Life Insurance.

techs

Lifer
Sep 26, 2000
28,561
4
0
http://news.yahoo.com/s/ap/200..._su_co/benefit_battles

Employers use federal law to deny benefits

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.

Amschwand asked repeatedly whether there was anything else he needed to do and was told no. He asked that the new policy be sent to him. Spherion never did so.

He died without returning to work. His widow said he easily could have worked a day if that was what it took to activate the new policy. Spherion could have waived the one-day-of-work provision, as it did for other employees but not for Amschwand.

Spherion spokesman Kip Havel issued a brief statement when contacted by The Associated Press after the high court declined to review the case. "We are pleased the court has made its decision and the matter has finally been resolved," Havel said.

The court also recently turned down an appeal from Louis Gerard "Gerry" Goeres, who sued Charles M. Schwab & Co. over hundreds of thousands of dollars in retirement plan benefits.

For 16 months, Schwab mistakenly refused to acknowledge Goeres as the beneficiary in the retirement plan of his domestic partner, Stephen Ward, a Schwab employee who died in 1999. By the time Schwab acknowledged its error, the value of the account had declined by more than $500,000. Goeres sued for the rest. Federal courts dismissed the suit. "Unfortunately, legal relief is not available," U.S. District Judge Charles Breyer said in ruling against Goeres.

"You know the Schwab commercial, `Talk to Chuck?'" Goeres said. "I thought if Chuck knew this, he'd say, 'Oh my God, this is so wrong.' I live on naive dreams."

Schwab said in court papers that Goeres could have taken legal action soon after Ward's death, when he first was told he was not the beneficiary.

Amschwand-Bellinger said the cases show the need for either the court or Congress to provide "some sort of meaningful remedy for employees when employers have a breach of fiduciary duty."

A Texas native who lives in an unincorporated Houston suburb, she has since remarried and has an 18-month-old daughter. She is president and executive director of the Amschwand Sarcoma Cancer Foundation, which she founded with her first husband.

She recognizes that she is more fortunate than many others who have fought similarly futile battles for benefits under ERISA. "What if we had had children and I was a stay at home mom?" said Amschwand-Bellinger, who previously worked for a public hospital system. "What if I was 60 years old, with no skill sets, and I had to go back to work?"





Yes, once again the corporations with their government lackeys have found a way to cheat the working classes of America.
How long will we let the Republicans and their Supreme Court judges continue to take every opportunity to screw us?
 

woodie1

Diamond Member
Mar 7, 2000
5,947
0
0
I thought both houses of Congress were controlled by the Dems. Why haven't they corrected this legal loophole? Judges don't write law they just interpret it. Congress wrote the law and they have to fix it.

Did you not read this?

-------------------------------------------------------------------------------------------------
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.

---------------------------------------------------------------------------------------------------

Seems clear where the blame lies.
 

GooeyGUI

Senior member
Aug 1, 2005
688
0
76
There still needs to be a high enough majority to override Bush's veto pen.

This isn't just about life insurance either. The larger scope is about employee benefits being denied.
 

Double Trouble

Elite Member
Oct 9, 1999
9,272
103
106
You start with an interesting article, and then add stupid comments. Clearly, it doesn't take much to see this is wrong. People should get the benefits they've paid for. How you manage to try and make a logical leap of idiocy to blame "republicans and their supreme court judges" is a mystery. You do realize that the law that makes the situations described in the article possible was created and passed through a solidly democratic congress, yes? How exactly is that the fault of the republicans again?

The courts have are there to interpret the laws, not make them. Congress passed ERISA, it's up to congress to fix it if they don't like some part of it. Neither democrats or republicans have chosen to fix this problem, but somehow in your rabid frothing at the mouth anti-republican zealotry you fail to spend even a second of rational thought on the issue.

