/06/06/16-35609.pdf
Since 2011. An occasional commonplacing of the U.S. Circuit Courts of Appeal.
Neither an authoritative statement of the law nor legal advice. Quick work.
Showing posts with label ERISA. Show all posts
Showing posts with label ERISA. Show all posts
First Circuit: Kelley v. Fidelity Mgmt. Trust Co.
Souter, ERISA, Agency
Funds transferred to the plan administrator's account for a fixed-sum disbursement to the beneficiary are not transmogrified into plan assets while in the holding account, and the general beneficiaries of the plan therefore have no claim on the interest earned.
Kelley v. Fidelity Mgmt. Trust Co.
Fifth Circuit: Judy Hunter, et al v. Berkshire Hathaway, Inc., et
ERISA
Although general amendment provision of Plan allowed repeal of provisions prohibiting reductions in benefits, the acquiring company was bound by the terms of the merger, and is therefore barred from causing the acquired company to make (some of?) the amendments at issue.
Judy Hunter, et al v. Berkshire Hathaway, Inc., et
Fifth Circuit: Mark Gomez v. Ericsson, Inc.
ERISA, Employment
Given substantial administrative operation supporting it, the severance plan is governed by the terms of ERISA.
As there were ambiguities in the Plan, no abuse of discretion in denial of benefits under release of claim provision where former employee returned computer without some files.
Mark Gomez v. Ericsson, Inc.
Fifth Circuit: Linda Singletary v. Prudential Ins Co. of America
ERISA, Insurance, Choice of Law, Preemption
As the cause of action is a statutory one, courts should not construe a challenge to the denial of benefits into an equitable challenge to the adequacy of disclosure of limitations.
General concerns of public policy insufficient to invalidate choice of law provision in pendent cause of action.
ERISA preempts state statute, as it has nothing whatsoever to do with risk pooling.
Linda Singletary v. Prudential Ins Co. of America
Sixth Circuit: Self-Insurance Inst. of Am. v. Rick Snyder
ERISA, Preemption
State tax on insurance claims is not preempted by express preemption provision of ERISA, as the recordkeeping and residency requirements do no impermissably intrude on the purposes of the act.
Self-Insurance Inst. of Am. v. Rick Snyder
Fifth Circuit: Mary Smith, et al v. Regional Transit Authority
ERISA, Agency
IRS standard is the appropriate test for determining, for the purposes of ERISA, if a private company is an agency or instrumentality of a government body, and by this standard, the private company that operates the transit system qualifies.
Deft not estopped from invoking governmental exemption, as the terms of the statute control.
Statute of limitations ran from first letter saying that some claims would not be funded.
PArty asserting discovery violation has to establish significance of the evidence sought.
Mary Smith, et al v. Regional Transit Authority
Sixth Circuit: USA v. Ralph Dennis
ERISA
Health care providers have no direct standing under the Act.
Assignment of the right to payment is sufficient to guarantee derivative standing under the Act.
Where a provider and an insurer have a post-reimbursement recoupment agreement and reversal of payment is not subsequently passed back to the customer, a provider's claim that the insurer has recouped covered costs doesn't state a claim under the Act, since the insured customer is not affected by the question.
Circuit split hinted at.
USA v. Ralph Dennis
Eighth Circuit: Theodore Ingram v. Terminal Railroad Association
ERISA
Where additional evidence is admitted during the proceedings, a court can retain the abuse of discretion standard by making its decision from the administrative record.
Administrator's characterization of relocation expenses was reasonable.
District court did not abuse discretion in finding that Administrator's offset of prior plan's benefits for full vesting -as opposed to the actual early retirement payments - was reasonable.
http://media.ca8.uscourts.gov/opndir/16/01/143589P.pdf
Where additional evidence is admitted during the proceedings, a court can retain the abuse of discretion standard by making its decision from the administrative record.
Administrator's characterization of relocation expenses was reasonable.
