Articles Posted in ERISA

Lawyers who handle ERISA cases always have to explain to their clients that in ERISA cases, the administrative process has to be completed before a lawsuit can be filed.  This is illustrated in this 2019 opinion from the Southern District of Texas, Houston Division case styled, Lisa K. Bunner v. Dearborn National Life Insurance Company, et. al.

This case arises out of denial of long-term disability benefits to Lisa contained in her employee welfare benefit plan.  This case is governed by the Employee Retirement Income Security Act of 1974 (ERISA).

The details of this case can be read in the opinion.  What is relevant here is the Court stating / emphasizing the requirement that the administrative process be exhausted prior to filing a lawsuit.

Here is another case for life insurance lawyers to read and make part of their knowledge of life insurance cases involving ERISA.  The case is from the Northern District of Texas, Dallas Division.  The case style is, Stephanie Taylor v. Metropolitan Life Insurance Company.

This ERISA life insurance case was decided on motions for summary judgment in favor of MetLife.

Stephanie is the beneficiary under a policy of life insurance insuring her husband, Jonathan.  They had a policy of Basic Employee Life Insurance for $136,000 and $271,000 of Supplemental Employee Life Insurance.

How does Federal law work with the Texas Slayer Statute, Texas Insurance Code, Section 1103.151?

This question is answered in the 1992, Fifth Circuit opinion styled, Metropolitan Life Insurance Co. v. White.

This is a summary judgement case.  Terri Yohey was the named insured under a group life insurance policy issued by Metropolitan under the Federal Employees Group Life Insurance Act (FEGLIA).  At the time of her death she had not designated a beneficiary.  Her widower, Leslie Yohey, was convicted of her murder.

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.

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.

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.”

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.

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.

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.

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.