Employee Health Insurance and ERISA

Useful Rulings on Employee Health Insurance and ERISA

Recent Rulings on Employee Health Insurance and ERISA

JUAN CARLOS RODRIGUEZ INDIVIDUALLY AND AS SUCCESSOR IN INTEREST FOR CELIA VAZQUEZ VS. KAISER FOUNDATION HEALTH PLAN INC

., p 126) states: Kaiser Foundation Health Plan Arbitration Agreement I understand that (except for Small Claims Court cases, claims subject to Medicare appeals procedure or the ERISA claims procedure regulation, and any other claims that cannot be subject to binding arbitration under governing law) any dispute between myself, my heirs, relatives, or other associated parties on the one hand and Kaiser Foundation Health Plan, Inc.

  • Hearing

LISA MARIE BROOKS VS LARA E FIELDING

ERISA Preemption “ERISA is a comprehensive federal law designed to promote the interests of employees and their beneficiaries in employee pension and benefit plans.” (Port Medical Wellness, Inc. v. Connecticut General Life Insurance Company (2018) 24 Cal.App.5th 153, 171.) “The purpose of ERISA is to provide a uniform regulatory regime over employee benefit plans.

  • Hearing

RAMIN M. ROOHIPOUR, M.D., INC., A CALIFORNIA CORPORATION VS AETNA, INC., A CONNECTICUT CORPORATION

“Accrual of an ERISA action is a question of federal law, and thereunder an ERISA claim ‘accrues either at the time benefits are actually denied, or when the insured has reason to know that the claim has been denied.’” Wise v. Verizon Communis. Inc. (9th Cir. 2010) 600 F. 3d 1180, 1188. In Wise, the court determined that the “fourth letter triggered [participant’s] ERISA claim because only after receiving this letter was she informed that no further internal appeals were possible.” Id.

  • Hearing

  • Type

    Insurance

  • Sub Type

    Intellectual Property

SERINA SAYRE, ET AL. VS KAISER FOUNDATION HEALTH PLAN, INC., A CORPORATION, ET AL.

ARBITRATION AGREEMENT* “I understand that (except for Small Claims Court cases, claims subject to a Medicare appeals procedure or the ERISA claims procedure regulation, and any other claims that cannot be subject to binding arbitration under governing law) any dispute between myself, my heirs, relatives or any associated parties on the one hand and Kaiser Foundation Health Plan, Inc.

  • Hearing

  • Type

    Personal Injury/ Tort

  • Sub Type

    Medical Malpractice

SERINA SAYRE, ET AL. VS KAISER FOUNDATION HEALTH PLAN, INC., A CORPORATION, ET AL.

ARBITRATION AGREEMENT* “I understand that (except for Small Claims Court cases, claims subject to a Medicare appeals procedure or the ERISA claims procedure regulation, and any other claims that cannot be subject to binding arbitration under governing law) any dispute between myself, my heirs, relatives or any associated parties on the one hand and Kaiser Foundation Health Plan, Inc.

  • Hearing

  • Type

    Personal Injury/ Tort

  • Sub Type

    Medical Malpractice

SPENCER RECOVERY CENTERS FLORIDA, INC. V. UNITED HEALTHCARE SERVICES, INC.

Thus, for example, Defendants’ argument that some of the patients’ claim are barred by ERISA fails. The evidence shows that Defendants’ most recent listing of alleged ERISA plan members identifies, at most, only 87 ERISA plan beneficiaries out of the 123 members involved in this lawsuit. PAMF 3. (1) Breach of Implied-in-fact Contract “[A]n implied-in-fact contract entails an actual contract, but one manifested in conduct rather than expressed in words.” (Maglica v. Maglica (1998) 66 Cal.App.4th 442, 455.)

  • Hearing

DOCTORS HOSPITAL OF MANTECA, INC. VS GARDNER TRUCKING, INC.

Indeed, in a case decided after The Meadows, the Ninth Circuit itself stated that in The Meadows it “recognized that ERISA preempts the state claims of a provider suing as an assignee of the beneficiary’s rights to benefits under an ERISA plan,” but went onto hold “that ERISA does not preempt ‘claims by a third-party who sues an ERISA plan not as an assignee of a purported ERISA beneficiary, but as an independent entity claiming damages,’ because such claims do not ‘relate’ to ERISA preemption.”

  • Hearing

CHERYL SILLIMAN V. COUNTY OF KERN MEDICAL PLAN

Plaintiffs argue that this case focuses on ERISA violations by the Plan, and that those violations occurred in San Luis Obispo County supporting venue here.

