ERISA and Life Insurance News

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Attorneys at Law

ERISA and Life Insurance News Covering ERISA and Life, Health and Disability Insurance Litigation

INSIDE THIS ISSUE Fourth Circuit Applies Fiduciary Exception to Attorney-Client Privilege............................................3 Insurer May Waive Policy Provisions Regarding Change of Beneficiaries...............................5 Non-Compliance with Claim Manual Does Not Require Reversal ..........................................5 Benefits Payable to “Surviving Spouse” Separated from Insured for 20 Years.............................6 Action Allowed Against Beneficiary to Recover ERISA Plan Benefits .....................................6 Breach of Fiduciary Duty Action Dismissed Because Plaintiffs Lacked Standing to Sue...................7 Providing Incomplete Records to Reviewing Physician Was Not an Abuse of Discretion................8 STD Insurer Not Liable for Producing Records in Employment Litigation.............................9 Failure to Consider Subjective Pain Results in Award of Benefits and Fees....................................10 Substantial Value of Benefits Claim Did Not Make Conflict of Interest More Signficant................11

oCToBER 2011

Plan Participant May Be Able to Claim Benefits and Appropriate Equitable Relief under ERISA ERISA’s civil enforcement provisions set forth the exclusive causes of actions and remedies available under ERISA. Plan participants and beneficiaries may bring actions “to recover benefits due [them] under the terms of the plan, to enforce rights under the terms of the plan, or to clarify [their] rights to future benefits under the terms of the plan.” ERISA, § 502(a)(1)(B). Actions alleging breach of fiduciary duties, actions to enjoin violations of ERISA or of the plan, actions for other equitable relief for such violations, and actions for violations of ERISA’s reporting requirements, may be brought by participants, beneficiaries, fiduciaries, and the Secretary of Labor. ERISA, §§ 502 (a)(2)-(a)(5). The plaintiffs in Del Rosario v. King & Prince Seafood Corp., 2006 u.S. Dist. LEXIS 76777, *4 (S.D. Ga. mar. 7, 2006), sought “recovery of benefits they believe they are owed” under their former employer’s Employee Stock Ownership plan, relying on § 502(a)(1)(B) of ERISA. They also alleged breach of fiduciary duty under § 502(a)(3). The defendants moved to dismiss the breach of fiduciary duty claim based on well-settled Eleventh Circuit precedent holding that an ERISA claimant who seeks the kind of relief available under § 502(a)(1)(B) – “to recover benefits due to him under the terms of his plan, to enforce his rights under the terms of the plan, or to clarify his rights to future benefits under the terms of the plan” – may not also pursue a breach of fiduciary duty action under § 502(a)(3). See Katz v. Comprehensive Plan of Group Ins., 197 F.3d 1084, 108990 (11th Cir. 1999) (upholding district court’s conclusion “that an ERISA plaintiff with an adequate remedy under § [502](a)(1)(B), cannot alternatively plead and proceed under § [502] (a)(3).”). CoNTINuED oN pAGE 2>>


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ERISA and Life Insurance News by Smith Moore Leatherwood - Issuu