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For Whom The Bell (Equitably) Tolls: Erisa Compliance And Denial Of Benefits Notices Circuit Split, Sarah Smith
For Whom The Bell (Equitably) Tolls: Erisa Compliance And Denial Of Benefits Notices Circuit Split, Sarah Smith
Akron Law Review
The circuit courts are split as to how a plan administrator of an ERISA-governed employee benefit plan must notify a claimant of a time limitation placed on a claimant’s ability to seek judicial review of an adverse benefit decision. Some courts indicate that inclusion of this time limitation in the Summary Plan Description is sufficient to notify a claimant. Other courts have held that the time period must specifically be included in adverse determination notices, which are documents notifying claimants of the denial of their claim and the right to judicial review. Much of the debate among courts concerns the …
Are We Protected From Hmo Negligence?: An Examination Of Ohio Law, Erisa Preemption, And Legislative Initiatives, Amy K. Fehn
Are We Protected From Hmo Negligence?: An Examination Of Ohio Law, Erisa Preemption, And Legislative Initiatives, Amy K. Fehn
Akron Law Review
This comment discusses the various theories of HMO liability that are emerging in other jurisdictions as well as the extent to which current Ohio law bars several of these theories. In addition, this comment also discusses ERISA's preemption of state laws related to HMO liability. Finally, this comment analyzes legislative initiatives and other forms of regulation aimed at protecting consumers from HMO abuses .
Managed Care Organizations Manage To Escape Liability: Why Issues Of Quantity Vs. Quality Lead To Erisa's Inequitable Preemption Of Claims, Patricia Mullen Ochmann
Managed Care Organizations Manage To Escape Liability: Why Issues Of Quantity Vs. Quality Lead To Erisa's Inequitable Preemption Of Claims, Patricia Mullen Ochmann
Akron Law Review
In evaluating patients’ potential legal remedies, this Comment explores 1) the emergence of managed care organizations in the United States; 2) the creation of the Employee Retirement Income Security Act of 1974 (“ERISA”) and how it impacts patients’ claims against their MCOs; 3) the question of “quantity” versus “quality” in evaluating whether ERISA preemption exists; 4) three theories (direct liability, breach of fiduciary duty, and vicarious liability) used to hold MCOs liable for injuries resulting from malpractice or the wrongful denial of benefits; 5) state legislative attempts to circumvent ERISA’s inequitable preemption of claims; and 6) why, given ERISA’s failure …