Also, FYI, if 4 justices want to hear the case, they can issue a writ of certiorari. There are easily 4 justices on the SCOTUS that are 1) not right-wing and 2) not appointed by republicans, yet they chose not to even hear this case. Why? because the law is pretty clear and there is nothing constitutionally wrong with the law, it's a simple matter of congress having to fix it if they so choose.

You really should try to occasionally see past your zealotry and joint the real world sometime.....
 

Engineer

Elite Member
Oct 9, 1999
39,234
701
126
Originally posted by: woodie1
I thought both houses of Congress were controlled by the Dems. Why haven't they corrected this legal loophole? Judges don't write law they just interpret it. Congress wrote the law and they have to fix it.


You blame the Democrats and their razor thin majority yet you fail to see that this has been happening nearly a decade under GOP rule (including both the President and 6 years of fully GOP controlled Congress). Not suprising that you throw that under the bed though.

Both sides should be ashamed that this has not been fixed.
 

ProfJohn

Lifer
Jul 28, 2006
18,251
8
0
Details from the court case
In August 1999, Amschwand was diagnosed with a rare form of heart cancer and took leave from his job. While he was on leave, Spherion changed life insurance carriers and purchased a new group policy from Aetna Life Insurance Company. Amschwand elected a total of $426,000 in basic and supplemental coverage under the new policy. Spherion confirmed that Amschwand was enrolled under the new policy. Pet. App. 2a-4a, 29a-30a.

Amschwand wrote checks to Spherion to cover the cost of his life insurance. Spherion cashed the checks, depositing them into an account in the name of the In terim/PPA Health Benefits Trust. Spherion paid monthly premiums to Aetna on the group life insurance policy, which was held in Spherion's name. Pet. App. 4a, 29a-30a; Sixth Am. Compl. 4, 6; Spherion Answer to Sixth Am. Compl. 4, 5; R. 950, 1539, 1566-1567, 1881, 2077-2093, 2494-2495; MDPROD1358-1359.

Unbeknownst to Amschwand, however, the Aetna policy contained a provision denominated the "Active Work Rule." That provision stated:

If the employee is ill or injured and away from work on the date any of his or her Employee Coverage (or any increase in such coverage) would become effec tive, the effective date of coverage (or increase) will be held up until the date he or she goes back to work for one full day.

Pet. App. 3a, 29a. Although Aetna agreed to waive the Rule for employees identified by Spherion who were on leave on the effective date of the new group policy, Spherion did not provide Amschwand's name to Aetna. Spherion also never informed Amschwand about the Active Work Rule. And, despite Amschwand's repeated requests for the summary of coverage under the policy or other documentation of his coverage, Spherion failed to provide Amschwand with the summary, which de scribed the Active Work Rule. Instead, Spherion re peatedly informed Amschwand that he was covered at the levels that he had elected. Id. at 3a-4a, 29a-30a.

After Amschwand's death, petitioner, who is his wi dow, filed a claim for the life insurance benefits with Aetna. Aetna denied the claim on the ground that Amschwand was ineligible for the benefits under the Active Work Rule because he had not returned to work for a full day after the policy became effective. Aetna affirmed the denial of benefits on administrative appeal. Pet. App. 5a, 30a; R. 2494-2495.
link
 

dmcowen674

No Lifer
Oct 13, 1999
54,894
47
91
www.alienbabeltech.com
Originally posted by: woodie1
I thought both houses of Congress were controlled by the Dems. Why haven't they corrected this legal loophole? Judges don't write law they just interpret it. Congress wrote the law and they have to fix it.

Did you not read this?

Let us know when the Dems have full real control.

Until then...
 

ProfJohn

Lifer
Jul 28, 2006
18,251
8
0
Bad news for you Bush haters...
Separately, despite the urging of the Bush administration, the court refused to hear the case of a widow denied $426,000 in life insurance benefits on grounds that a federal retirement law does not entitle her to sue for compensation. Lawyers for the Houston-area woman asked the court to intervene in the dispute, in which Melissa Amschwand accuses her late husband's employer of breach of fiduciary duty in connection with the life insurance policy.
link
 

GoingUp

Lifer
Jul 31, 2002
16,720
1
71
Originally posted by: Techs

Yes, once again the corporations with their government lackeys have found a way to cheat the working classes of America.
How long will we let the Republicans and their Supreme Court judges continue to take every opportunity to screw us?


