Insurer not required to disclose internal guidelines for determining if mental health benefits are medically necessary, but court rules denial of benefits was reasonable

Article Abstract:

The US 1st Circuit Court of Appeals in Doe v. Travelers Insurance Co. held that an employee health insurance company was not required to disclose internal guidelines it used when making coverage determinations regarding the medical necessity of mental health insurance benefits. The court found that the guidelines did not fall under ERISA section 104(b)(2). However, the court found that the facts supported the unreasonable denial of benefits.

Direct Health and Medical Insurance Carriers, Hospital and medical service plans, Medical Care Insurance, Cases, Practice, Mental health, Health insurance, Health insurance industry, Insurance, Insurance policies

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Plan administrator abused discretion by failing to qualify a DRO intended to correct calculations in his spouses's QDRO

Article Abstract:

The US 4th Circuit Court of Appeals in Fox v. Fox held that an abuse of discretion under ERISA existed when a qualified retirement plans administrator did not qualify a domestic relations order submitted to correct original calculations in an existent qualified order. The court found that unreasonable personal motivations instigated the administrator's failure.

Employee Benefits & Services, Human resource management, Influence, Employee benefits, Qualified benefit plans, Marriage law

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