The Families First Coronavirus Response Act (FFCRA) and the Coronavirus Act, Relief, and Economic Security Act (CARES) Act and related guidance require group health plans and insurers to cover the costs of COVID-19 diagnostic testing without cost-sharing, prior authorization, or other medical management requirements. If plans do not negotiate a rate for the testing, they must pay for the testing at the cash rate Read More
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Split 2nd Circuit Panel Rejects Ex-Disney Worker’s Bid for Severance
A split panel of the Second Circuit Court of Appeals has ruled that the Walt Disney Co. does not owe severance pay to a terminated former worker after she became unable to work following a stroke. The court found that since Nancy Soto’s termination did not fall within the definition of a “layoff,” Disney did not violate ERISA when it denied her a severance payment. As a result, the U.S. Court of Appeals for the Read More
DOL, IRS, and HHS Release Joint FAQs and Process Guide on Surprise Billing Independent Dispute Resolution
The Department of Labor (DOL), the Internal Revenue Service (IRS), and the Department of Health and Human Services (HHS) have released Frequently Asked Questions Regarding the Federal Independent Dispute Resolution Process (FAQs). This new guidance relates to the No Surprises Act, which Congress enacted in 2021 as part of the Consolidated Appropriations Act (CAA). The three federal agencies issued Federal Read More
Employer’s Failure to Time Provide COBRA Election Notice Results in Retroactive Coverage and Penalties
In Buford v. General Motors, L.L.C., case number 4:16-CV-14465-TGB-MKM, the U.S. District Court of Michigan ruled that General Motors violated COBRA election notice requirements when it failed to timely provide an employee with a COBRA election notice upon his retirement. As a result, General Motors was subject to statutory penalties due to violating federal law. Buford retired from General Motors on Read More
Hyatt Wins Summary Judgment in Pandemic Furlough Suit
A California federal district court granted summary judgment to Hyatt Corporation against a class of former employees who alleged that they were entitled to accrued vacation time from Hyatt after Hyatt laid them off, indefinitely, at the start of the COVID-19 pandemic. The judge found that by laying the employees off rather than terminating them, Hyatt had not severed the employer-employee relationship, and therefore Read More
Former Goldman Sachs Workers Achieve Class Status in 401(k) Mismanagement Case
U.S. District Judge Edgardo Ramos granted class status to tens of thousands of Goldman Sachs Group Inc. ex-employees in an ERISA suit related to mismanagement of its employee 401(k) plan. In support of its motion to certify the class, Falberg also pointed to other courts which recently have certified ERISA classes of retirement plan participants suing financial services providers for unfairly promoting proprietary Read More
EEOC and GA Company Reach Consent Decree Ending ADA Violation Suit
The U.S. Equal Employment Opportunity Commission (EEOC) and Ranew’s Management Co. Inc., a Georgia industrial company, reached a consent decree in Equal Employment Opportunity Commission v. Ranew's Management Co. Inc. et al., case number 5:21-cv-00443, U.S. District Court for the Middle District of Georgia. The decree provides that the company will pay J. Bryant Beeland, a former chief financial officer, $250,000, Read More
Court Orders Aetna to Boost Coverage for Mental Health Treatment in ERISA Case
A North Carolina federal judge found that Aetna Life Insurance Co. abused its discretion and violated ERISA in underpaying and denying claims for coverage for two mental health facilities in Texas. In doing so, Aetna violated the terms of the Bank of America Group Benefits Program and its medical necessity criteria. Alan R. and J.R., beneficiaries of the health plan, filed suit against Aetna in April 2020. J.R., Read More