Originally posted by: woodie1
I thought both houses of Congress were controlled by the Dems. Why haven't they corrected this legal loophole? Judges don't write law they just interpret it. Congress wrote the law and they have to fix it.

Did you not read this?

-------------------------------------------------------------------------------------------------
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.

---------------------------------------------------------------------------------------------------

Seems clear where the blame lies.

PWNED like the little troll that Techs is
 

Specop 007

Diamond Member
Jan 31, 2005
9,454
0
0
Originally posted by: dmcowen674
Originally posted by: woodie1
I thought both houses of Congress were controlled by the Dems. Why haven't they corrected this legal loophole? Judges don't write law they just interpret it. Congress wrote the law and they have to fix it.

Did you not read this?

Let us know when the Dems have full real control.

Until then...

LOL, what you want 100%??

THEY HAVE MAJORITY. They have done nothing.

Looks like your own party is selling the working class right down the river.

As for techs and HIS blind partisanship, its nearly as disgusting as yours.
 

Engineer

Elite Member
Oct 9, 1999
39,234
701
126
Originally posted by: ProfJohn
Bad news for you Bush haters...
Separately, despite the urging of the Bush administration, the court refused to hear the case of a widow denied $426,000 in life insurance benefits on grounds that a federal retirement law does not entitle her to sue for compensation. Lawyers for the Houston-area woman asked the court to intervene in the dispute, in which Melissa Amschwand accuses her late husband's employer of breach of fiduciary duty in connection with the life insurance policy.
link

But the GOP congress didn't seem to care what he thought, now did they? Kudos to Bush (not often) for that one though.
 

Engineer

Elite Member
Oct 9, 1999
39,234
701
126
Originally posted by: Specop 007
Originally posted by: dmcowen674
Originally posted by: woodie1
I thought both houses of Congress were controlled by the Dems. Why haven't they corrected this legal loophole? Judges don't write law they just interpret it. Congress wrote the law and they have to fix it.

Did you not read this?

Let us know when the Dems have full real control.

Until then...

LOL, what you want 100%??

THEY HAVE MAJORITY. They have done nothing.

Looks like your own party is selling the working class right down the river.

As for techs and HIS blind partisanship, its nearly as disgusting as yours.

Again, the DEMs did nothing and neither have the GOP, who held power for nearly a decade with this issue around. Blame the DEMs "only" if you must, but only a hack would blame them only when the GOP held control for a decade and even with Bush's urging them on this one (to fix it).
 

Specop 007

Diamond Member
Jan 31, 2005
9,454
0
0
Originally posted by: Engineer
Originally posted by: Specop 007
Originally posted by: dmcowen674
Originally posted by: woodie1
I thought both houses of Congress were controlled by the Dems. Why haven't they corrected this legal loophole? Judges don't write law they just interpret it. Congress wrote the law and they have to fix it.

Did you not read this?

Let us know when the Dems have full real control.

Until then...

LOL, what you want 100%??

THEY HAVE MAJORITY. They have done nothing.

Looks like your own party is selling the working class right down the river.

As for techs and HIS blind partisanship, its nearly as disgusting as yours.

Again, the DEMs did nothing and neither have the GOP, who held power for nearly a decade with this issue around. Blame the DEMs "only" if you must, but only a hack would blame them only when the GOP held control for a decade and even with Bush's urging them on this one (to fix it).

Maybe they did and it was stopped from one of the ever present Democratic filibusters?

Or can you say with 100% certainly the Republicans never even tried to address the situation.

But the point remains. The party that is generally viewed as the party for the little guy have effectively thrown the little guy under the bus for the past 2 years!
 

