ERISA

Life Insurance And Murder – ERISA

March 30, 2019 | Mark S. Humphreys

What happens when the named beneficiary on a life insurance policy intentionally causes the death of the insured? That was the question in this case from the Western District of Texas, San Antonio Division, opinion styled, Garrett Bean and Aneila Bean v. Minerva Alcorta.

Plaintiff’s father,Garry, has a $130,000 life insurance policy under which Alcorta was named the primary beneficiary and Garrett and Aneila were secondary beneficiaries of 50% each of the policy.

Alcorta was charged with intentional first degree murder of Garry.

Employer Health Plan That Is Governed By ERISA

March 23, 2019 | Mark S. Humphreys

The 5th Circuit Court of Appeals issued an opinion on January 31, 2019, in a case that is governed by the ERISA. The opinion is styled, Karen A. Rittinger v. Healthy Alliance Life Insurance Company.

Here, the beneficiary of a health plan governed by ERISA brought action against the plan administrator challenging the denial of coverage for her bariatric surgery and the follow-up surgery required after she developed complications. This Court ruled in favor of the plan administrator, ruling the administrator did not abuse its discretion when it treated e-mail from the plan beneficiary’s husband as a first-level appeal, and the administrator did not abuse its discretion in denying health plan beneficiary’s second level appeal.

Pursuant to 29 U.S.C.A., Sections 1001 et seq., the Court of Appeals reviews a district court’s grant of summary judgment in an ERISA case de novo.

Press Release # 4

March 16, 2019 | Mark S. Humphreys

The Law Office of Mark S. Humphreys, P.C., recently got a surprise for his client when contesting an ERISA life insurance claim.

The insured worked in Louisiana and had a life insurance policy through his employer. The insured was not married and did not have any children. Thus, the insured named his brother’s child as the beneficiary of his life insurance policy. The amount of the policy was $100,000. The insured was killed in a one vehicle accident. A claim was made for benefits. The plan administrator denied the claim benefit based on an exclusion if the deceased died as the result of intoxication. The toxicology report indicated proof of cocaine in the body of the insured at the time of the accident.

Mark hired a toxicology expert to write a report and contested the denial of benefits through the administrative process that has to be followed in ERISA claims. The report pointed out that the amount of cocaine in the system of the deceased was stated as being a “trace” amount. The toxicology expert report pointed out there was no way to prove intoxication had anything to do with the cause of death when the amount is just a “trace.”

Press Release # 3

March 12, 2019 | Mark S. Humphreys

Mark Humphreys law offices announce a recent settlement in two ERISA (Employee Retirement Income Security Act) cases in favor of clients. The laws of ERISA are governed by Federal Law rather than State Insurance Law. The laws are drastically in favor of the insurers.

One case involved a claim for Short Term Disability (STD) benefits and the other was for Long Term Disability (LTD) benefits.

The disability benefits were purchased by the employees through payroll deduction. These benefits, part of employee benefits packages, can also include health coverage and life insurance coverage.

ERISA Case Review

January 13, 2019 | Mark S. Humphreys

Employee Retirement Income Security Act (ERISA) cases have their own set of rules. Two things stand out about ERISA cases. One is that a person is not entitled to a jury trial in an ERISA case, rather a Judge reviews the administrative record in the case when deciding who is going to prevail in the case. Two is that there is very little to no discovery in the case.

This is illustrated in the 1998, 5th Circuit Court of Appeals opinion, Vega v. National Life Ins. Services, Inc.

Vega is a summary judgement case where Vega is appealing the decision rendered against hit. Part of his appeal addresses how the Court ruled as it relates to discovery in the case.

Life Insurance – ERISA

January 9, 2019 | Mark S. Humphreys

Here is a life insurance case that involves a plan under the Employee Retirement Income Security Act (ERISA). It is a 2018, 5th Circuit Court of Appeals case styled, Jason Crawford v. Metropolitan Life Insurance Company.

