How should federal courts conduct a de novo review of Employee Retirement Income Security Act benefit claims? One approach was delineated by the U.S. Court of Appeals for the Seventh Circuit in 2009 in Krolnik v. Prudential Insurance Company of America.[1] There, the court pronounced the phrase “de novo review” as “misleading” and explained the de novo review standard […]
Are undocumented employees entitled to the same employer-sponsored benefits as their co-workers? According to a recent ruling from the 8th U.S. Circuit Court of Appeals, apparently not. In Avera McKennan v. Meadowvale Dairy Employee Benefit Plan, 2020 WL 5085954 (8th Cir., Aug. 28), the appeals court ruled that a hospital (Avera) was unable to recoup significant […]
The most critical issue in Employee Retirement Income Security Act benefits litigation is the standard of judicial review applied by the courts. Under the deferential arbitrary and capricious standard of review, the court reviews a claim record compiled by the insurance company[1] to determine whether a claim denial was “downright unreasonable”[2] and not merely wrong. Because […]
The Patient Protection and Affordable Care Act[1] made a number of significant changes to health insurance coverage in the U.S. One of the most important provisions of the law, which is also known as Obamacare, was a requirement that patients whose benefits are denied are entitled to independent external review. The implementing regulation[2] requires that […]
There has been a growing number of rulings relating to health insurance denials involving mental health treatment. A recent example is Jamie F v. Unitedhealthcare Insur. Co., 2020 WL 4249200 (N.D. Cal., July 23), involved a claimant who had a long history of being treated for several mental illnesses including anorexia nervosa, depression, anxiety, obsessive-compulsive disorder and self-harming behaviors.
This month marks thirtieth anniversary of the passage of the Americans with Disabilities Act of 1990 (“ADA”), 42 U.S.C. § 12101 et seq., a landmark piece of civil rights legislation that prohibits discrimination on the basis of disability. The ADA requires that people with disabilities be granted equal access to employment, public services, and public accommodations. […]
Employee benefit claimants are frequently surprised by the limited remedies to them under the Employee Retirement Income Security Act. However, a recent U.S. Supreme Court ruling in Liu v. U.S. Securities and Exchange Commission,[1] might open the door to additional remedies.
An aspect of Employee Retirement Income Security Act benefits litigation that distinguishes it from other civil litigation is that discovery in ERISA cases is only stingily granted. Although, as will be shown below, that appears to be changing. There is no statutory basis for limiting discovery in ERISA cases, nor do the Federal Rules of […]
Protecting LGBTQ rights is of great importance for this country, and the legal issues related to transgender healthcare can be particularly complicated. Many employer-sponsored healthcare plans now explicitly cover transgender-related healthcare. Part of the reason is likely economic. According to the Williams Institute, there are currently just under 1.4 million Americans who identify as transgender, […]
Mark D. DeBofsky is a name partner of DeBofsky Law — on the web at debofsky.com. He handles civil and appellate litigation involving employee benefits, disability insurance and other insurance claims and coverage issues. While most ERISA claims are heard in federal court, claims for benefits may also be brought in state court. The ERISA […]
The scope and breadth of the Employee Retirement Income Security Act’s statutory preemption of state laws that relate to employee benefit plans[1] has confounded the courts since ERISA was enacted in 1974. In recent years, a battle front has emerged over the power of local governments to ensure universal health care for workers. The U.S. District […]
This country is suffering from a retirement crisis, unlike any other in its history. According to the Economic Policy Institute, nearly half of all American families have no retirement savings. For those that do, the savings are minimal. In 2016, the median retirement account balance for working-aged families was $7,800, while the median account balance […]