by Cody AllisonERISA and Mental Health Coverage
If you believe you have been wrongfully denied your ERISA, or non-ERISA, long-term disability benefits, give us a call for a free lawyer consultation. You can reach Cody Allison & Associates, PLLC at (615) 234-6000, or toll free (844) LTD-CODY. We are based in Nashville, Tennessee; however, we represent clients in many states (TN, KY, GA, AL, MS, AR, NC, SC, FL, MI, OH, MO, LA, VA, WV, just to name a few). We will be happy to talk to you no matter where you live. You can also e-mail our office at cody@codyallison.com. Put our experience to work for you. For more information go to www.LTDanswers.com
In the recent case of Emch v. Community Insurance Company d/b/a Anthem Blue Cross and Blue Shield, No. 1:17-CV-00856, 2019 WL 5538196 (S.D. Ohio Oct. 25, 2019), the plaintiff filed a putative class action alleging that an employer-sponsored health insurance plan improperly denied claims for residential mental health services for the plaintiff’s minor son. Notably, the plaintiff alleged that Ohio Rev. Code § 3923.281 (the Ohio Parity Act), a mental health parity statute in Ohio state law, was incorporated into the terms of the plan through a “Conformity with Law” clause, empowering him to seek relief through ERISA for alleged violations of the Ohio Parity Act.
The court denied the defendant’s motion to dismiss the complaint, holding that the plaintiff had stated plausible claims for relief under 29 U.S.C. § 1132(a)(1)(B) and 29 U.S.C. § 1132(a)(3) because the plan incorporated the Ohio Parity Act’s requirement that plans cover the “diagnosis and treatment of biologically based mental illnesses on the same terms and conditions as, and … provide benefits no less extensive than, those provided under the policy of sickness and accident insurance for the treatment and diagnosis of all other physical diseases and disorders ….” Ohio Rev. Code § 3923.281(B); see Emch, 2019 WL 5538196, at *3.
The court analyzed two prior district court cases where plaintiffs had argued that state mental health parity laws were incorporated into their plans: Bushell v. Unitedhealth Group, Inc., No. 17-CV-2021, 2018 WL 1578167 (S.D.N.Y. Mar. 27, 2018), and A.F. ex rel. Legaard v. Providence Health Plan, 35 F. Supp. 3d 1298 (D. Or. 2014). The defense urged the court to follow the reasoning in Bushell that rejected a similar claim and cautioned that it would improperly expand the scope of relief available under ERISA. See Bushell, 2018 WL 1578167 at *4 (holding that the plaintiff “cannot enforce” a New York mental health parity law “under the guise of an ERISA claim” and noting that a contrary conclusion “would mean that this one provision allows suit for violation of any state or federal law”). But the court followed the reasoning in Legaard that a plaintiff has standing to enforce provisions of state statutes incorporated into her plan through ERISA. See Legaard, 35 F. Supp. 3d at 1305 (holding that plaintiff had stated a cause of action under 29 U.S.C. § 1132(a)(3) for violation of the Oregon mental health parity statute, and that “ERISA provides courts with the power to enjoin violations of state law regulating insurance that have become part of the terms of the plan”). The Emch litigation continues following the court’s denial of the motion to dismiss. This case is discussed at this link: https://www.jdsupra.com/legalnews/recent-decisions-addressing-mental-69640/
by Cody AllisonJohnson v. General Electric Company, (9th Circuit May 21, 2019) No. 18-35581
If you believe you have been wrongfully denied your ERISA, or non-ERISA, long-term disability benefits, give us a call for a free lawyer consultation. You can reach Cody Allison & Associates, PLLC at (615) 234-6000, or toll free (844) LTD-CODY. We are based in Nashville, Tennessee; however, we represent clients in many states (TN, KY, GA, AL, MS, AR, NC, SC, FL, MI, OH, MO, LA, VA, WV, just to name a few). We will be happy to talk to you no matter where you live. You can also e-mail our office at cody@codyallison.com. Put our experience to work for you. For more information go to www.LTDanswers.com
In this case, the Court reviewed and found that the lower court did not err in finding that the claimant did not establish her further entitlement to long term disability payments under the plan terms. The Court found that she was entitled to payments based on her “normal straight-time annual earnings” but was not entitled to payments based on commissions, other variable compensation or special or supplemental payments, unless the Pension Board at General Electric determined that normal straight-time earnings also includes this income. The Court found that the Board had not made such a determination.
