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The Department of Health and Human Services ("HHS") has rescinded earlier regulations governing the health plan identifiers ("HPIDs") that group health plans were required to obtain and use in standard electronic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.

Participant's Disability Claim is Time-Barred

The U.S. Court of Appeals for the Second Circuit has ruled, in Arkun v. Unum Group, that a plan participant could not sue to restore her long-term disability ("LTD") benefits because the suit was time barred by the plan's provisions. Facts. The employee became disabled in 1999 and began receiving LTD benefits. In 2004, the plan informed her that she was no longer disabled and that benefits would ...

Court Upholds LTD Insurer's Claim Denial Based on Failed Validity Tests

The Eighth Circuit Court of Appeals, in Johnston v. Prudential Ins. Co., has affirmed a lower court's ruling that the defendant insurer acted appropriately in terminating the plaintiff's long term-disability ("LTD") insurance benefits based on evidence that the plaintiff was "deliberately exaggerating" his symptoms.