This appeal presented the question of whether a provision of the federal Health Insurance Portability and Accountability Act (HIPAA), Pub. L. No. 104-191, 110 Stat. 1936, preempted Montana's "little HIPAA" law, Mont. Code Ann. 33-22-526(2)(a), for purposes of both conferring federal subject matter jurisdiction and defeating state-law causes of action on the merits. The federal and state HIPAA provisions at issue prohibited certain insurers from charging different premiums to similarly situated participants on account of a participant's health and status-related factor. The court affirmed the district court and held that federal HIPAA preempted the Montana law, both jurisdictionally and on the merits, because Montana's HIPAA provision was identical to, and expressly relied upon, federal law. The court held, however, that federal law did not preempt a claim for relief under a separate Montana unfair insurance practices statute that barred insurers from engaging in unfair discrimination when charging policy premiums to similarly situated individuals, Mont. Code Ann. 33-18-206(2). View "Fossen, et al. v. Blue Cross and Blue Shield of MT, Inc." on Justia Law
Plaintiff appealed the district court's dismissal of her ERISA, 29 U.S.C. 1001 et seq., action against defendant as not timely filed. Plaintiff was employed by defendant as a stockbroker in 1979 and starting in 1982, plaintiff had been disabled periodically from her employment. Plaintiff applied for long-term disability benefits around January 15, 1987. The court held that plaintiff's claim did not accrue in 1990 with regard to the ERISA statute of limitations, as the district court found, but rather accrued when her claim was finally denied on January 14, 2004. Therefore, plaintiff's action, filed on February 16, 2006, commenced within the four-year statutory limitations period for ERISA claims. The court also held that the limitations provision in the policy here did not apply to disability cases in which the claimant contested the amount of benefits or claims that the benefits have been miscalculated. Accordingly, the court vacated the judgment of the district court and remanded for further proceedings. View "Withrow v. Bache Halsey Stuart Shield, Inc." on Justia Law
Posted in: ERISA, Injury Law, Insurance Law, Labor & Employment Law, U.S. 9th Circuit Court of Appeals
Plaintiff filed an action against defendants (collectively, the Plan) for refusing to pay certain long-term disability benefits. At issue was whether the district court erred in granting summary judgment for defendants and dismissed plaintiff's claims without prejudice due to his failure to exhaust available administrative remedies under the Plan. The court held that the district court adopted the Plan's reading of ERISA, 29 C.F.R. 250.503-1(i) without the benefit of the Secretary of Labor's interpretation of that provision. Therefore, deferring to the Secretary's plausible approach, the court held that where a claimant sought review of his or her disability claims, the quarterly meeting rule was restricted to multiemployer plans. Accordingly, the Plan was required to render a decision within 90 days of plaintiff's administrative appeal and failed to do so. Consequently, plaintiff's claims must be deemed exhausted and the judgment was reversed and remanded. View "Barboza v. CA Assoc. of Prof'l Firefighters, et al." on Justia Law
The court agreed to hear this case en banc in order to reconsider its precedent as to which parties could be sued as defendants in actions for benefits under 29 U.S.C. 1132(a)(1)(B), part of ERISA. Some of the court's previous decisions had indicated that only a benefit plan itself or the plan administrator of a benefit plan covered under ERISA was a proper defendant in a lawsuit under that provision. The court concluded that the statute did not support that limitation, however, and that an entity other than the plan itself or the plan administrator could be sued under that statute in appropriate circumstances. Therefore, the court held that Reliance Standard Ins. Co. was a proper defendant in a lawsuit brought by plaintiff under ERISA and overruled its prior decisions to the contrary. To apply that decision and to resolve other issues raised in the appeal, the court transferred this case back to the three-judge panel to which the case was previously assigned. View "Cyr v. Reliance Standard Life Ins. Co." on Justia Law
Defendants, the chairman and chief executive officer of Lunde Electric Company ("company"), appealed convictions stemming from the misappropriation of employee 401(k) contributions to pay the company's operating expenses. At issue was whether there was sufficient evidence to support defendants' convictions under 18 U.S.C. 664, for embezzlement or conversion of elective deferrals, and 18 U.S.C. 1027, for false or misleading statements in a required Employee Retirement Income Security Act of 1974 ("ERISA"), 29 U.S.C 1001 et seq., document. The court held that there was sufficient evidence to support defendants' convictions on Counts 17 and 18 under section 664 where there was sufficient evidence for the jury to conclude that the 1991 Profit Sharing Plan had been restated before defendants retained their employees' elective deferrals in the company's general account; where defendants commingled their employees' contributions with the company's assets to prop up their failing business and therefore, intentionally used their employees' assets for an unauthorized purpose; where they sent participants account statements showing 401(k) balances which were in fact non-existent; where defendants' decision to deviate was the wilful criminal misappropriation punished by section 664; and where defendants were alerted repeatedly about their obligation to remit the deferrals and defendants hid their actions from employees. The court also held that there was sufficient evidence to support defendants' convictions on Count 21 under section 1027 where defendants' initial decision to mislead their own employees about the solvency of their retirement plans by filing false account statements and false Form 5500s were the behaviors targeted by section 1027.
Posted in: Constitutional Law, Criminal Law, ERISA, Insurance Law, Labor & Employment Law, U.S. 9th Circuit Court of Appeals, White Collar Crime