Federal Health & Welfare Updates

Sep 25, 2024

Court: Denial of Wilderness Therapy Benefits Not Compliant with ERISA

On September 12, 2024, in Amy G. v. United Healthcare, the US District Court of Utah (the court) ruled that the denial of wilderness therapy benefits by defendants United Healthcare and United Behavioral Health (UBH) was arbitrary and capricious because UBH failed to provide a sufficient explanation and analysis for the denial, as required by ERISA. The court remanded the claim back to the defendants for reevaluation and redetermination.

Sep 11, 2024

Sixth Circuit: Slayer Rule Applies to ERISA Life Plans

On August 19, 2024, the United States Court of Appeals for the Sixth Circuit (Sixth Circuit) held that the federal common law prevented the named beneficiary of ERISA group life insurance from benefiting from his murder of the insured and a co-beneficiary.

Aug 28, 2024

HHS Announces Inflation Adjustments to Civil Monetary Penalties

HHS recently announced inflation-adjusted penalty amounts related to violations of Summary of Benefits and Coverage (SBC), Medicare Secondary Payer (MSP), and HIPAA privacy and security rule requirements. These new penalty amounts are calculated based on a cost-of-living increase of 1.03241% and are applied to penalties assessed on or after August 8, 2024, for violations occurring on or after November 2, 2015.

Aug 28, 2024

Seventh Circuit Rules on Therapy Limitations for Autism under the MHPAEA

On August 5, 2024, the Seventh Circuit Court of Appeals (Seventh Circuit) affirmed the district court’s ruling in favor of insurer Group Health Cooperative (the defendant) when they denied claims for therapy treatment brought by parents on behalf of their autistic child (plaintiffs) based upon then-current medical literature. The plaintiffs asked the defendant health insurer to pay for certain treatments for their autistic child that occurred  between 2017 and 2019. The defendant refused to pay since the medical literature at the time did not support speech therapy as a treatment for autism for...

Aug 28, 2024

House Committee Members Send Letter to DOL Regarding CAA 2021 Service Provider Disclosure Enforcement

On August 20, 2024, representatives Robert Scott and Mark DeSaulnier, ranking members, respectively, of the House Committee on Education and the Workforce and the Subcommittee on Health, Education, Labor, and Pensions, sent a letter to the DOL’s Employee Benefits Security Administration (EBSA) assistant secretary Lisa Gomez asking for increased oversight on group health plan service providers. In part, the letter stems from a springtime New York Times (NYT) investigation into a data analytics company, which alleged the company engaged in harmful...

Aug 14, 2024

Third Circuit Rules Termination of ERISA Disability Benefits Is Abuse of Discretion

On July 29, 2024, in Mullins v. CONSOL Energy Inc. Long Term Disability Plan, the Third Circuit Court of Appeals (Third Circuit) held that the termination of a coal miner’s ERISA long-term disability benefits by the claims administrator, Lincoln Financial Group (Lincoln), was not based on substantial evidence in the record and was therefore an abuse of discretion. The Third Circuit vacated the prior district court judgment upholding Lincoln’s termination decision and remanded the case back to the district court for reinstatement of the miner’s benefits.

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PPI Benefit Solutions does not provide legal or tax advice. Compliance, regulatory and related content is for general informational purposes and is not guaranteed to be accurate or complete. You should consult an attorney or tax professional regarding the application or potential implications of laws, regulations or policies to your specific circumstances.

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