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The Wagner Law Group

The Wagner Law Group is a nationally recognized practice in the areas of ERISA and employee benefits, estate planning, employment, labor and human resources and investment management.

 

Established in 1996, The Wagner Law Group is dedicated to the highest standards of integrity, excellence and thought leadership and is considered to be amongst the nation's premier ERISA and employee benefits law firms. The firm has seven offices across the country, providing unparalleled legal advice to its clients, including large, small and nonprofit corporations as well as individuals and government entities worldwide. The Wagner Law Group's 34 attorneys, senior benefits consultant and five paralegals combine many years of experience in their fields of practice with a variety of backgrounds. Seven of the attorneys are AV-rated by Martindale-Hubbell and six are Fellows of the American College of Employee Benefits Counsel, an invitation-only organization of nationally recognized employee benefits lawyers.  Seven of the firm's attorneys have been named to the prestigious Super Lawyers list for 2017, which highlights outstanding lawyers based on a rigorous selection process.

 

 

 

Contact Info

The Wagner Law Group

 

  Integrity | Excellence

  

Boston 

Tel: (617) 357-5200 

Fax: (617) 357-5250 

99 Summer Street 

13th Floor

Boston, MA 02110

 

Washington, D.C.

Tel: (202) 969-2800

 

Fax: (202) 969-2568

 800 Connecticut Avenue, N.W.

Suite 810

Washington, D.C. 20006

 

Chicago

Tel: (847) 990-9034

Fax: (847) 557-1312

190 South LaSalle Street

Suite 2100

Chicago, IL 60603

 

  

Palm Beach Gardens 

Tel: (561) 293-3590
Fax: (561) 293-3591
7108 Fairway Drive
Suite 125
Palm Beach Gardens, FL 33418

   

Tampa

Tel: (813) 603-2959

Fax: (813) 603-2961

101 East Kennedy Boulevard

Suite 2140
Tampa, FL  33602 

  

San Francisco

Tel: (415) 625-0002

Fax: (415) 358-8300

300 Montgomery Street

Suite 600

San Francisco, CA 94104

  

St. Louis

Tel: (314) 236-0065

Fax: (314) 236-5743
25 W. Moody Avenue
St. Louis, MO  63119 

 

Lincoln

Tel: (617) 532-8080

Fax: (617) 532-9090

55 Old Bedford Road

Lincoln, MA 01773

 

 

www.wagnerlawgroup.com

 

 

 

   Employee Awarded Benefits Due to Employer's Flawed Administrative Procedures

  

April 19, 2018

 

 

 

In Frye v. Metropolitan Life Insurance Co., a federal district court in Arkansas has held that an employee is entitled to proceeds from dependent life and accidental death and dismemberment (AD&D) insurance policies, despite the fact that her son was ineligible for such coverage due to his age at the time of his death.

 

Facts. The employee provided her son's birthdate and other pertinent information when she enrolled him in the employer's medical plan in 2012. At that time, the employee also elected dependent life and AD&D coverage for her son, but she was not required to provide any information for that coverage.

 

The son's coverage under the employer's dependent life and AD&D insurance policies began in 2013 and automatically renewed in 2014 and 2015. Although her son lost eligibility for coverage when he turned twenty-three years old in 2014, the employee did not notify the employer or the insurer. Moreover, neither the employer nor insurer alerted the employee that her son had aged out of coverage, and they continued to deduct premiums for the coverage from her wages.

 

After her son's death in 2015, the employee filed a claim for life and AD&D benefits with the insurer. Acting as the plan's claims administrator, the insurer denied the employee's claim, explaining that the policies only covered dependents less than 23. The insurer subsequently concluded that the decedent was ineligible for coverage during the 2015 plan year, and the employer refunded the premiums collected from the employee after the decedent had turned 23.

 

The employee appealed the adverse benefit determination, and the insurer upheld its decision to deny benefits. In turn, the employee sued the employer in federal court under the provisions of ERISA.

 

District Court. In reviewing the case, the court found that the evidence presented confirmed that the insurer had correctly denied benefits under the plan provisions, since the policy unambiguously terminated dependent eligibility at age 23.

 

The court next reviewed whether the employee was entitled to appropriate equitable relief under ERISA. The court concluded that the employer and insurer had breached their fiduciary duties by using flawed administrative procedures that failed to confirm eligibility for coverage, thereby allowing employees to enroll dependents who were either ineligible or became ineligible. Specifically, the court noted that the employer's administrative procedures focused too much on reducing expenses while overlooking how simple screening for age would be.

 

Ultimately, the court concluded that although the plan document required the employee to notify the insurer of changes in dependents' eligibility status, the employee's failure did not relieve the employer and insurer of their fiduciary duties. Therefore, the court held that the appropriate remedy was a surcharge against the employer and insurer equal to the amounts the employee would have received if the coverage had been in effect when her son died.

 

 

 

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This Newsletter is provided for information purposes by The Wagner Law Group to clients and others who may be interested in the subject matter, and may not be relied upon as specific legal advice.  This material is not to be construed as legal advice or legal opinions on specific facts. Under the Rules of the Supreme Judicial Court of Massachusetts, this material may be considered advertising.