Transportation Industry Newsletter - Fall 2015

Page 1

September

2015 4 Investment Annuity

6 Conflicting Statutes

8 Restrictive Covenant

10 Message From the Editors

5 Billing Dispute

7 Rescission of Disability

9 Plan Fiduciary’s Claim

11 Continuing Breach Theory Rejected; Disability Benefits Claim Barred by Statute of Limitation

Not Exempt, and Cash Value of Life Insurance Not Fully Exempt, from Bankruptcy Estate

Between Patient and Hospital Preempted by ERISA

and Validity of STOLI Policies Certified to Florida Supreme Court

Policies Reversed Based on Ambiguous Questions in Applications

in Agent’s Contract Depends on Whether Customer Lists Constitute “Trade Secret”

against Attorneys for Equitable Relief Survives Motion to Dismiss

ERISA & LIFE INSURANCE NEWS

Covering ERISA and Life, Health and Disability Insurance Litigation

Courts Tackle Issues Left Unresolved by Heimeshoff v. Hartford At the very end of 2013, the Supreme Court in Heimeshoff v. Hartford Life & Accident Insurance Company, 134 S. Ct. 604 (2013), enforced a three-year contractual limitation period which commenced when the ERISA plan participant’s proof of disability was due. Recognizing that a cause of action does not accrue until the issuance of a final denial, the Court nonetheless ruled: “Absent a controlling statute to the contrary, a participant and a plan may agree by contract to a particular limitations period, even one that starts to run

before the cause of action accrues, as long as the period is reasonable.” 134 S. Ct. at 610. In Heimeshoff, approximately one year remained to file suit following the end of the administrative review process, allowing the Court to conclude that the limitation provision was “reasonable.” Responding to concerns regarding the effect of a lengthy administrative review period on the running of such a limitation period, the Court reasoned that “in the rare case where internal review prevents participants from bringing § 502(a) (1)(B) actions within the contractual period, courts are well equipped to apply traditional doctrines that may nevertheless allow participants to proceed.” 134 S. Ct. at 615. The Court specifically suggested “waiver or estoppel” where the

administrator’s conduct caused the participant to miss the lawsuit deadline, and “equitable tolling” in the event that “extraordinary circumstances” prevented the timely filing of a suit. The Court did not directly address related scenarios, such as when a disability claim has been paid through the entire contractual limitation period and only thereafter denied, leaving the participant with no recourse if the plan terms are applied literally. Similarly, and although it was an issue in the district court, the Court did not address the extent to which a plan administrator must notify the participant (beyond the notice provided by the plan documents themselves) of the contours of any applicable contractual limitation provision. >>


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