A California ERISA Potpourri to begin the New Year

Los Angeles, CA: Something old and something new to begin the year on the California ERISA file. ERISA is the Employee Retirement Income Security Act (as amended 1974), a federal statute that also reaches into individual states and is designed to protect the rights, and the future incomes of workers having already retired, or nearing retirement and already beyond their peak earning years.

January 12, 2017

US Supreme Court to Review ERISA Findings from Appellate Courts

Washington, DC: A court challenge that pits church-based health networks against ERISA provisions and interpretations is to be heard by the highest court in the land, following notification on December 2 that the US Supreme Court is going to weigh in by agreeing to review recent decisions by the appellate courts. As one of the health networks is based in California, the case is expected to have some influence and impact on California ERISA labor law.

December 11, 2016

California ERISA Lawsuit Alleges Pension Underfunding Worth $1.2 Billion

Los Angeles, CA: A California ERISA lawsuit is demonstrative of the interpretation possible with regard to just what is, and isn’t a so-called ‘church’ pension plan. The latter is a less-restrictive, less-regulated entity that is not required to meet the normally strict guidelines and requirements for managing an employee pension plan under provisions of the Employee Retirement Income Security Act, as amended in 1974.

September 23, 2016

Florida Blue Agrees to Settle ERISA Lawsuit

Sacramento, CA: Florida Blue has agreed to settle an ERISA lawsuit, in a move that could have implications for a similar lawsuit filed in California. The lawsuit involves the insurer's refusal to cover Harvoni, a potentially life-saving drug that has been shown to successfully treat hepatitis C.

Florida Blue was one of multiple insurance companies - including Blue Shield of California and Anthem Blue Cross Life - that face lawsuits alleging violations of the Employee Retirement Income Security Act (ERISA) and/or other acts designed to protect patients and policyholders.

Harvoni has been proven successful at treating hepatitis C in up to 95 percent of cases, and with few side effects. But patients with hepatitis C say their insurance companies have denied them the treatment, finding their livers are not damaged enough to warrant the medication, or arguing that the treatment is too experimental.

Plaintiffs say the real reason claims for the treatment are turned down is the price. An eight-week treatment course costs around $63,000 while a 12-week course is around $99,000. So even though it is effective, it's also costly.

As a result of the denials - which policyholders say put their lives and their health in jeopardy - lawsuits were filed against multiple insurance companies. That's because hepatitis C is linked to permanent liver damage, liver cancer, and death. According to the lawsuits, up to 70 percent of patients with hepatitis C will develop chronic liver disease. Patients without liver damage are still reportedly at a higher risk of heart attack, joint pain, and arthritis. Lawsuits filed against insurance companies encompass both ERISA-covered plans and those that are not covered by ERISA.

Blue Cross and Blue Shield of Florida (doing business as Florida Blue) has now reportedly agreed to settle the ERISA lawsuit filed against it. According to court documents, plaintiffs in the lawsuit alleged Florida Blue's actions "increase the risk of developing liver cancer by 15%."

Bloomberg BNA (6/23/16) reports Florida Blue has now agreed to cover Harvoni for its policyholders with hepatitis C. Plans covered by ERISA and those not covered by it are included in the settlement, which was given preliminary approval by Judge Robin L. Rosenberg.

What effect this settlement will have on similar lawsuits remains to be seen.

The lawsuit is Oakes v. Blue Cross & Blue Shield of Florida, Inc., case number 9:16-cv-80028, in the US District Court for the Southern District of Florida. The Blue Shield of California lawsuit is Homampour et al v. California Physicians' Service, case number 3:15-cv-05003, in US District Court, Northern District of California.

July 22, 2016

Tibble ERISA Lawsuit Dismissed

San Francisco, CA: An ERISA lawsuit nine years in the making has been dismissed, after making its way from the California courts up to the Supreme Court and being sent back to the lower courts. The lawsuit, which alleged violations of the Employee Retirement Income Security Act (ERISA), claimed breach of fiduciary duty. Now, the Ninth Circuit has dismissed the lawsuit, finding that the plaintiffs should have raised the claim of improper plan monitoring before the case went to the Supreme Court.

May 15, 2016

Court Grants Class-Action Status to ERISA Lawsuit

Los Angeles, CA: A California District Court judge has granted class certification to a California ERISA lawsuit filed against Transamerica Life Insurance Company. The lawsuit, filed by Jaclyn Santomenno and others, alleged Transamerica charged excessive fees, in violation of the Employee Retirement Income Security Act (ERISA).

March 23, 2016

Cigna Settles ERISA Lawsuit

Los Angeles, CA: Cigna has agreed to settle an ERISA lawsuit alleging patient harassment. The ERISA lawsuit was filed against Cigna by Nutrishare Inc, an intravenous nutrition provider. In the lawsuit, Nutrishare alleged Cigna harassed patients who attempted to use out-of-network benefits and denied coverage that should have been allowed.

January 29, 2016

Insurance Lawsuits Allege ERISA Violations

Los Angeles, CA: A "California ERISA lawsuit has been filed against Blue Shield of California Life and Health Insurance Co., alleging the insurer violated ERISA laws by wrongfully denying necessary medical treatment. The lawsuit joins other lawsuits filed against various insurers alleging they are wrongfully denying hepatitis patients vital treatment.

November 8, 2015

California ERISA Lawsuit Results in Settlement Exceeding a Half-Million

Los Angeles, CA Not many notice. Even fewer would take the time or have the tenacity to take action. However, three whistleblowers in California did just that when they detected irregularities in ERISA retirement and benefit plans they were hired to help manage and filed a California ERISA lawsuit. For their efforts, the trio is to receive compensation representing lost wages and damages from no fewer than 12 trustees affiliated with five union trust funds and their Los Angeles-based service provider.

September 19, 2015

Jury Finds for Plaintiff in California Denied Disability Insurance Lawsuit

Santa Rosa, CA A California woman who was denied disability insurance payments to which she was entitled under the terms of her policy was awarded more than three-quarters of a million dollars by a federal jury. The award provides solace to claimants who allege similar denials by an industry that appears to turn down claims as a matter of course.

March 27, 2014
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