Failure to exhaust administrative remedies. Ravencraft v. UNUM Life Insurance Company of America

Ravencraft v. UNUM Life Insurance Company of America, 212 F.3d 341 (6th Cir. 2000): Although ERISA does not explicitly require it, the Sixth Circuit and most of the others require that a participant pursue all plan remedies before bringing suit. An action against a plan or plan fiduciary will be dismissed if the participant fails to exhaust the administrative remedies available to it under the plan unless he or she can show that pursuing those remedies would be futile, such as where the available remedies are inadequate or unfair. If a participant's case is dismissed solely because of the failure to follow the procedural steps for review under the plan, the dismissal should be without prejudice so that the participant can file suit again, if necessary, after he or she goes back to pursue the remedies available under the plan.     

"Any Willing Provider" laws not preempted by Employee Retirement Income Security Act (ERISA). Kentucky Association of Health Plans, Inc. et. al. v. Miller, Commissioner, Kentucky Department of Insurance

"Any Willing Provider" laws are not preempted by ERISA because they are state laws regulating insurance if they are (1) specifically directed toward entities engaged in insurance and (2) substantially affect the risk-pooling arrangement between the insurer and the insured. Thus, a state may prohibit health maintenance organizations (HMOs) from creating exclusive "provider networks" of doctors, hospitals and other health care providers by excluding other providers who are "willing and able" to comply with all the HMO's contractual terms if the law meets the new two-prong test established by the Supreme Court in this case. The Court made a "clean break" from using the McCarran-Ferguson Act factors for determining whether certain practices constitute "the business of insurance," when deciding when they regulate insurance for purposes of ERISA preemption.     

Administration--delayed benefits payment; interest. Fotta v. Trustees of the United Mine Workers of America, Health and Retirement Fund of 1974, 165 F.3d.209 (3rd Cir. 1998)

In a case of first impression, the Third Circuit holds that a beneficiary of an ERISA plan may sue the plan for interest on delayed benefits payments under Section 502(a)(3)(B) regardless of whether he also seeks to recover unpaid benefits. A beneficiary is not made whole when a plan pays benefits after delay since he has lost the time value of the money. Interest for delayed benefits payments is appropriate equitable relief that prevents the plan from being unjustly enriched at the beneficiary's expense. Since interest is money damages that is restitutive in nature, it is a form of equitable relief. Interest is not prohibited as "extracontractual" since it is compensation that is part of the contractual obligation.     

Public plans--Americans with Disabilities Act--discrimination-disparate treatment of mental disabilities. Rogers v. Department of Health and Environmental Control, 174 F.3d 431 (4th Cir.1999)

Title II of the Americans with Disabilities Act of 1990 (ADA), which prohibits discrimination in the services, programs or activities of public entities, does not require a state's long-term disability plan to provide the same level of benefits for mental and physical disabilities. By placing mental disabilities in different risk classifications from physical disabilities, South Carolina's long-term disability plan did not violate a South Carolina statute that prohibits discrimination "between insureds of the same class and risk involving the same hazards."