The recent case of Gooden v. Unum Life Ins. Co. of Am., 2016 WL 3059752 (E.D. Tenn. March 30, 2016) involved a familiar scenario - whether a "list bill" arrangement constitutes an ERISA plan.The plaintiff was a physician who worked for a clinic in Florida between 1987 and 2007.In 1991, an insurance broker sold several individual disability income policies to some of the physicians who worked at the clinic, including Dr. Gooden.However, the individual doctors purchased their own policies - the clinic itself had no involvement whatsoever.However, because more than three of the doctors participated, Unum set up a "FlexBill" which offered premium discounts of approximately 15% since a single bill was sent to the clinic and the physicians paid their premiums through payroll deductions.
Although the ERISA law generally preempts state law causes of action that relate to claims for employee benefits, a recent federal court ruling from California Dale v. Reed Group, Ltd., 2015 WL 6954915 (N.D. Cal. November 10, 2015), permitted an exception to that general rule.Ed Dale, an employee of Intel Corporation who became disabled, was refused long-term disability benefits.In challenging the benefit denial, he added a claim for intentional infliction of emotional distress (IIED), which Intel and its benefit administrators tried to have dismissed on ERISA preemption grounds.He maintained that in the course of his claim, he was accused of lying or exaggerating his claims, urged to take experimental medication and forced to undergo examinations that caused pain, emotional distress and anxiety.
A recent ruling from a federal court in Alabama - Rosen v. Provident Life and Accident Insur. Co., 2015 WL 260839 (N.D.Ala. January 21, 2015) addressed a controversial issue involving ERISA preemption. Typically, ERISA is implicated only where an employer sponsors a retirement plan or offers group coverage to its employees for disability, life, or health insurance. However, several insurance companies offer employers a discount on premiums if they are able to issue a series of individually underwritten disability insurance policies, and the premiums are billed to the employer on a single bill. This often occurs with medical and legal professional practices. Many courts have held that such a practice established an ERISA welfare benefit plan.