District court did not abuse discretion in finding that Administrator's offset of prior plan's benefits for full vesting -as opposed to the actual early retirement payments - was reasonable.
http://media.ca8.uscourts.gov/opndir/16/01/143589P.pdf
Second Circuit: Yale-New Haven Hospital v. Nicholls, et al.
ERISA
Denial of en banc, with dissent from denial.
ERISA annuity/lump sum benefits / posthumous domestic orders. Or something like that.
http://www.ca2.uscourts.gov/decisions/isysquery/78742b70-321c-4ada-8a3a-2b2b4f09d6b8/1/doc/13-4725comb_opn.pdf#xml=http://www.ca2.uscourts.gov/decisions/isysquery/78742b70-321c-4ada-8a3a-2b2b4f09d6b8/1/hilite/
Denial of en banc, with dissent from denial.
ERISA annuity/lump sum benefits / posthumous domestic orders. Or something like that.
http://www.ca2.uscourts.gov/decisions/isysquery/78742b70-321c-4ada-8a3a-2b2b4f09d6b8/1/doc/13-4725comb_opn.pdf#xml=http://www.ca2.uscourts.gov/decisions/isysquery/78742b70-321c-4ada-8a3a-2b2b4f09d6b8/1/hilite/
Eighth Circuit: Grasso Enterprises v. Express Scripts
ERISA / Injunctions
Issuance of a preliminary injunction mandating compliance with a plan interpretation is not a remedy available to plaintiffs under ERISA.
Pharmacies do not have direct standing under ERISA.
http://media.ca8.uscourts.gov/opndir/16/01/151578P.pdf
Issuance of a preliminary injunction mandating compliance with a plan interpretation is not a remedy available to plaintiffs under ERISA.
Pharmacies do not have direct standing under ERISA.
http://media.ca8.uscourts.gov/opndir/16/01/151578P.pdf
Eighth Circuit: McCaffree Financial Corp. v. Principal Life Insurace Co.
ERISA
As the terms of the mutual fund investment were negotiated at arms length prior to any fiduciary relationship between the parties, and a winnowing of investment options and subsequent advice had insufficient nexus to protected ERISA relationships, an assertion under ERISA of excessive fees doesn't state a claim.
http://media.ca8.uscourts.gov/opndir/16/01/151007P.pdf
As the terms of the mutual fund investment were negotiated at arms length prior to any fiduciary relationship between the parties, and a winnowing of investment options and subsequent advice had insufficient nexus to protected ERISA relationships, an assertion under ERISA of excessive fees doesn't state a claim.
http://media.ca8.uscourts.gov/opndir/16/01/151007P.pdf
Third Circuit: Laurence Kaplan v. Saint Peter's Healthcare System
ERISA, Religion -- statutory construction.
While a church agency can maintain an exempt plan, only a church can establish one.
Plain meaning.
Surplussage, Expressio unius..., Remedial statute, Statutory context.
Other statements by same sources in legislative record undermine indications to the contrary.
IRS ruling was not a rulemaking, so only accorded persuasive deference. (Christiansen, not Skidmore)
In subsequent lawmaking that seemed to legislate against the background of a contrary interpretation, Congress never evinced a detailed knowledge of the statutory scheme.
First Amendment not implicated, as churches themselves are free to set up plans.
http://www2.ca3.uscourts.gov/opinarch/151172p.pdf
While a church agency can maintain an exempt plan, only a church can establish one.
Plain meaning.
Surplussage, Expressio unius..., Remedial statute, Statutory context.
Other statements by same sources in legislative record undermine indications to the contrary.
IRS ruling was not a rulemaking, so only accorded persuasive deference. (Christiansen, not Skidmore)
In subsequent lawmaking that seemed to legislate against the background of a contrary interpretation, Congress never evinced a detailed knowledge of the statutory scheme.
First Amendment not implicated, as churches themselves are free to set up plans.
http://www2.ca3.uscourts.gov/opinarch/151172p.pdf
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