Ninth Circuit Court of Appeals has ruled, in Steigleman vs. Symetra Life, that neither an employer nor its trade association created an ERISA-covered plan merely because the employer paid for long...
Law Alert
Pre-existing Condition Exclusion Enforceable Despite Employer Misrepresentation
The Fifth Circuit Court of Appeals, in Bunner v. Dearborn Nat’l Life Ins. Co., has held that a disability insurer properly denied a claim for long-term disability (“LTD”) benefits based on the...
Plan Administrators May Not Adopt Rationales for Benefit Denials Not Raised During the Claims Review Process
The Ninth Circuit Court of Appeals, in Collier v. Lincoln Life Assurance Co. of Boston, has held that when a district court engages in a de novo review of an ERISA plan administrator’s denial of...
DOL “Clarifies” Guidance on the Bonding Requirements to PEPS and Their Pooled Plan Providers
By Stephen Wilkes, Seth Gaudreau and Susan Rees A recent Information Letter from Eric Berger, Chief, Division of Coverage, Reporting and Disclosure, in the Office of Regulations and Interpretations...
IRS Announces Increase in PCORI Fee
The IRS has released Notice 2022-59 to announce the “applicable dollar amount” for the Patient-Centered Outcomes Research Institute (“PCORI”) fee for plan years ending before October 1, 2023....
Department of Labor Proposes Updates to the Voluntary Fiduciary Correction Program
In 2002, the Employee Benefits Security Administration (“EBSA”) of the Department of Labor (“DOL”) established the Voluntary Fiduciary Correction Program (“VFCP”), a free program designed to...
IRS Announces Expansion of Change in Status Rules for Cafeteria Plans
One of the basic rules under which cafeteria plans operate is that elections are irrevocable except in certain limited circumstances. Further, even when those limited circumstances apply, the change...
The Wagner Law Group Signs Letter to Congress on Crucial HSA Issue
During the pandemic, Congress allowed telehealth services to be provided to HSA-eligible individuals without cost-sharing and without regard to whether they had met their deductibles under their...
IRS to Permit Determination Letters in Limited Circumstances for Individually Designed Code Section 403(b) Plans
Historically, an important element of compliance for tax-qualified plans under Code Section 401(a) or 403(a) was the submission of a request for a favorable determination letter on the form of the...
New IRS Regulations Resolve “Family Glitch” Issue
The IRS has issued final regulations amending the Affordable Care Act (“ACA”) rules regarding eligibility for the law’s premium tax credit (“PTC”). The new rules provide that the “affordability” of...
Despite TPA’s Contractual Obligation, Employer May Still Be Liable for COBRA Notice Violation
An Alabama district court, in Howard v. Ivy Creek of Tallapoosa, LLC, has held that an employer could not avoid liability for failing to provide a COBRA election notice to a plan participant at the...
Independent Review Prevents “Cat’s Paw” Liability in FMLA Retaliation Claim
The Tenth Circuit Court of Appeals, in Parker v. United Airlines, Inc., has held that the “cat’s paw” theory of liability for FMLA retaliation or interference claims does not apply if the employer...
IRS Releases 2023 Welfare Benefit Plan Limits
The IRS has released Revenue Procedure 2022-38, which sets forth the 2023 inflation-adjusted limits for certain employee welfare benefit plans and the dollar amounts used for certain discrimination...
IRS Issues Important Guidance with respect to Required Minimum Distribution Regulations
By Jon Schultze and Barry Salkin The SECURE Act made significant revisions to the required minimum distribution rules under Internal Revenue Code (“Code”) Section 401(a)(9) that apply to defined...
Agencies Request for Comments on Issues Related to New Disclosures Under the No Surprises Act Indicate the Importance of Informing Marginalized Populations and Maintaining Privacy of Advance Health Care Information
By Roberta Casper Watson, Dannae Delano and Barry Salkin It should come as no surprise that most Americans do not have the information available to them that is necessary to make informed decisions...
IRS Announces 2023 Cost-of-Living Adjustments Affecting Retirement Plans
By Ari Sonneberg The Internal Revenue Service announced cost-of-living adjustments affecting certain dollar limitations for pension plans and other retirement-related limitations for 2023 in Notice...
Court Finds Employer’s Evidence of COBRA Notice Mailing Procedures Insufficient
An Illinois federal district court, in Earl v. Jewel Food Stores, Inc., has concluded that an employer failed to show it made a good faith effort to provide a COBRA election notice to a terminated...
