Townhall.com, Where Your Opinion Counts
Talk Radio:   Bill Bennett   Mike Gallagher   Dennis Prager   Michael Medved   Hugh Hewitt   
TOP NEWS   LeftArrow - Townhall.com   RightArrow - Townhall.com  
Columns, funnies & more in your inbox!
Saturday, July 05, 2008
Employers use federal law to deny benefits
By MARK SHERMAN
Vote on It:
Average Vote:
[+] Text [-]
 
Poll
Who will Obama pick to be his VP?




Dying of cancer, Thomas Amschwand did everything he was told to make sure his wife would collect on the life insurance policy he had through his employer.

"He was obsessed with dotting every `i' and crossing every `t'," Melissa Amschwand-Bellinger recalled about her husband, who died in 2001 at age 30.

But Spherion Corp., the temporary staffing company where Amschwand worked, told Amschwand-Bellinger she would not receive any of the $426,000 in benefits she believed she was due. When she went to court, Spherion succeeded in getting her lawsuit thrown out. The Supreme Court on June 27 refused to review the case.

Amschwand-Bellinger received a refund of the few thousand dollars in insurance premiums she and her husband dutifully had paid. The total, she said, would not cover the costs of his funeral.

The story has played out often under the federal Employee Retirement Income Security Act. Designed to protect employee benefits, the law has been used by employers as a shield against suits.

Federal appeals courts, interpreting Supreme Court decisions dating to 1993, consistently have said companies that offer health, life and retirement benefits under ERISA cannot be sued for large amounts of money, or damages. Instead, they can be sued only for typically smaller sums such as Amschwand's insurance premiums.

Several federal judges have bemoaned the unfairness even as they have felt constrained to rule in favor of employers.

"The facts ... scream out for a remedy beyond the simple return of premiums," Judge Fortunato Benavides of the New Orleans-based 5th U.S. Circuit Court of Appeals said in the Amschwand case. "Regrettably, under existing law it is not available."

The Bush administration has argued that the appeals courts are misreading the precedents and has asked the high court at least twice to clarify the earlier rulings. So far it has refused.

Congress, which could amend ERISA to make clear such suits are allowed, also has taken no action.

The result, in the view of ERISA experts, the administration and some lawmakers, is perverse.

"The beneficiary under the policy didn't get the promised benefit," said Colleen Medill, an expert on ERISA at the University of Nebraska-Lincoln. "To say we're just going to return your premiums, that's a total farce. That's not what they paid the premiums for. They paid them for the benefits."

Sen. Patrick Leahy, chairman of the Senate Judiciary Committee, said at a recent hearing that before ERISA became law, employees clearly could sue for benefits in state courts.

The court rulings, said Leahy, D-Vt., have left people "more vulnerable than they were before the law was passed."

Spherion's decision to deny benefits to Amschwand-Bellinger turned on an odd set of facts. Spherion, which employs about 300,000 people, switched insurers after Thomas Amschwand was diagnosed with a rare form of heart cancer. The new policy did not take effect until an employee worked one full day. Spherion never informed Amschwand of the requirement. Continued...

1 2
| Full Article & Comments | Next >
Share:
Vote on It:
Average Vote:
 
Subject: Insurers are SATANIC!
A family member has been on disability for 7 years with a disability carrier. He has had phone calls that go click, request for all his credit card statements, found himself to be followed by a PI's, and asked if he would like around 40% of his benefits to end his claim. He has a rare neurolical disorder and sometimes cannot sleep for 30 straight hours or more and is on pain meds to move around like a normal human being. But at least he was paid, yet he is one false PI report away from termination. He tells me that not a month goes by that he doesn't read in a support group of a spouse asking for help as the provider in the family was just terminated because the "in house" doctor has reviewed a file and decided they can work.

The article is correct...you think you have coverage? GUESS AGAIN! Under ERISA if they terminate you and you win a court case you get ONLY your benefits. You will surrender 35-40% of your benefits in legal fees and the judge cannot award them. Some scumbag at a company that is making about $40,000 a year has selected your file when he is told his quota of claims that month to "get off the books".

The AMA authored a paper a few years ago telling physicians in groups not to buy group coverage as it falls under ERISA where you have far fewer rights. While you might pay 50% more in premiums for an individual policy, you have rights in the state courts which involve "bad-faith" and that means a poorly handled claim will be nailed in damages.

Read this and learn:
http://www.my3cents.com/showReview.cgi?id=12173
Sign Up to Post Your CommentsSign Up to Post Your Comments
If you are already registered, click here to login. Otherwise, please take a few seconds to register with Townhall.com. Once you sign up, you’ll be able to post your comments immediately, use the action center, get podcasts, and more!
Note: Fields marked with a red asterisk (*) are required.
Salutation:
First Name:
*
Last Name:
*
Email:
*
Nickname:
*
Note: Nick name will be shown when you post comments.
Address 1:
*
Address 2:
City:
*
State:
*
Zip:
*
Phone:
      
Your daily dose of conservative columns, editorial cartoons, talk radio, news, and more!
(Bi-Weekly) We highlight the best opportunities from our partners for surveys, action items and more.