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Birmingham Bar Associations Bulletin Summer 2015

Conclusion When handling an ERISA claim, it is important to be aware of all the pitfalls that can occur so you can protect your client and serve his or her needs fully and faithfully. All too often, attorneys not versed in ERISA or familiar with this special area of litigation proceed blindly without knowing all they need to know to protect their clients’ interests. In those instances, the last and fi nal mistake those attorneys may have made will have been the failure to seek assistance from another attorney whose regular practice involves knowing where these pitfalls are and how to avoid them. G ENDNOTES 1 An “employee welfare benefi t plan” under ERISA includes any insurance plan “established or maintained by an employer or by an employee organization, or by both….” 29 U.S.C. § 1002(1). 2 While exceptions to ERISA’s scope exist, those exceptions are limited to specifi c circumstances. For example, under 29 U.S.C. § 1003(b) (1), ERISA does not apply to an employee welfare benefi ts plan that is a “governmental plan.” A “governmental plan” for purposes of this exception is any “plan established or maintained for its employees by the Government of the United States, by the government of any State or political subdivision thereof, or by any agency or instrumentality of any of the foregoing.” 29 U.S.C. § 1002(32). 3 Th e United States Supreme Court has suggested recently the availability of an equitable surcharge remedy, see Cigna Corp. v. Amara, ___ U.S. ___, 131 S.Ct. 1866, 179 L.Ed.2d 843 (2011), but case law developing the extent of this remedy has been limited to date. 4 Th e only state laws excluded from ERISA’s preemption clause are those qualifying under its savings clause, § 1144(b)(2)(A), which states, “nothing in this subchapter shall be construed to exempt or relieve any person from any law of any State which regulated insurance, banking, or securities.” 5 See, e.g., Smith v. Life Ins. Co. of N. Am., 33 F. Supp. 3d 1324 (N.D. Ala. 2014)(ordering discovery in an ERISA insurance case) 6 See Burks v. American Cast Iron Pipe Co., 212 F.3d 1333, 1338 (11th Cir. 2000) (holding that “the district court should allow discovery before considering summary judgment against the plaintiff s.”); see also Adams v. Hartford, 589 F. Supp. 2d 1366, 1368 (N.D. Ga. 2008) (“Th e court concludes that the plaintiff is entitled to pursue any discovery in this ERISA case that ‘is relevant in itself or that appears reasonably calculated to lead to the discovery of admissible evidence”). ERISA was “enacted to promote the interests of employees such as Plaintiff … and protect their contractually defi ned rights” and certainly does not eliminate the procedural safeguards provided by the Rules of Civil Procedure. Firestone Tire and Rubber Co. v. Bruch, 489 U.S. 101, 113, 109 S. Ct. 948 (1989). 7 A partial sampling of cases includes Melech v. Life Ins. Co. of N. Am., 857 F. Supp. 2d 1281, 1285 (S.D. Ala. 2013) (ordering the production of LINA’s claims manual and documentation on its compensation and performance evaluation structure in an ERISA case governed by a deferential review standard); Branch v. Life Ins. Co. of N. Am., 2009 Insurance Law Psychological Evaluations Dr. Ron Bray, Alabama Licensed Psychologist, has relocated his practice from Jasper to the Birmingham area and is now accepting referrals for evaluations on your clients who are going through court proceedings. His new address is 400 Vestavia Parkway, Suite 135, Vestavia Hills, AL 35216. To schedule an appointment, call 205-648-9314 and speak to office manager Jean. If it is more convenient for you, he can see your client at your office. At this point he is not set up to accept credit/debit cards as payment, only cash or check. Your referrals will be greatly appreciated. WL 3781217, *4-*6 (M.D. Ga. Nov. 11, 2009) (allowing discovery in an ERISA case against LINA which included LINA’s internal policies and procedures and information relevant to whether LINA’s claims department was not properly insulated from LINA’s fi nancial confl ict of interest); Kruk v. Metropolitan Life Ins. Co., 267 F.R.D. 435, 439-442 (D. Conn. 2010) (interpreting 29 C.F.R. § 2560.503-1(m) and ordering MetLife in an ERISA case to produce its policies and guidelines pertaining to the plaintiff ’s claim regardless of whether such were actually consulted or relied upon in making the benefi t determination); and Anderson v. Unum Life Ins. Co. of America, 414 F. Supp. 2d 1079 (M.D. Ala. 2006) (citing to a services agreement produced in discovery to determine what entity denied Plaintiff ’s claim for benefi ts and thus the standard of review to be employed by the Court). 8 Although the Act itself includes no express provision requiring the exhaustion of remedies before the fi ling of a lawsuit, the Eleventh Circuit and other courts generally require exhaustion as a precondition to litigation. Perrino v. Southern Bell Tel. & Tel. Co., 209 F.3d 1309, 1315 (11th Cir. 2000). Birmingham Bar Bulletin/ Summer 2015 25


Birmingham Bar Associations Bulletin Summer 2015
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