Boom: The ERISA Law Blog

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Latest from Boom: The ERISA Law Blog

An ERISA Plan Administrator’s Playbook in Assessing Disability from “Chronic Fatigue Syndrome”

December 17, 2020

Some of the more challenging disability claims involve impairment resulting from Chronic Fatigue Syndrome. There are no tests for Chronic Fatigue Syndrome, and the impairment assessment often relies heavily on self-reported symptoms and…the credibility of the claimant and the treating physician. But there are distinct ways to help the court assess these claims. This new case provides a helpful playbook of arguments to make in assessing chronic fatigue, or self-reported, disability types of cases. Lukianczyk …

Boom: The ERISA Law Blog

ERISA: 6th Circuit — Ways to Defend Disgorgement and Breach of Fiduciary Duty Claims Under Section 1132(a)(3)

By Mike Reilly

December 2, 2020

You know that typically claimants seeking ERISA-governed benefits make claims for recovery under Section 1132(a)(1)(B). Now you are likely seeing more simultaneous assertions of equitable claims for breach of fiduciary duty and disgorgement under Section 1132(a)(3). A successful claimant asserting this theory may recover additional forms of monetary relief, and may get broader discovery. But the availability of relief under Section 1132(a)(3) claims is narrow: a claimant may pursue a Section 1132(a)(3) claim “only where…

Boom: The ERISA Law Blog

ERISA: Three Key Tips on Making Sure the ERISA Plan Properly Designates Fiduciary Duties to Claims Administrators

By Mike Reilly

October 14, 2020

You already know that ERISA plans frequently delegate discretionary authority to an administrator or fiduciary to make benefit decisions. When reviewing the claim decision, courts may examine whether the ERISA Plan administrator properly designated authority to a claims administrator to make benefit decisions for the Plan. If the delegation of authority is not done according to a process set forth in the ERISA Plan for designating administrators, the Court will apply the de novo standard…

Boom: The ERISA Law Blog

ERISA: When Do Courts Deny Claimants’ Attorney Fee Motions in Cases Remanded to the Claims Administrator?

By Mike Reilly

September 4, 2020

You already know that an ERISA plan recipient may recover attorney fees when prevailing in an action to enforce rights under the plan. But to win attorney fees, the claimant must show: “[success] on [a] significant issue of litigation which achieves some of the benefit…sought in bringing the suit…’” something more than “‘trivial success on the merits’ or a ‘purely procedural victory….’” SO… what IS “trivial success on the merits” or a “purely procedural victory”?…

Boom: The ERISA Law Blog

8th Circuit–Procedural Irregularities– Does “Decisional Delay” Automatically Trigger Application of De Novo Review Instead of Discretionary Review? Not So Fast

By Mike Reilly

September 4, 2020

You already know that denials of ERISA-governed disability benefits are reviewed under a de novo standard unless the benefit plan gives the administrator discretionary authority to determine eligibility for benefits or to construe the terms of the plan. But courts sometimes override this grant of discretionary review and apply de novo review when there is a conflict of interest (the administrator both decides and funds the benefit) and there were procedural irregularities in the claims…

Boom: The ERISA Law Blog

ERISA: Plans That are Members of Trusts (with Many Employer/Member in Many States) May Have Better Chance Winning Choice of Law Issue–Abuse of Discretion Standard Applied

By Mike Reilly

July 30, 2020

You know that many states ban discretionary language in ERISA plans. This issue tees up litigation over what state law will apply –the choice of law issue. This new case is a good read because it provides helpful analysis when litigating choice of law issues: the structure of the plan may help win choice of law issues. Choice of law decisions may be more favorable when the employer’s plan is part of a trust with…

Boom: The ERISA Law Blog

ERISA 3rd Circuit: Out-of-Network Health Care Provider’s Breach of Contract and Promissory Estoppel Claims NOT Preempted by ERISA

By Mike Reilly

July 27, 2020

ERISA preemption of state law claims is today’s topic… This issue comes up more frequently now with managed care organizations creating networks of doctors or preferred providers, and the issue that arises is: at what rate should the insurer pay for services provided by out-of-network health care providers. And what happens when the insurer expressly agrees to pay the out-of-network provider, before services are rendered? Does ERISA preempt the breach of contract claim brought by…

Boom: The ERISA Law Blog

Disability Policies: “Counting the Days” to Application of the Contractual Limitations Provision

By Mike Reilly

July 14, 2020

You already know about the contractual limitations provision in disability policies. The provision works to bar untimely lawsuits. So, it is no surprise that the interpretation/application of these provisions has been the subject of significant litigation. Here’s a short new case concluding the contractual limitations provision was “unambiguous,” and dismissing the claim as untimely. Kuber v. Prudential Insurance Company of America, 2020 WL 3542308 (11th Cir. June 30, 2020). FACTS: Kuber stopped working due to…

Boom: The ERISA Law Blog

ERISA and the Pandemic: Quick Guidance on New, Temporary Changes to DOL Regulations Affecting Timing of Health/Disability Claims and Appeals

By Mike Reilly

May 8, 2020

This just in…. On May 4, 2020, The Department of Labor (DOL), the Department of the Treasury, and the Internal Revenue Service issued the final ruling, linked here final ruling that “extend[s] certain timeframes otherwise applicable to group health plans, disability and other welfare plans, pension plans, and their participants and beneficiaries under ERISA and the Code.” This email focuses solely on changes and extensions made to the timeframes for participants to exercise rights pertaining…

Boom: The ERISA Law Blog

ERISA: Mini-Primer on Choice of Law Issues to Determine the Standard of Review

By Mike Reilly

April 2, 2020

As you know, many states have imposed statutes which affect which standard of review governs ERISA claim decisions. Many policies include a “choice of law” provision, setting forth which state law will govern the standard of review. But what happens when the policy does not have a “choice of law” provision? How does the court determine which state law governs the standard of review in ERISA claims? This new case provides practitioners with an excellent…

Boom: The ERISA Law Blog

Blog Authors

An ERISA Plan Administrator’s Playbook in Assessing Disability from “Chronic Fatigue Syndrome”

ERISA: 6th Circuit — Ways to Defend Disgorgement and Breach of Fiduciary Duty Claims Under Section 1132(a)(3)

ERISA: Three Key Tips on Making Sure the ERISA Plan Properly Designates Fiduciary Duties to Claims Administrators

ERISA: When Do Courts Deny Claimants’ Attorney Fee Motions in Cases Remanded to the Claims Administrator?

8th Circuit–Procedural Irregularities– Does “Decisional Delay” Automatically Trigger Application of De Novo Review Instead of Discretionary Review? Not So Fast

ERISA: Plans That are Members of Trusts (with Many Employer/Member in Many States) May Have Better Chance Winning Choice of Law Issue–Abuse of Discretion Standard Applied

ERISA 3rd Circuit: Out-of-Network Health Care Provider’s Breach of Contract and Promissory Estoppel Claims NOT Preempted by ERISA

Disability Policies: “Counting the Days” to Application of the Contractual Limitations Provision

ERISA and the Pandemic: Quick Guidance on New, Temporary Changes to DOL Regulations Affecting Timing of Health/Disability Claims and Appeals

ERISA: Mini-Primer on Choice of Law Issues to Determine the Standard of Review

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