Posts Categorized: Court Cases

Ninth Circuit Issues Shocking Opinion Concerning Health Care Provider ERISA Claims

in Court Cases, Health Benefits

The Ninth Circuit Court of Appeals is not known for being employer-friendly.  So, when the Ninth Circuit issued its latest opinion on health care provider ERISA claims, most thought it would be against employer-sponsored health plans.  But, in a shocking opinion, the Ninth Circuit dealt health care providers a serious (and possibly fatal) blow to their recent crusade to use ERISA to pursue claims for reimbursement against employer-sponsored health plans. In DB Healthcare v. Blue Cross Blue Shield of Arizona, Inc. and Advanced Women’s Health Center, Inc. v. Anthem Blue Cross Life and Health Insurance Co., the Ninth Circuit affirmed… Continue Reading

Wellness Benefits Case Arising Before the 2016 ADA Regulations Is Dismissed

in Court Cases, Welfare Benefits, Wellness Programs

The debate on the interaction between wellness programs, the ADA prohibition on involuntary medical exams and the ADA safe harbor relating to employee benefit plans will not be clarified.  Last week, the U.S. Court of Appeals for the 7th Circuit upheld the lower court’s dismissal of the case, EEOC v. Flambeau, Case No. 3:14-cv-00638-bbc.  The 7th Circuit dismissed the EEOC’s case against Flambeau on the basis that it was moot – the employer had dropped its mandatory wellness program which included biometric screenings as a condition for enrolling in its subsidized health benefits, and there had been no harm to… Continue Reading

The Demise of ERISA Preemption has been Exaggerated

in Court Cases, Health Benefits

Many states have recently enacted laws requiring insurers, and self-funded health plans, to report detailed medical information to state databases, including eligibility and medical claims data.   The purpose of collecting this information in what are known as “all payer claim databases” is to find ways to control health care costs and improve outcomes.  Today, in a case challenging Vermont’s law requiring self-funded health plans subject to ERISA to disclose this information, the Supreme Court, in a 6-2 decision, agreed with the Second Circuit Court of Appeals:  the Vermont statute is preempted by ERISA with respect to self-funded health plans. Click here… Continue Reading

Liability under ERISA for Reducing Work Schedules?

in Affordable Care Act, Court Cases

Earlier this week, the Southern District of New York denied a motion to dismiss a case against Dave & Buster’s, Inc. – a development that is sure to concern many employers around the country.  This case, Marin v. Dave & Busters,  raises the question of whether an employer, by reducing its employees’ full-time hours to avoid providing health insurance or paying a penalty under the Affordable Care Act, is discriminating in violation of ERISA Section 510.  In a nutshell, ERISA Section 510 makes it unlawful for an employer to discriminate against a participant for exercising a right to which he… Continue Reading

Harris v. Amgen

in Court Cases, Fiduciary Issues, Qualified Plans

On January 25, 2016, the United States Supreme Court issued an opinion in Harris v. Amgen that will impact the pleading standard for stock drop litigation. The plaintiffs in Harris are former employees of Amgen Inc. who participated in their employer’s qualified ESOPs. When the value of Amgen stock fell significantly from 2005 to 2007, participants sued, claiming that Amgen violated their fiduciary duty of care under ERISA by continuing to offer the Amgen common stock fund as an investment option in the plans, when they knew (or should have known) that the stock was being sold to participants at… Continue Reading