  • Hearing

RAMIN M. ROOHIPOUR, M.D., INC. VS AETNA, INC., A CONNECTICUT CORPORATION

Wrongful Denial of ERISA Plan Benefits; 2. Breach of Contract; 3. Breach of Covenant of Good Faith and Fair Dealing; and 4. Unjust Enrichment. Defendant moves for summary judgment as to the First Amended Complaint. Alternatively, Defendant moves for summary adjudication of the following issues: Issues 1 to 4 – The first through fourth causes of action fail as to Assignors 4 to 6 because Plaintiff lacks standing because the health plans forbid assignment.

  • Hearing

  • Type

    Insurance

  • Sub Type

    Intellectual Property

UNIVERSITY OF SOUTHERN CALIFORNIA ON BEHALF OF ITS KECK HOSPITAL OF USC AND ON BEHALF OF ITS USC KENNETH NORRIS JR. CANCER HO VS GARDNER TRUCKING, INC. HEALTH BENEFIT PLAN

Defendant demurs the SAC in its entirety on the grounds that Plaintiff’s claims are preempted by ERISA. ERISA: ERISA is a federal law that sets minimum standards for employer sponsored retirement and health plans. “As a part of this integrated regulatory system, Congress enacted various safeguards to preclude abuse and to secure the rights and expectations that ERISA brought into being” including broad preemption provisions. Marshall v. Bankers Life & Casualty Co. (1992) 2 Cal.4th 1045, 1051.

  • Hearing

ST. JOSEPH HOSPITAL OF ORANGE V. I.C. SECURITY PRINTERS, INC.

It is apparently an ERISA plan. There is no contract between the parties as to the rates the hospital will charge, and the health care plan will pay, for services and supplies the hospital provides members of the defendant health care plan. The complaint alleges, among other cause of action, breach of implied contract, quantum meruit, and an injunction against unfair business practices. At bottom, the complaint primarily requests money.

  • Hearing

TAYLER HANNES VS PARKS MANAGEMENT COMPANY

The Policy does not cover the following claims: (1) workers' compensation claims, unemployment insurance claims, (3) any claims that could be made to the National Labor Relations Board, (4) administrative claims filed with appropriate state agencies under applicable State wage and hour laws or regulations, such as claims filed with the California Department of Labor Standards Enforcement, (5) claims under the Employee Retirement Income Security Act ("ERISA"), and (6) claims made in small claims court, as long

  • Hearing

  • Judge Donna Geck
  • County

    Santa Barbara County, CA

RACHEL LEE, ET AL. VS KAISER FOUNDATION HEALTH PLAN, INC., ET AL.

The disclosure reads as follows: Some of the offered health plans, including Kaiser, require resolution of medical malpractice and other disputes, (except for certain benefit-related disputes if your Employer must comply with ERISA) through binding arbitration. If you select one of these plans you agree to give up your right to a jury or court trial for resolution of these disputes.

  • Hearing

  • Type

    Personal Injury/ Tort

  • Sub Type

    Medical Malpractice

TAWANDA PITRE VS LOS ANGELES UNIFIED SCHOOL DISTRICT ET AL

Item 13b(2)(c) is checked, indicating that a Non-ERISA insured plan paid medical expenses, but Item 13a(1) and 13b(2)(e) state that $0 were paid. Item 14a and b are both blank. But, both Items 15a, 15b(2), and 15b(3) are checked, indicating Petitioner has paid or become obligated to pay for “attorney’s fees included in the total fee amount shown in Item 14a” and “other expenses included in the total shown in item 14b” in the amount of $1,375. Also, Items 17a and 17c are blank. Item 16 is blank.

  • Hearing

LILIBETH CASTILLO ET AL VS THOMAS J CAHILL

Total medical expenses were $5,885.26, in satisfaction of which the lienholders have agreed to accept $1,234.25 and of which the ERISA self-funded plan has agreed to accept $205.45. (Petition, ¶ 13.) Castillo’s share of litigation expenses is $373.19. (Petition, ¶ 14b.) Attorney fees are requested in the amount of 25 percent of the gross settlement amount, $3,500.00, consistent with the contingency fee agreement with counsel. (Petition, ¶ 14a & attachment 14a.)

  • Hearing

  • Judge Donna Geck
  • County

    Santa Barbara County, CA

ALFARO VS WHEEL PROS LLC

conversion, overpayment of wages, misappropriation of trade secrets, confidential information, and/or other intellectual property; and claims for violation of any federal, state, or other governmental law, statute, regulation, or ordinance, including amendments, and including but not limited to Title VII of the Civil Rights Act of 1964, the Age Discrimination in Employment Act, the Americans with Disabilities Act, the Rehabilitation Act, the Family and Medical Leave Act, the Equal Pay Act, the False Claims Act, ERISA

  • Hearing

EMILIE KHATCHETOURIAN VS HARRIS ASCENCIO

Employee Theft including ERISA Compliance, 23. Forgery or Alteration, and 31. Money & Security.” (Oppn., 8:5-8.) Defendants do not address these other categories and, therefore, have failed to establish that there is no triable issue of material fact that Defendants did not breach any provision in the insurance policy (not just the one provision on which the Defendants relied to deny coverage). The court, therefore, denies the motion on these grounds as well.

