This week’s notable decision is Wilson v. Safelite Grp., Inc., No. 18-3408, __F.3d__, 2019 WL 3000995 (6th Cir. July 10, 2019), where the Sixth Circuit answers the question of what constitutes an employee pension benefit plan under ERISA. At issue is a deferred compensation plan for executive employees that the district court determined to be an employee pension benefit plan under 29 U.S.C. § 1002(2)(A)(ii) and not a bonus plan exempted from ERISA under 29 C.F.R. § 2510.3-2(c). Analyzing the plain text of ERISA and the bonus plan regulation, the Sixth Circuit affirmed the district court’s decision.
Continue Reading Sixth Circuit Finds that Deferred Compensation Plan for Executive Employees is an Employee Pension Benefit Plan
Sixth Circuit Rules That Indian Tribe Can Pursue Breach of Fiduciary Duty Claim Against Health Plan Administrator
This week’s notable decision is the Sixth Circuit’s most recent decision in Saginaw Chippewa Indian Tribe of Michigan v. Blue Cross Blue Shield of Michigan, No. 17-1932, __F’Appx__ (6th Cir. Aug. 30, 2018), one of many cases against BCBSM for charging its self-funded customers hidden administrative fees. The Tribe maintained two self-insured policies with BCBSM, one covered tribal members (“Member Policy”) and the other covered tribal employees (“Employee Policy”).
In 2014, the Sixth Circuit affirmed the district court’s ruling that Defendant BCBSM violated ERISA by increasing its customer’s hospital claims with hidden administrative surcharges. See Hi-Lex Controls, Inc. v. Blue Cross Blue Shield of Michigan, 751 F.3d 740 (6th Cir. 2014). In this case, in addition to the undisclosed administrative fees claim at issue in Hi-Lex, the Tribe also alleged that BCBSM violated its fiduciary duties under ERISA by failing to take advantage of federal regulations that permit Indian Tribes to pay reduced services provided by Medicare-participating hospitals and that BCBSM charged hidden fees as part of the company’s Physician Group Incentive Program (“PGIP”).
Continue Reading Sixth Circuit Rules That Indian Tribe Can Pursue Breach of Fiduciary Duty Claim Against Health Plan Administrator