This is a summary judgment case granted in favor of MetLife. This Court sustained the ruling in favor of MetLife.

The deceased, Tracy Crawford, worked as a flight attendant for Southwest Airlines. Tracy enrolled in the company offered life insurance benefit plan in 2008, and submitted a paper document naming her great-nephew as the primary beneficiary.

ERISA Win

October 20, 2018 | Mark S. Humphreys

Here is a rare win in an ERISA case. Unfortunately the win is the the 7th Circuit Court of Appeals rather than the 5th Circuit which controls most ERISA plans for readers of this blog.

The ERISA case is styled, Susan Hennen v. Metropolitan Life Insurance Company. The case does illustrate how to win an ERISA case.

Hennen had received short term disability (STD) benefits for two years as the result of a back injury. Hennen then applied for long term disability (LTD) benefits. The disability plan that Hennen had contained a two year limit for neuromusculoskeletal disorder, subject to exceptions, including one for radiculopathy, a “Desease of the peripheral nerve roots supported by objective clinical findings of nerve pathology.” After Metlife terminated Hennen’s benefits, she sued under ERISA, arguing that Metlife’s determination that she did not have radiculopathy was arbitrary and capricious. The court hearing the case had granted summary judgment in favor or Metlife. This appeals court reversed the ruling saying Metlife acted arbitrarily when it discounted the opinions of four doctors who diagnosed Hennen with radiculopathy in favor of one physician who ultimately disagreed, but only while recommending additional testing that Metlife declined to pursue.

Life Insurance And ERISA Ruling

August 12, 2018 | Mark S. Humphreys

Here is a case from the United States 7th Circuit that deals with life insurance when the policy is an Employee Retirement Income Security Act (ERISA) policy. The case is styled, Emma Cehovic-Dixneuf v. Lisa Wong.

Pursuant to 29 U.S.C., Section 1104(a)(1)(D), ERISA requires administrators of employee benefit plans to comply with documents that control the plans. In the case of life insurance policies, that means death benefits are paid to the beneficiary designated in the policy, notwithstanding equitable arguments or claims that others might assert.

In this case, the employee, Georges Cehovic, had two life insurance policies through his employer and the policies named his sister Emma as the sole and primary beneficiary. When Georges died, his ex-wife, Wong, claimed that she and the child she had with Georges were entitled to the policy benefits.

ERISA Disability Claim

July 24, 2018 | Mark S. Humphreys

Disability claims filed under an ERISA plan are different than disability claims that are not governed by ERISA. The United State District Court, Northern District, Dallas Division, issued an opinion in 2018, that discusses these types of cases. The case is styled, Aaron Rome v. HCC Life Insurance Company.

This is a dispute between a former professional hockey player (Aaron) and his insurer (HCC).

Aaron suffered a career ending injury. He sough benefits under the HCC policy and was denied. Aaron filed suit in State Court including claims for violations of State law and the case was removed to Federal Court where HCC filed motions to have have the State law claims dismissed under Rule 12(b)(6) or in the alternative a motion for summary judgment.

ERISA – Conflict Of Interest – Life Insurance

July 15, 2018 | Mark S. Humphreys

Employee Retirement Income Security Act (ERISA) cases are difficult at best. But finally, here is a win in the courts. The 5th Circuit issued a ruling on June 13, 2018, in favor of a claimant. The case is styled, Ester Hill White v. Life Insurance Company of North America.

Among other issues, the Court first addressed whether LINA had a conflict of interest. This issue arises when the insurer of the plan also determines whether the claimant is entitled to benefits. A conflict of interest, such as the one in this case, should prove more important where circumstances suggest a higher likelihood that it affected the benefits decision.

The Court was concerned with LINA’s failure to address Dr. Fochtman’s report in its denial of life insurance benefits. White argues that such failure amounts to procedural unreasonableness. Procedural unreasonableness is important in its own right and also justifies the court in giving more weight to the conflict.