Administration - fiduciary duty; representations concerning benefits; changes in plans; vesting of health benefits on retirement

Article Abstract:

The Equitable Life Assurance Society of the US was sued by six of its retirees when the former changed the terms of the payment obligations of its medical care plan. The plaintiffs argued that their health benefits vested when they retired at the level available on retirement, that they had certain rights separate from those created by the health benefits plan from individual contracts that Equitable had made with them, and that Equitable violated its fiduciary duty under the ERISA for enforcing the plan under terms that did not exist at the time of their retirement. All three of the plaintiffs' claims, however, were rejected by the courts.

Life Insurance, Direct Life Insurance Carriers, Retirement Benefits, Managed care plans (Medical care), Retirees, Equitable Life Assurance Society of the United States

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Senkier v. Hartford Life and Accident Insurance Co., 948 F.2d 1050, 14 EBC 2317 (7th Cir. 1991)

Article Abstract:

The Seventh Circuit Court of Appeals decided in the Senkier versus Hartford Life and Accident Insurance Co case that group accident insurance policy available through ERISA plan does not cover accidents that occur during or as a result of medical treatment. The court further stated that allowing coverage for injuries or death caused by medical treatment changes the accident insurance policy into a medical malpractice policy. In addition, the court also stated that in cases of accidental death during medical treatment, damages for negligence and malpractice are a more appropriate remedy.

Accident and health insurance, Laws, regulations and rules, Accident insurance, United States. Court of Appeals for the 7th Circuit, Dereng, Donna Jean, Hartford Life and Accident Insurance Co.

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Failure to exhaust administrative remedies

Article Abstract:

The law on whether an individual should try all ERISA plan administrative remedies before bringing a court action is discussed. The case of Ravencraft v. UNUM LIfe Insurance Company of America is detailed.

Exhaustion of administrative remedies, UNUM Life Insurance Company of America

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subjects list: Cases, Insurance industry, Life insurance industry
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