Insurer Must Make “Reasonably Proximate” Coverage Determinations
The U.S. Court of Appeals for the First Circuit has ruled, in Shields v. United of Omaha, that an insurer must make a coverage determination for a plan participant within a reasonable period of time...
Court Defers to Insurer’s Discretionary Authority
The Eleventh Circuit Court of Appeals, in Stewart v. Hartford Life & Accident Insurance Company, has upheld a lower court’s decision to deny a plaintiff’s appeal for long-term disability (“LTD”)...
Ninth Circuit Requires Lower Court to Consider New Evidence in LTD Suit
The Ninth Circuit Court of Appeals, in Kay v. Hartford Life and Accident Insurance Company, has reversed a lower court’s decision upholding an insurer’s termination of long-term disability (“LTD”)...
Federal Court Finds Key Part of ACA’s Preventive Service Mandate Unconstitutional
A Texas federal district court, in Braidwood Management, Inc. v. Becerra, has held that the Affordable Care Act’s (“ACA’s”) requirement that most group health plans and health insurers cover certain...
Department of Labor Updates Guidance on Independence of Qualified Plan Accountants
Plan sponsors of large employee benefit pension plans are familiar with the requirement of audited financial statements for annual reporting purposes. That requirement is discussed in the DOL’s...
“Probate Exception” Precludes Federal Jurisdiction over ERISA Lawsuit
The Sixth Circuit Court of Appeals, in American Electric Power Service Corporation v. John K. Fitch et al., has affirmed a district court’s dismissal of a group health plan’s ERISA action seeking...
Pay for Performance 2022: From Disclosure to Execution … to Retention
By Mark Poerio Tight labor markets tend to sharpen loyalty issues, as employers compete for an edge by which to retain — and motivate — their key employees. It does not take rocket science to defuse...
ERISA Lawsuit Time-Barred Due to Plan’s Limitations Period
The Eleventh Circuit Court of Appeals, in Bakos v. Unum Life Insurance Company of America, has upheld the dismissal of a lawsuit for wrongful denial of long-term disability (“LTD”) benefits because...
No Surprises in Agencies’ Reproposal of Independent Dispute Resolution Regulations on No Surprise Act Billing Arbitration
By Danae Delano, Roberta Watson and Barry Salkin Last November, we published a law alert regarding the first two rounds of regulatory guidance on the No Surprise Billing portion of the Consolidated...
SEC Provides Further Guidance in its Staff Bulletin: Standards of Conduct for Broker-Dealers and Investment Advisers Conflict of Interest
By Stephen Wilkes and Seth Gaudreau The U.S. Securities and Exchange Commission (“SEC”) recently published a Staff Bulletin (the “Bulletin”) providing further fiduciary standards guidance for...
Court Finds Employee-Paid LTD Policy Was Part of Employer’s ERISA Plan
A federal district court in the Middle District of Tennessee has held, in Insurance Company of America, that a long-term disability (“LTD”) policy offered under an employer’s group health plan was...
Inflation Reduction Act’s Impact on Group Health Plans
On August 16, 2022, President Biden signed into law the Inflation Reduction Act (“IRA”). The new legislation contains several provisions impacting group health plans. Below is a description of...
IRS Releases ACA Affordability Rates for 2023
The Internal Revenue Service has issued Revenue Procedure 2022-34 to implement the 2023 index adjustments for certain Affordable Care Act (“ACA”) contribution percentages used to determine...
Department of Labor (“DOL”) Proposes to “Update” QPAM Exemption
One of the most frequently used of the prohibited transaction class exemptions is Prohibited Transaction Class Exemption 84-14, which provides an exemption for Qualified Plan Asset Managers (the...
Agencies Issue Guidance on Contraception Coverage Requirements
The Department of Labor, Department of Health and Human Services, and the IRS (the “Agencies” ) have issued Frequently Asked Questions 54 (“FAQs”) regarding the contraception coverage requirements...
Employer Cannot Terminate Employee’s Vested Retiree Life Insurance Benefits
The U.S. Court of Appeals for the Fourth Circuit, in Bellon v. The PPG Employee Life, has ruled that an employer cannot terminate retiree life insurance coverage of employees for whom it had...
Wage and Hour Updates for Maine, New York, and New York City
By Katherine Brustowicz, David Gabor, Virginia Peabody I. Maine – Mandatory Vacation Payout Upon Separation from Employment Maine will follow Massachusetts’ lead in implementing mandatory vacation...
