Health & Welfare

Final Regulations Rescind HIPAA Health Plan Identifier Rules

The Department of Health and Human Services ("HHS") has rescinded earlier regulations governing the health plan identifiers ("HPIDs") that group health plans were required to obtain and use in standard electronic transmissions as specified in the Health Insurance Portability and Accountability Act of 1996 ("HIPAA"). Background. The HPID is a unique 10-digit number that identifies a group health ...

LTD Claim Denial Subject to Stricter Standard of Review Due to Untimely Decision

The Seventh Circuit Court of Appeals, in Fessenden v. Reliance Standard Life Ins. Co., has held that a plan administrator's decision to deny a participant's claim for long-term disability ("LTD") benefits was subject to the de novo standard of review because the administrator failed to comply with ERISA's deadline for issuing a claims decision.

Participant May Sue Insurer Before Exhausting Administrative Remedies

The U.S. District Court for the District of Arizona has ruled, in Greiff vs. Life Insurance Company of North America, that a long-term disability plan participant need not exhaust an insurer's administrative remedies before suing in federal court, unless the insurance contract and other relevant communications specifically require such exhaustion.

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.