  • Hearing

BONNIE ALISSA HUNNICUTT ET AL VS VASA PARK ASSOC INC ET AL

Rather, Petitioner merely declares in paragraph 13b(2) that $22,378.85 of the total $31,544.18 needs to be reimbursed to an ERISA self-funded plan. However, the remainder is simply unaccounted for. The petitions must be denied because Petitioner has not filed completed petitions. CONCLUSION The petitions for minors’ compromises filed on February 18, 2020 are DENIED. Petitioner is ordered to give notice of this ruling.

  • Hearing

  • Type

    Personal Injury/ Tort

  • Sub Type

    other

SAMUEL NATHAN BERGER VS LOS ANGELES UNIFIED SCHOOL DISTRICT

. $1,057 were paid by a non-ERISA insured plan and are not requested to be reimbursed. This leaves unaccounted medical expenses amount to $27.73. Additionally, the terms of the proposed special needs trust are not acceptable for nine reasons. First, the proposed special needs trust reads as through it is a third party trust created with third party’s funds. However, this is not a third party trust.

  • Hearing

  • Type

    Personal Injury/ Tort

  • Sub Type

    other

STANDARD INSURANCE COMPANY V. SCOTT

Thus, the following material allegations of the Complaint must be disregarded as though they did not exist: that the insurance policy was a “non-ERISA . . . policy” (Complaint, ¶ 1); and that Scott was the wife of decedent and married to him when he died. (¶ 2.) But these allegations are key to Scott’s claim that Beasley and Mims have no valid claim to all the proceeds of the life insurance policy.

  • Hearing

(NO CASE NAME AVAILABLE)

ERISA Preemption CHPC’s assertion that the Employment Retirement Income Security Act of 1974 (ERISA) preempts both causes of action in the cross-complaint are also unfounded. The Employee Retirement Income Security Act of 1974 (ERISA) section 514 expressly preempts “any and all State laws insofar as they may now or hereafter relate to any employee benefit plan.” (29 U.S. 1144(a); Port Medical Wellness, Inc. v.

  • Hearing

IN RE CLOUDERA, INC. SECURITIES LITIGATION

Securities, Derivative & ERISA Litigation (S.D. Tex. 2003) 258 F.Supp.2d 576, 649 [control claim alleged where “Alliance was the largest institutional shareholder of Enron, clearly a basis for power to control Enron and impliedly a major reason for Savage’s appointment to the Enron board …”; “[m]oreover, it cannot be ignored that Alliance was Savage’s employer …”]; In re American Apparel, Inc. Shareholder Litigation (C.D. Cal., Aug. 8, 2013, No.

  • Hearing

SOBERTEC LLC VS. UNITEDHEALTH GROUP INC

The Ninth Circuit has stated that where a third party medical provider sues an ERISA plan based on contractual obligations arising directly between the provider and the ERISA plan (or for misrepresentations of coverage made by the ERISA plan to the provider), no ERISA-governed relationship is implicated and the claim is not preempted. Ibid.

  • Hearing

DUAL DIAGNOSIS TREATMENT CENTER VS. HEALTH NET, INC., ET AL

Finally, Sovereign argues Health Net should not be allowed to assert ERISA preemption as an affirmative defense because ERISA preemption claims are waived unless timely raised. Sovereign contends Health Net first raised a potential ERISA defense eight months ago, on October 10, 2019, in opposition to Sovereign’s motion for summary adjudication. Sovereign further contends it has been prejudiced because Health Net has failed to provide the necessary disclosure as required by ERISA regulations.

  • Hearing

  • Judge

    Paul A. Bacigalupo or Virginia Keeny

  • County

    Los Angeles County, CA

HEALTH NET LIFE INSURANCE COMPANY VS ZOE DEL PRETE ET AL.

Equally concerning, Respondents clearly raised the ERISA jurisdiction issue in their opposition papers and Petitioner failed to address the jurisdictional and preemptions issues in its reply. Instead, Petitioner summarily dismissed ERISA as “irrelevant”. (See Reply, at p. 2.) However contrary to Petitioner’s claims and based upon the plain language of the arbitration provision, whether or not ERISA applies is relevant. (Ibid.)

  • Hearing

1 2 3 4 5 6 7 8     last » 

For full print and download access, please subscribe at https://www.trellis.law/.

Please wait a moment while we load this page.