Notably, the Court found that the lower court did not err in allowing in extrinsic evidence — statements of GE and MetLife employees — because, when the de novo review applies, the court must exercise its discretion to consider new evidence in order to get the full picture to exercise its informed judgment.
by Cody AllisonExhaustion of Administrative Remedies under ERISA
If you believe you have been wrongfully denied your ERISA, or non-ERISA, long-term disability benefits, give us a call for a free lawyer consultation. You can reach Cody Allison & Associates, PLLC at (615) 234-6000, or toll free (844) LTD-CODY. We are based in Nashville, Tennessee; however, we represent clients in many states (TN, KY, GA, AL, MS, AR, NC, SC, FL, MI, OH, MO, LA, VA, WV, just to name a few). We will be happy to talk to you no matter where you live. You can also e-mail our office at cody@codyallison.com. Put our experience to work for you. For more information go to www.LTDanswers.com
Fortier v. Hartford Life & Accident Ins. Co., 916 F.3d 74 2019 EB Cases 55547 (1st Cir. 2019) (exhaustion of administrative remedies).
Fortier received long-term disability (LTD) benefits under a group disability plan insured by Hartford Life & Accident Insurance Company (“the Plan”). The Plan only pays 24 months of benefits for disabilities caused by mental illnesses. Hartford approved and paid Fortier’s LTD benefits before sending her notice on September 13, 2011 that her benefits would terminate in the future on November 1, 2011 due to the Plan’s Mental Illness Limitation. The letter informed Fortier of her right to appeal within 180 days of the date that she received the letter. Fortier retained an attorney who submitted a timely appeal and was able to get her benefits reinstated. Shortly after reinstating her claim, Hartford explained that since it did not give Fortier prior notice of the application of the Mental Illness Limitation, it was starting the 24-month period as of September 13, 2011 and no benefits will be payable beyond September 12, 2013.
After completing an investigation and review of Fortier’s claim, Hartford notified Fortier’s attorney by letter dated July 17, 2013 that it would stop paying benefits on September 13, 2013 because it had determined that the Mental Illness Limitation applied to the claim. The letter also notified Fortier of her right to appeal within 180 days of receipt of the letter. Fortier did not appeal within 180 days but sent in a letter purporting to appeal two months after Hartford’s stated deadline. Hartford declined to consider the appeal because it was untimely.
The First Circuit rejected the plaintiff’s argument that the 180-day period should run from the date of the termination of benefits and not from the date of the July 17, 2013 notice of the adverse decision. It held that the 180-day time limit to appeal an adverse benefit determination began to run from the date of the notice of the determination. The court also found that Hartford followed the terms of the Plan, which were consistent with ERISA’s requirements, when it provided her notice of the benefit determination and her right to appeal within 180 days.
Although the doctrine of “substantial compliance” has been applied to excuse an insurer’sfailure to comply with ERISA’s notice requirements, it does not apply to late appeals by claimants. The court agreed with the Seventh Circuit’s decision in Edwards v. Briggs & Stratton Ret. Plan, 639 F.3d 355 (7th Cir. 2011), which reasoned that applying the doctrine to the exhaustion requirement “would render it effectively impossible for plan administrators to fix and enforce administrative deadlines while involving courts incessantly in detailed, case-by-case determinations as to whether a given claimant’s failure to bring a timely appeal from a denial of benefits should be excused or not.” Id. at 362. The court also explained that nothing in the ERISA regulations is undermined by insurers applying deadlines strictly against plan participants.
