Employee Health Insurance and ERISA

Useful Rulings on Employee Health Insurance and ERISA

Recent Rulings on Employee Health Insurance and ERISA

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

    Jul 10, 2020

  • 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

    Jul 08, 2020

  • 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

    Jul 01, 2020

(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

    Jun 29, 2020

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

    Jun 26, 2020

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

    Jun 25, 2020

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

    Jun 22, 2020

  • 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

    Jun 11, 2020

MECHANICS BANK VS. ORION PACIFIC

The issue then becomes if the funds in the rollover IRA account are traced to non-alienable ERISA funds, which statute takes precedence, PACA or ERISA? Neither Sunkist nor Rider cites a case resolving this conflict. With these principles and issues in mind, the court rules on Sunkist’s objection. Ruling The rules of law outlined above make clear that Orion had the right to pay salary or profit distributions to Rider if those payments were in the ordinary course of business.

  • Hearing

    Jun 10, 2020

DOCTORS MEDICAL CENTER OF MODESTO INC VS GARDNER TRUCKING INC

Code §17200 et seq. is not preempted by ERISA. When liberally construed, the allegations are not entirely dependent upon Explanations of Benefits, but refer to other behaviors as well. Under these circumstances, Morris B. Silver M.D. Inc. v. International Longshore & Warehouse (2016) 2 Cal.App.5th 793, does not require a finding of federal preemption. b) The Court finds that, when liberally construed, the pleading sufficiently alleges the claims for punitive damages (Civ.

  • Hearing

    Jun 10, 2020

WUN-LING CHANG, M.D., INC. VS BLUE CROSS OF CALIFORNIA, ET AL.

These claims do not include any claims arising under federal plans, such as ERISA, FEHBA, Medicare Advantage, and Medi-Cal plans. [SAC, ¶31.] The SAC alleges an actual, ongoing controversy. Taking a liberal reading of the SAC, Anthem’s alleged practice is ongoing. Thus, Defendant’s argument that declaratory relief “should not be used to adjudicate past events” is not persuasive. [Demurrer at 13:24.]

  • Hearing

    Feb 20, 2020

  • Type

    Insurance

  • Sub Type

    Intellectual Property

ORR V. COOPER

The petition states the minor incurred $30,000 in medical expenses for emergency treatment and surgery to correct the damage, which was paid by a non-ERISA self-funded plan that is not requesting reimbursement. However, the petition states that Medi-Cal paid $1,078.41 for medical expenses and has agreed to accept $1,078.41 in full satisfaction of its lien rights. There are copies of the bills substantiating the claimed medical expenses are attached to the petition as required by Local Rule 7.10.12A.(6).

  • Hearing

    Feb 07, 2020

ATON CENTER VS UNITED HEALTHCARE INSURANCE COMPANY

At this stage of the case, the Court is unable to conclude that the complaint's causes of action are preempted by ERISA Section 514. (See, Silver v. International Longshore and Warehouse Union-Pacific Maritime Association Welfare Plan (2016) 2 Cal.App.5th 793.)

  • Hearing

    Feb 06, 2020

  • Type

    Contract

  • Sub Type

    Breach

ATON CENTER VS UNITED HEALTHCARE INSURANCE COMPANY

At this stage of the case, the Court is unable to conclude that the complaint's causes of action are preempted by ERISA Section 514. (See, Silver v. International Longshore and Warehouse Union-Pacific Maritime Association Welfare Plan (2016) 2 Cal.App.5th 793.)

  • Hearing

    Feb 06, 2020

  • Type

    Contract

  • Sub Type

    Breach

SORIANO VS. ROBERTSON'S READY MIX, LTD.

Rosas’ total class action experience to be working on the defense of a single ERISA class action while an associate at her prior firm. In her time doing plaintiff’s work, has Ms. Rosas ever been appointed lead counsel in a wage-and-hour class action? If she has not been appointed class counsel in the past, has she ever worked on wage-and-hour class actions before, whether plaintiff or defense side? 10.

  • Hearing

    Jan 31, 2020

AGRICULTURAL CONTRACTING SERVICES ASSOCIATION, INC. V. ADMINISTRATIVEHEARING BUREAU OF THE CALIFORNIA DEPARTMENT OF INSURANCE, ET AL.

Bankers Life & Casualty Co. (1992) 2 Cal.4th 1045, 1051-1052 [benefit plan bore the burden of proof to establish that ERISA preempted tort claims]; see Evid. Code, § 500.) Therefore it was petitioner’s burden to show they were an ECE. The ALJ did not change the burden of proof. Petitioner Failed to Prove the ECE Exception Code of Federal Regulation part 2510.3-40(b)(l)-(3) sets forth the criteria indicative of an ECE.

