We are anticipating the upcoming oral arguments (November 27) and decision in U.S. Airways, Inc. v. McCutchen, a case at the United States Supreme Court. This case involves a situation where the employer-sponsored plan fronted the payment of health care costs a participant incurred in an automobile accident, on the condition that the participant repay any monies recovered. The case begs the question, “If you were the victim of a car accident, would you agree to a settlement that required you to pay?” The answer appears to be “no,” unless perhaps you were gambling $866 and refusing to repay … Continue Reading
We occasionally hear that an employer wants to promise greater health care coverage than is provided under the plan terms, either in a sympathetic scenario, or to facilitate a separation. Unfortunately, this “generosity” can leave the employer obligated to provide costly benefits, without insurance coverage.
Treating a Qualified Beneficiary on Short-term Disability as Continuing to be an Eligible Employee
Take, for example, Clarcor v. Madison National Life Insurance. The employer maintained a self-funded health plan, and purchased a stop-loss policy. The policy provided that coverage was limited to benefits paid in accordance with plan terms. Under the plan terms, … Continue Reading