GooeyGUI

Senior member
Aug 1, 2005
688
0
76
Originally posted by: ProfJohn
Bad news for you Bush haters...
Separately, despite the urging of the Bush administration, the court refused to hear the case of a widow denied $426,000 in life insurance benefits on grounds that a federal retirement law does not entitle her to sue for compensation. Lawyers for the Houston-area woman asked the court to intervene in the dispute, in which Melissa Amschwand accuses her late husband's employer of breach of fiduciary duty in connection with the life insurance policy.
link

Could be a stance to appear concerned while knowing the Supreme Court won't be hearing the case. Or, even if it did, the result would have to follow written law as it exists.
 

fallout man

Golden Member
Nov 20, 2007
1,787
0
0
That story is fucked up.

Isn't this a simple breach-of-contract issue? When I pay into my life insurance fund, I expect that when a meteorite hits me, the beneficiaries will get the return I have signed up for.

Is this is a case of life insurance companies playing the health insurance company game of "pre-existing condition shuffle?" They should get their pants sued the fuck off. Absolutely disgusting.
 

Engineer

Elite Member
Oct 9, 1999
39,234
701
126
Originally posted by: Specop 007

But the point remains. The party that is generally viewed as the party for the little guy have effectively thrown the little guy under the bus for the past 2 years!

LOL, and the GOP has thrown the little guy under the bus every year forever. Oh, and it's been 1.5 years, not 2. Both parties have done nothing even you think and assume that ONLY one hasn't.
 

DonaldC

Senior member
Nov 18, 2001
752
0
0
Talk about screwed up. Why can't Congress stop their bickering long enough to fix this. Wait, they don't care about us - that's just a sham to get reelected.
 

bamacre

Lifer
Jul 1, 2004
21,030
2
61
"Employee Retirement Income Security Act."

Sounds like the federal government getting involved in things it has no authority to get involved in.

Quite ironic that Techs would complain.
 

GroundedSailor

Platinum Member
Feb 18, 2001
2,502
0
76
Originally posted by: fallout man
That story is fucked up.

Isn't this a simple breach-of-contract issue? When I pay into my life insurance fund, I expect that when a meteorite hits me, the beneficiaries will get the return I have signed up for.

Is this is a case of life insurance companies playing the health insurance company game of "pre-existing condition shuffle?" They should get their pants sued the fuck off. Absolutely disgusting.

Not that I like or agree with how this case turned out, but for the sake of discussion, the argument about breach of contract can be turned both ways. The guy did not comply with the active work rule and therefore, theoretically, breached his part of the contract.

Unfortunately ignorance of the law is no excuse and thus congress needs to change the laws on this to better protect the little guy.


 

Double Trouble

Elite Member
Oct 9, 1999
9,272
103
106
The quick summary is that Spherion made a mistake in not reporting the guys name to Aetna when the new policy started as an "exemption" as they had for other employees. Spherion was able to use ERISA as a shield against the lawsuit, and the guy/his family got screwed as a result.

Lets see. Who created ERISA? Democrats. Who held control of congress for the majority of time since ERISA was enacted (1974)? Democrats. Who currently holds the majority in congress? Democrats. This is like the AMT -- it needs to be addressed, but both sides are too busy playing politics to address it.
 

Fern

Elite Member
Sep 30, 2003
26,907
173
106
These type stories - insurance/employee benefit problems - have me pusuaded that before UHC (really just universal health insurance) is forced upon us, there needs to be reform in these areas. Otherwise, many of us will just end up with faulty/useless insurance products that don't actually deliver.

Fern
 

MadRat

Lifer
Oct 14, 1999
11,910
238
106
Insurance companies are the mob. If anyone thinks they will beat them at their own game you are naive.
 

JS80

Lifer
Oct 24, 2005
26,271
7
81
What a horrible business decision. Watch the corporate Spherion accounts renewal rate plummet.