  • Hearing

    Jan 30, 2020

  • Type

    Administrative

  • Sub Type

    Writ

ABED DUBESTER VS AMPAM PARKS MECHANICAL, INC., ET AL.

The Agreement provides: “This Agreement covers all matters directly or indirectly related to Your recruitment, employment with the Company, or termination of employment from the Company, including, but not limited to, alleged violations of Title VII of the Civil Rights Act of 1964 (and all amendments thereto); sections 1981 through 1988 of Title 42 of the United States Code (and all amendments thereto); the Employee Retirement Income Security Act of 1974 (“ERISA”) (and all amendments thereto); the Americans

  • Hearing

    Jan 24, 2020

  • Type

    Employment

  • Sub Type

    Wrongful Term

MENDOZA VS. 12072 TRASK INC.

In fact, page two of Exhibit A appears to have handwriting that fills in the deletions: “me” filling in a blank in the word “Income” as part of a reference to ERISA, and “rimi” filling in a blank in the word “Discrimination” as part of a reference to the ADEA. However, Exhibit A and the document from the personnel file appear otherwise identical. Significantly, Plaintiff identifies no substantive differences in their terms. Seizing on the differences between the two documents, Plaintiff took Mr.

  • Hearing

    Jan 17, 2020

CALIFORNIA HOTEL & LODGING ASSOCIATION VS CITY OF LONG BEACH

There was an additional issue of ERISA preemption which is not raised here, but no preemption was found under either Cal/OSHA or ERISA. The Oakland Ordinance at issue there was quite similar to §5.49.04: “A. Purpose.

  • Hearing

    Jan 08, 2020

HOPE D MALONEY ET AL VS ALLYSON RENEE DIXON

First, Petitioner asks for a reimbursement to a Non-ERISA insured plan in the amount of $829.16 in paragraph 13b(2)(c), but does not account for this payment in any other portion of the petition. As such, the Court cannot ascertain whether this medical expense is to be paid from the gross settlement or not. Second, Petitioner has failed to submit a proposed order granting the petition and a proposed order depositing the net settlement into a blocked account.

  • Hearing

    Jan 07, 2020

  • County

    Los Angeles County, CA

DOCTORS MEDICAL CENTER OF MODESTO INC VS GARDNER TRUCKING INC

Nor is such a claim preempted by ERISA; the new cause of action is not entirely dependent upon Explanations of Benefits, but refers to other behaviors as well. Under these circumstances, Morris B. Silver M.D. Inc. v.

  • Hearing

    Jan 03, 2020

OLIVER IAN TIO, ET AL. VS SILVIA WEISZ, ET AL.

If approved, $60,000.00 will be used to pay medical expenses paid by a non-ERISA insured plan, $250,000.00 will be used to pay attorneys’ fees, and $17,250.00 will be used to pay for costs associated with this suit, leaving a balance of $672,750.00 for Claimant.

  • Hearing

    Dec 12, 2019

  • Type

    Personal Injury/ Tort

  • Sub Type

    other

DANONE SIMPSON INSURANCE SERVICES LLC VS EDWIGE LIGONDE ET A

As to the first category, Plaintiff claims it was prejudiced by not having been given more time during its re-cross-examination of Ligonde to question him about certain documents, known as ERISA Form 5500s. Plaintiff included these documents in his own exhibit list. (Dickinson Decl., Ex. 8 at 4:6, 6:23.) Plaintiff presented direct testimony on these forms. (Dickinson Decl., Ex. 3 at 634-647.) Plaintiff simply chose not to examine Ligonde on these issues.

  • Hearing

    Dec 03, 2019

  • Type

    Business

  • Sub Type

    Intellectual Property

ALCOHOL AND SUBSTANCE ABUSE PROGRAMS, INC. VS UNITED HEALTHCARE SERVICES, INC., ET AL.

Seventh and Ninth Causes of Action: ERISA Preemption Preferred next argues that Plaintiff’s claims are also “potentially preempted” by ERISA. (Motion, 9-10.) Preferred argues that while Plaintiff alleges that its own claims are not based on ERISA, Plaintiff failed to affirmatively allege that patient J.O.’s claims do not arise from ERISA. (Id.)

  • Hearing

    Dec 02, 2019

  • Type

    Contract

  • Sub Type

    Breach

MAZER VS. RAZER USA, LTD

The Court held that “[i]n determining whether employment relationship existed, for purposes of ERISA, characterization of hired party as an “independent contractor” or “employee,” in contract between parties may be probative of parties' intent, but all of the incidents of the relationship must be assessed and weighed with no one factor being decisive.” Id., at 1492.

  • Hearing

    Nov 22, 2019

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