Health & Welfare

ERISA Plan Administrator Denies STD Claim Too Quickly

The United States District Court for the District of Nevada, in Speca v. Aetna Life Ins. Co., has ruled that a ERISA plan administrator did not provide a full and fair review when it denied a short term disability ("STD") claim in just 14 days and before receiving medical records from the plaintiff's treating physicians.

Attending Children's Special Education Meetings Covered by FMLA

The U.S. Department of Labor ("DOL") has released Opinion Letter FMLA 2019-2-A confirming that an employee may take leave under the Family Medical Leave Act of 1993 ("FMLA") to attend special education meetings called "Individualized Education Programs" ("IEPs") for children with serious health conditions.

Requirements for Requesting FMLA Leave Cannot Be More Onerous than for Requesting Non-FMLA Leave

The United States District Court for the Southern District of Alabama, in Moore v. GPS Hospitality Partners IV, LLC, etc., has ruled that an employer's notice and procedural rules for requesting FMLA leave violated the law because it placed additional burdens on employees seeking FMLA leave. Law. Employees who take FMLA leave may be required to comply with the employer's usual and customary ...

Plan Administrator Deemed an ERISA Fiduciary

The Fourth Circuit Court of Appeals, in Dawson-Murdock v. Nat'l Counseling Group, Inc., has allowed a life insurance beneficiary to sue her husband's employer for breach of fiduciary duties concluding that she had sufficiently alleged that the employer was an ERISA fiduciary.

IRS Releases ACA Affordability Rates for 2020

The Internal Revenue Service has issued Revenue Procedure 2019-29 to implement the 2020 index adjustments for certain Affordable Care Act ("ACA") contribution percentages used to determine affordability under the employer shared responsibility mandate. Background. Under the ACA, contribution percentages are used to determine: (i) whether an Applicable Large Employer ("ALE") is subject to the ...

IRS Expands List of Preventive Care Benefits

IRS has issued Notice 2019-45 which expands the list of "preventive care benefits" permitted to be provided by a high deductible health plan ("HDHP") when determining if an individual is eligible to make tax-exempt contributions to a health savings account ("HSA"). In general, an individual is eligible to contribute (or have his or her employer contribute) to an HSA if he or she participates in ...

A Sigh of Relief For Employers Subject to Potential ACA Disparate Impact Discrimination Claims

In the aftermath of Title VI of the Civil Rights Act of 1964, litigants have pressed courts on what conduct meets the criteria for a disparate impact discrimination claim. Typically, a disparate impact discrimination claim contends that a facially neutral employment practice has a discriminatory effect on a protected class of people such as race, gender, or age. In contrast to traditional ...

Was The Court of Claims Correct for the Wrong Reason?

In Iowa Bankers Benefit Plan v. United States, the Court of Federal Claims decided that the Iowa Bankers Benefit Plan, a group health arrangement, is within the Affordable Care Act ("ACA") definition of a "covered entity" under Section 9010 of the ACA, subject to the annual fee on health insurance providers. Section 9010 of the ACA is not codified, but is interpreted by the IRS regulation at 26 ...

Court Finds an Employee's Vacation While On FMLA Leave is Acceptable

The Massachusetts Supreme Judicial Court ("SJC"), in DaPrato v. Mass. Water Resources Authority, has affirmed a jury's finding that an employee was wrongfully terminated for taking a vacation to Mexico during a period of Family and Medical Leave Act ("FMLA") leave. In doing so, the SJC also upheld the trial court's decision to award the employee liquidated damages under the FMLA.

Apprenticeship Training Programs Must File Electronic Notice to be Exempt from ERISA's Reporting and Disclosure Requirements

The U.S. Department of Labor ("DOL") has issued new regulations requiring apprenticeship training programs to file electronically in order to take advantage of an exemption from ERISA's reporting and disclosure requirements. (See DOL Reg. § 2520.104-22) An apprenticeship training program ("ATP") is an employee welfare benefit plan that exclusively provides apprenticeship training and other ...