Health & Welfare

No Breach of ERISA Fiduciary Duty for Employer's Failure to Provide Notice of Life Insurance Conversion Rights

The Sixth Circuit Court of Appeals, in Vest v. Resolute FP US Inc., has affirmed a district court's decision to dismiss a breach of fiduciary duty claim based on a sponsoring employer's failure to disclose information about conversion rights, because the plaintiff's complaint did not contain unique facts and circumstances that showed the employer knew its "silence might be harmful."

HHS's Final Rule Increases Penalty Amounts for HIPAA Noncompliance

HHS has issued a final rule, effective October 11, 2018, to implement certain inflation adjustments to the civil monetary penalties imposed on violations of the administrative simplification rules of the Health Insurance Portability and Accountability Act ("HIPAA"). Background. The inflation adjustments are required under the Federal Civil Penalties Inflation Adjustment Act of 2015 (the "Act"). ...

ERISA Does Not Preempt State's Unfair Trade Practices and Mental Health Parity Laws

In Hansen v. Group Health Plan Cooperative, the Ninth Circuit Court of Appeals ruled that a state's unfair trade practices and mental health parity laws will not be preempted by ERISA unless certain requirements are met. Facts: A group of psychiatric service providers sued an insurance company under the state's unfair trade practices law, claiming that the insurer's use of certain screening ...

IRS Provides Additional Guidance on Paid Family and Medical Leave Tax Credit

The IRS has issued Notice 2018-71 which provides additional guidance on the paid Family and Medical Leave Act ("FMLA") tax credit which was created by the Tax Cuts and Jobs Act of 2017.

Individual Policies May Create ERISA-Covered Plan

The federal district court for the Eastern District of California has ruled, in Bommarito v. Northwestern Mutual Life, that a group of individual insurance policies are an ERISA-covered plan because of the employer's actions regarding the purchase of the policies.

Agreement Required District Court to Consider Information from Post-Complaint Internal Review Process

The First Circuit Court of Appeals, in Doe v. Harvard Pilgrim Health Care ("HPHC"), has held that the district court erred in upholding a benefit claim denial because it neglected to enforce an agreement between the parties to supplement the record to include information generated during a post-complaint benefits review.

Certain Employers Receiving IRS Letters to Request Information on ACA Reporting

The IRS has been sending letters to certain employers to request information about whether they satisfied their ACA reporting obligations for 2015 and 2016. Specifically, the letter is entitled "Request for Employer Reporting of Offers of Health Insurance Coverage" or "Letter 5699."

DOL Confirms that Organ Donors Can Qualify for FMLA Leave

The U.S. Department of Labor ("DOL") has released Opinion Letter FMLA 2018-2-A confirming that organ donation surgery can qualify as a "serious health condition" that is eligible for protection under the Family and Medical Leave Act of 1993 ("FMLA"). The DOL's opinion comes in response to an inquiry it received from Congresswoman Jaime Herrera Beutler (R-WA, 3rd District).

Unwanted Employer-Paid Life Insurance Taxable to Employee

The Fifth Circuit Court of Appeals, in Ramsay v. Commissioner of Internal Revenue, has upheld the Tax Court's determination that the value of employer-paid group term life insurance was taxable compensation for an employee despite his claim that he neither requested nor wanted the coverage.

Court Says Administrator's Denial of Disability Benefit Claim Was Arbitrary and Capricious

The Tenth Circuit Court of Appeals, in McMillan v. AT&T Umbrella Benefit Plan No. 1, has affirmed a district court's decision to reverse a plan administrator's denial of short-term disability benefits on the basis that that it acted arbitrarily and capriciously in denying an employee's claim.