Health & Welfare

Courts Decides ACA’s Individual Out-Of-Pocket Limits Do Not Apply Retroactively

The U.S. District Court for the Southern District of New York, in Fisher v. Aetna Life Ins. Co., has upheld its prior determination that a beneficiary was required to meet the ACA’s family out-of-pocket cost-sharing limit rather than the individual limit. In reaching this outcome, the court concluded that HHS regulations interpreting the ACA’s cost-sharing provisions were not retroactively ...

Courts of Appeal Split on Circumstances Where it is Appropriate to Override the Arbitrary and Capricious Standard of Review

The U.S. Court of Appeals for the Eighth Circuit has ruled, in McIntyre v. Reliance Standard Life, that a claims decision will be judged under the arbitrary and capricious standard despite the fact that the claims administrator had a conflict of interest and that there were irregularities in the claims procedure.

IRS Again Extends Deadline for ALEs to Furnish ACA Reporting Forms to Employees

The IRS has issued Notice 2020-76, which provides an automatic deadline extension for Applicable Large Employers’ (“ALE”) reporting obligations to employees under the Affordable Care Act’s (“ACA”) Employer Mandate for the 2020 tax year. 

Plan Participants Must be Informed of Plan Documents and Standards of Review

The Tenth Circuit Court of Appeals has ruled, in Lyn M. v. Premera Blue Cross, that the “arbitrary and capricious” standard cannot be applied to a plan administrator’s denial of a participant’s claim unless the plan administrator has sufficiently notified the participant in advance that its decision will be subject to this standard of review.

Employer May Be Held Liable for Service Provider’s Error

The Second Circuit Court of Appeals, in Sullivan-Mestecky v. Verizon Communications, Inc., has held that a plaintiff properly pled her breach of fiduciary duty claim for equitable relief against an employer in connection with a third party administrator’s (“TPA’s”) clerical error in calculating life insurance benefits payable to her under the employer’s ERISA welfare plan.

DOL Responds to Decision of Southern District of New York Invalidating Four Provisions of the Family First Coronairus Response Act

By  Dannae Delano, Barry Salkin and Roberta Casper Watson

Additional COVID-19 FAQs from the DOL About School Reopenings

The Department of Labor (“DOL”) has issued additional Frequently Asked Questions (“FAQs”) on the administration of Emergency Paid Sick Leave under the Families First Coronavirus Response Act (“FFCRA”) and issues related to school reopenings.

Massachusetts Extends Annual Payroll Tax Exemption for Insured Plans

The Massachusetts Department of Family and Medical Leave has announced that the “annual” payroll tax exemptions received by employers for insured plans under the Paid Family and Medical Leave Law (the “Law”) have been extended. 

Ninth Circuit Rejects Request for Attorney’s Fees in ERISA Administrative Appeal

The Ninth Circuit Court of Appeals has held, in Castillo v. Metropolitan Life Ins. Co.,  that ERISA does not authorize an award of attorney’s fees incurred during the administrative phase of the ERISA claims process. 

DOL Releases New FMLA Forms

The U.S. Department of Labor (“DOL”) has released updated Family and Medical Leave Act (“FMLA”) forms.