Lastly, like the Seventh and Ninth Circuits, which have considered this issue, the court held that New Hampshire’s common law notice-prejudice rule does not apply to ERISA appeals: “[t]he exhaustion requirement — and several of its underlying policy goals — would be undercut by an extension of a state law notice-prejudice rule to ERISA appeals.”
by Cody AllisonHow does the SECURE Act Impact Retirement Plans?
On December 20, 2019, the SECURE Act became law. SECURE stands for “Setting Every Community Up for Retirement Enhancement.” It has impacted ERISA plans. Mostly, this Act will affect the employers’ and plan providers’ side of the ERISA plan. However, you will want to be aware that you may be getting information from your plan provider soon which will make changes to your plan. These changes are required by SECURE.
Below is a link to an article which lists the major areas of change that will be coming to your ERISA plan. Review this list and make sure that what your provider is doing under SECURE is what is mandated. Remember, if you have difficulty with your plan, contact us — we are here to help.
If you believe you have been wrongfully denied your ERISA, or non-ERISA, long-term disability benefits, give us a call for a free lawyer consultation. You can reach Cody Allison & Associates, PLLC at (615) 234-6000, or toll free (844) LTD-CODY. We are based in Nashville, Tennessee; however, we represent clients in many states (TN, KY, GA, AL, MS, AR, NC, SC, FL, MI, OH, MO, LA, VA, WV, just to name a few). We will be happy to talk to you no matter where you live. You can also e-mail our office at cody@codyallison.com. Put our experience to work for you. For more information go to www.LTDanswers.com
https://www.natlawreview.com/article/secure-act-and-its-impact-retirement-plans
by Cody AllisonWhat are the Effects of ERISA on Healthcare Plans
The link below is to an article that examines how ERISA and the Affordable Care Act have meshed to allow for treatment. Spoiler! — not very well. ERISA plans may actually keep some provisions of the ACA from applying to certain individuals. Remember, if you are having difficulty with your ERISA claim, contact us. We are here to help!
If you believe you have been wrongfully denied your ERISA, or non-ERISA, long-term disability benefits, give us a call for a free lawyer consultation. You can reach Cody Allison & Associates, PLLC at (615) 234-6000, or toll free (844) LTD-CODY. We are based in Nashville, Tennessee; however, we represent clients in many states (TN, KY, GA, AL, MS, AR, NC, SC, FL, MI, OH, MO, LA, VA, WV, just to name a few). We will be happy to talk to you no matter where you live. You can also e-mail our office at cody@codyallison.com. Put our experience to work for you. For more information go to www.LTDanswers.com
https://www.healthaffairs.org/do/10.1377/hblog20170602.060391/full/
by Cody AllisonWHAT DOES ERISA COVER?
Below is the link to an informative article about the basics of ERISA and what is covered. It gives a thumbnail snapshot of ERISA for the layperson and will help you understand general information about ERISA. Remember, however, that the actual application of the law can be very complex and often requires an expert to work out. We are here to help you. If you have an ERISA claim, or are thinking of making an ERISA claim, call us. We can help!
If you believe you have been wrongfully denied your ERISA, or non-ERISA, long-term disability benefits, give us a call for a free lawyer consultation. You can reach Cody Allison & Associates, PLLC at (615) 234-6000, or toll free (844) LTD-CODY. We are based in Nashville, Tennessee; however, we represent clients in many states (TN, KY, GA, AL, MS, AR, NC, SC, FL, MI, OH, MO, LA, VA, WV, just to name a few). We will be happy to talk to you no matter where you live. You can also e-mail our office at cody@codyallison.com. Put our experience to work for you. For more information go to www.LTDanswers.com
https://www.thebalancecareers.com/what-is-erisa-law-3515060
by Cody AllisonWhat is ERISA?