Multiemployer Plan Developments: PBGC Final Rule on Special Financial Assistance and Withdrawal Liability Actuarial Assumptions Litigation
By Dannae Delano and Israel Goldowitz On July 8, 2022, the Pension Benefit Guaranty Corporation (“PBGC”) issued its Final Rule (the “Final Rule”) implementing the American Rescue Plan Act of 2021...
ERISA World Awaits Next EBSA Move on Proposed Restrictions on the Prohibited Transaction Exemptions Process
It has been almost four months since the Employee Benefit Security Administration (EBSA) of the Department of Labor (“DOL”) published its proposed amendments to regulations for the procedures by...
HHS Issues Guidance on HIPAA Protections
In response to the Supreme Court ruling in Dobbs v. Jackson Women’s Health Organization, which overturned Roe v. Wade, the U.S. Department of Health and Human Services (“HHS”) has issued new HIPAA...
IRS Announces Decreases in ACA Affordability Threshold and Increases in ACA Employer Shared Responsibility Penalties for 2022 Plan Years
The IRS has recently updated its Questions and Answers on Employer Shared Responsibility Provisions under the Affordable Care Act to reflect 2022 indexing adjustments for the ACA’s affordability...
Employer Responses to Overturning of Roe v. Wade
Many employers are considering how to respond to the recent ruling overturning Roe v. Wade, which has given states the leeway to outlaw abortion. Employers may have employees who are on either side...
Delay in Final Claims Appeal Determination Excuses Claimant from ERISA’s Exhaustion of Administrative Remedies Requirement
The Second Circuit Court of Appeals, in McQuillin v. Hartford Life & Accident Ins. Co., has ruled that a claimant exhausted his plan’s administrative remedies and was, therefore, entitled to sue...
Plan’s Lawsuit Deadline Not Enforceable Unless Communicated in Final Claims Denial
In two recent cases, a judge in the United States District Court for the District of Utah has ruled that, if an ERISA welfare benefit plan sets a time limit on when a claimant may file a civil...
Required Minimum Distribution Modifications Applicable to Defined Benefit Plans as Well
While most of the attention was on how the IRS’s proposed regulation would address tax-qualified defined contribution plans and IRAs, the IRS also took the opportunity to update the existing...
Employer Can Interfere with FMLA Rights Without Denying FMLA Leave
The United States Court of Appeals for the Seventh Circuit, in Ziccarelli vs. Dart, has ruled that an employer need not deny FMLA leave to an employee in order to interfere with his FMLA rights....
IRS Announces New Pre-Audit Compliance Pilot Program
Last week, the IRS announced via newsletter a new pre-audit compliance opportunity for employer-sponsored retirement plans selected for audit beginning immediately (the “Pilot Program”). Under the...
Interaction Between FMLA and Mental Health Conditions
The Department of Labor (“DOL”) has released Fact Sheet 280 (“Fact Sheet”) and a series of FAQs with regards to the interplay between the FMLA and mental health conditions. Law. Under the FMLA,...
IRS Provides Guidance on Leave-Based Donation Programs for Ukraine
The IRS has issued Notice 2022-28 (the “Notice”) to explain the tax treatment of employer leave-based donation programs to aid the people of Ukraine. The Notice begins by stating that the “invasion...
Small Employer Did Not Commit Itself to FMLA Leave Requirements
In Jones v. Wireless Time of Alabama, the U.S. District Court, Southern District of Alabama ruled that an employee was not entitled to FMLA leave despite the fact that her employer referred to the...
Insurer Breached Fiduciary Duty to Maintain Effective Benefit Enrollment System
The Eighth Circuit Court of Appeals, in Skelton v. Radisson Hotel Bloomington, has upheld a district court’s decision that an insurer acted as a fiduciary in determining eligibility and conducting...
Are Brokerage Windows an Effective Way of Limiting Fiduciary Risk After Hughes v. Northwestern?
In Hughes v. Northwestern University, 142 S.Ct. 737 (January 24, 2022), the Supreme Court held that fiduciaries to self-directed defined contribution retirement savings plans are responsible for...
IRS Announces 2023 Limits for HSAs, HDHPs and Excepted Benefit HRAs
The IRS has announced the cost-of living adjustments to the applicable dollar limits for health savings accounts (“HSAs”), high deductible health plans (“HDHPs”) and excepted benefit health...