On December 5, 2023, in <em>Ian C. v. United Healthcare Ins. Co.</em>, the Tenth Circuit Court of Appeals (Tenth Circuit) reversed the district court’s ruling that the defendant’s claim denial was not arbitrary and capricious because the defendant did not provide a “full and fair review” of the plaintiff’s claims.

On February 2, 2024, the DOL, HHS, and IRS (the departments) issued FAQ guidance on the implementation of certain requirements under the Transparency in Coverage (TiC) Final Rules. This FAQ clarifies the participant cost-sharing tool compliance requirements where a plan is providing cost estimates based on claims data, but there is extremely low utilization of the item or service at issue.

In January, the DOL issued five fact sheets that focus on different aspects of the FMLA.

On December 19, 2023, the US Court of Appeals for the Eleventh Circuit (the Eleventh Circuit) filed an opinion in W.A. Griffin, MD v. Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. , per curiam, affirming the decision of the district court that an assignment of benefits by a patient to a medical provider did not include sufficiently explicit language to transfer the right to bring nonpayment, statutory penalty suits under ERISA.

On January 11, 2024, the DOL published a final rule adjusting civil monetary penalties under ERISA. The annual adjustments relate to a wide range of compliance issues and are based on the percentage increase in the consumer price index for all urban consumers (CPI-U) from October of the preceding year. The DOL last adjusted certain penalties under ERISA in January of 2023. Highlights of the 2024 penalties that may be levied against sponsors of ERISA-covered plans include: 

On January 10, 2024, the Ninth Circuit Court of Appeals (the Ninth Circuit) ruled that an assignment of benefits includes the right of South Coast Specialty Surgery Center, Inc. (South Coast) to sue Blue Cross of California dba Anthem Blue Cross (Anthem) under ERISA Section 502(a) for Anthem’s alleged failure to fully reimburse the costs of medical services provided to South Coast’s patients. The Ninth Circuit reversed the district court’s dismissal of South Coast’s claim and remanded the case to  the district court for further action. Prior to 2019, South Coast submitted claims for...

Recently, HHS released a set of FAQs concerning an individual’s right to access health information. HIPAA requires covered entities, which include insurers and self-insured group health plans, to provide individuals with access to their protected health information (PHI), such as medical records, information related to enrollment, payment, or claims adjudication, and other records used by the covered entity to make decisions about those individuals. This right of access includes the right to obtain copies (paper or electronic) of the PHI and the right to direct the covered entity to transmit...

The IRS recently published the 2024 IRS Publication 15-B, the Employer's Tax Guide to Fringe Benefits. This publication provides an overview of the taxation of fringe benefits and applicable exclusion, valuation, withholding, and reporting rules. The IRS updates Publication 15-B each year to reflect any recent legislative and regulatory developments. Additionally, the publication provides the applicable dollar limits for various benefits for 2024.

On January 9, 2023, the DOL announced its final rule on worker classification for purposes of the Fair Labor Standards Act (FLSA).

On December 13, 2023, the US Court of Appeals for the Eleventh Circuit (Eleventh Circuit) held in Lapham v. Walgreen Co., that to prove Family and Medical Leave Act (FMLA) retaliation or interference claims, an employee must establish that an adverse employment decision was because of an FMLA leave request, not just motivated by the request. Plaintiff Doris Lapham worked for Walgreens in various roles and at multiple store locations for over a decade. Between 2011 and 2016, Ms. Lapham took intermittent FMLA leave to care for her disabled son. During that same period, Ms. Lapham...