The Self-Insurer November 2015 Digital Edition

When industry leaders and self-funded employers wish to learn about emerging trends and innovations, education about legislation and change in the self-insurance/ alternative risk transfer industry, they turn to The Self-Insurer. Each issue features in-depth exploration and insight wh
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Court: Third-Party Administrator Is Proper Defendant

MyHealthGuide Source: Bloomberg BNA Pension & Benefits Daily, 11/8/2013, www.BNA.com Case: Nystrom v. AmerisourceBergen Drug Corp., 2013 BL 308000, D. Minn., No. 0:13-cv-00557-DSD-JJK, 11/6/13 Article referred by John Eggertsen, Esq. Attorney at Law, Eggertsen Consulting, P.C. A h
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Bullock Cannot Save ERISA Fiduciary, a Sole Corporate Shareholder Whose Company Failed To Make Multiemployer Fund Contributions, From Being Unable To Discharge His Liability Through Personal Bankruptcy.

Article Found On: Benefits Link   Written By: Ron Kramer & Chris Busey Fiduciaries who breach their duties may pay the consequences far longer than they may think, for they may not even be able to escape liability through personal bankruptcy.  In Raso v. Fahey (In re Fahey), No. 1
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Administrator Deemed To Be Fiduciary and Breached Fiduciary Duty on Self-Insured Plan

Case: Hi-Lex Controls Incorporated, et al, v. Blue Cross and Blue Shield of Michigan Case No: 11-12557.  Hon. Victoria A. Roberts presiding. This is an action for alleged violations of the Employee Retirement Income Security Act of 1974 (“ERISA”). Plaintiffs filed suit on
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Court Finds Breach of Fiduciary Duty Against Broker for Failure to Explain Interaction of Stop-Loss and Self-Funded Health Plan Coverage

In Express Oil Change, LLC v. ANB Insurance Services, Inc., the sponsor of an employee health plan (the “Employer”) decided to convert its funding for the plan from a fully-insured to a self-funded basis. In preparation for the conversion, the Employer sought the advice and expertise
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It’s a Matter of When, Not If: Validity of Class Action Waivers in ERISA Plans To Be Tested

In addition to reporting on active ERISA litigation, the authors of this blog take a great interest in potential future litigation. One such area is the validity of class action waivers (as part of arbitration clauses) in ERISA plans. On Friday, the Securities Law Prof Blog*** by Univ
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Trial Moves Ahead for Broker That Failed to Explain Coordination of Stop-Loss Policy and Self-Insured PD

This controversy arises from Plaintiff Express Oil’s attempt to create a self-funded health benefits plan for its employees while eliminating any uninsured risk for itself by procuring stop-loss insurance. Express Oil employed and relied on Defendants ANB Insurance and Alan Wood to he
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TPA’s Beware of Fiduciary Liability

I read with interest Steve Polino’s “From the Bench” column in the February 2013 issue of The Self-Insurer and agree that the court finally got it right. Hopefully all TPAs will take note of this Fifth Circuit Court decision and adjust their administrative practices accordingly. While
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Court Declines To Follow Amara Dicta On Surcharge And Denies Plaintiff’s Claim For Reimbursement For Denied Medical Procedure Under ERISA § 502(a)(3)

Plaintiff underwent back surgery that she believed to be covered by her health insurance plan — a fact she claimed was confirmed by an insurance plan representative.  Yet, after the procedure, the plan denied her claim because the plan’s terms excluded surgical procedures that were no
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Seventh Circuit Sides With Fiduciaries On Question of Out-of-Network Disclosures

At the summary judgment stage of the case, the district court dismissed James’s denial-of-benefits and breach-of-fiduciary-duty claims, but awarded him minimal statutory damages against the health plan administrator. James has appealed.   Read More..
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