Below is a link that will take you to an article which explains the broader points of ERISA law in a nutshell. Many times the most difficult thing in making a claim under your long-term disability insurance plan is understanding what rules apply to your plan.
Long-term disability policies are written in such a way that they can be confusing to the layperson. Sometimes, things seemingly as simple as when and how to make a claim may be unreasonably confusing.
Remember, we are here to help you. Here at Cody Allison and Associates, we deal with problems like these every day. Contact us if you need to make a claim, or if you have made a claim and are uncertain as to how to proceed. Remember, we are here to help.
If you believe you have been wrongfully denied your ERISA, or non-ERISA, long-term disability benefits, give us a call for a free lawyer consultation. You can reach Cody Allison & Associates, PLLC at (615) 234-6000, or toll free (844) LTD-CODY. We are based in Nashville, Tennessee; however, we represent clients in many states (TN, KY, GA, AL, MS, AR, NC, SC, FL, MI, OH, MO, LA, VA, WV, just to name a few). We will be happy to talk to you no matter where you live. You can also e-mail our office at cody@codyallison.com. Put our experience to work for you. For more information go to www.LTDanswers.com
by Cody AllisonERISA and Arbitration
Below is a case dealing with arbitrating ERISA claims. Remember, if you need help, call us.
If you believe you have been wrongfully denied your ERISA, or non-ERISA, long-term disability benefits, give us a call for a free lawyer consultation. You can reach Cody Allison & Associates, PLLC at (615) 234-6000, or toll free (844) LTD-CODY. We are based in Nashville, Tennessee; however, we represent clients in many states (TN, KY, GA, AL, MS, AR, NC, SC, FL, MI, OH, MO, LA, VA, WV, just to name a few). We will be happy to talk to you no matter where you live. You can also e-mail our office at cody@codyallison.com. Put our experience to work for you. For more information go to www.LTDanswers.com
by Cody AllisonUNIFORM STANDARDS ON ERISA CLAIMS
Below is a link to an article regarding attempts to convince the U.S. Supreme Court to set a uniform standard in determining whether ERISA claims should be dismissed or allowed to proceed. These briefs as submitted argue that the ERISA law has been applied incorrectly by the lower courts and there is not set standard in determining how to cases proceed.
Remember, if you have trouble with your long-term disability claim or if you need help in filing one, contact us.
If you believe you have been wrongfully denied your ERISA, or non-ERISA, long-term disability benefits, give us a call for a free lawyer consultation. You can reach Cody Allison & Associates, PLLC at (615) 234-6000, or toll free (844) LTD-CODY. We are based in Nashville, Tennessee; however, we represent clients in many states (TN, KY, GA, AL, MS, AR, NC, SC, FL, MI, OH, MO, LA, VA, WV, just to name a few). We will be happy to talk to you no matter where you live. You can also e-mail our office at cody@codyallison.com. Put our experience to work for you. For more information go to www.LTDanswers.com
https://www.pionline.com/courts/groups-lobby-supreme-court-uniform-standard-erisa-violation-claims
by Cody AllisonERISA Cases – Key Decisions in 2018
Below is a link which discusses some key decisions made in relation to ERISA cases in 2018. It is important to be as familiar as possible with new developments in the ERISA law if you are making a claim for long-term disability. This is where we can help. We are well-versed in the law as it relates to ERISA, and we are here to help you. Contact us today!
If you believe you have been wrongfully denied your ERISA, or non-ERISA, long-term disability benefits, give us a call for a free lawyer consultation. You can reach Cody Allison & Associates, PLLC at (615) 234-6000, or toll free (844) LTD-CODY. We are based in Nashville, Tennessee; however, we represent clients in many states (TN, KY, GA, AL, MS, AR, NC, SC, FL, MI, OH, MO, LA, VA, WV, just to name a few). We will be happy to talk to you no matter where you live. You can also e-mail our office at cody@codyallison.com. Put our experience to work for you. For more information go to www.LTDanswers.com