This week’s notable decision is Castellon-Vogel v. International Paper Company, __F.App’x__, 2020 WL 5891679 (6th Cir. Oct. 5, 2020). Martha Castellon-Vogel (Vogel) worked as an engineer for International Paper Company (IPC). The company’s ERISA welfare benefit plan provided that Vogel could receive a severance package at the end of her employment if, among other conditions, she “sign[ed] a termination agreement acceptable to the Company.” After her job was eliminated, Vogel signed such a “Termination Agreement,” which included a broad General Release. That provision released IPC of liability for all employment-related claims arising during her tenure. She then received fifty-four weeks’ pay, in accordance with the Plan’s terms. Despite cashing the check, Vogel sued IPC. She argued on appeal that the Plan’s terms were illusory and that the General Release in the Termination Agreement was unenforceable for lack of consideration.
Continue Reading Sixth Circuit Affirms Dismissal of Claims Challenging Severance Plan’s General Release Requirement
Can Insurance Companies Delay the Adjudication of Claims Without Consequence?
This week’s notable decision is Jones v. Aetna, Inc., Case No. 19-cv-9683 (JPO), 2020 WL 5654697 (S.D.N.Y. Sep. 23, 2020). Jones involves an issue many providers are increasingly facing with health insurance companies—silently being placed on some sort of insurance company watch list/audit list or being flagged in some way causing the providers’ claims to be substantially delayed and appeal rights infringed. When health insurance companies take these drastic actions without providing any notice to providers, providers’ insurance revenue streams come under assault and threaten the financial health and longevity of the providers’ practices.
Here, Plaintiff Michael E. Jones, M.D., P.C., a New-York based plastic surgeon, filed a lawsuit seeking compensatory and injunctive relief on a broad range of legal theories, under various provisions of the Sherman Act, ERISA, and New York law when Aetna denied or otherwise failed to process and approve the medical claims of Aetna members Dr. Jones treated.
Continue Reading Can Insurance Companies Delay the Adjudication of Claims Without Consequence?
District Court Equitably Tolls Limitations Period in ERISA Lawsuit for Disability Benefits Based on Mental Incompetence
This week’s notable decision is a firm victory in Poisson v. Aetna Life Ins. Co., No. 8:20-cv-01030-JVS-DFM (C.D. Cal. Sept. 21, 2020). In 2011, claimant Jones suffered severe trauma to his head and face from a motorcycle accident. The trauma resulted in serious, permanent brain damage. Despite claimant returning to work—staying employed for almost three years—he was never able to resume the job responsibilities that he had prior to the accident. In March 2014, he was terminated and made a long-term disability claim.
Aetna denied the claim and Jones made several attempts to appeal, none of which were effective, perhaps because a psychological examination determined he “was not competent to manage funds on his own behalf and would require 24-hour care and supervision for the rest of his life.”
Continue Reading District Court Equitably Tolls Limitations Period in ERISA Lawsuit for Disability Benefits Based on Mental Incompetence