News & Analysis as of

Employee Retirement Income Security Act (ERISA) Insurance Claims

Rivkin Radler LLP

Insurance Update - May 20 2024

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Careening race cars, missing diamonds, and gold treasure provide some of the backdrop for insurance issues that courts had to decide this past month. We begin in Pennsylvania where the state’s high court reined in some loose...more

Carlton Fields

Litigation Lineup: Recent Decisions in Life and Disability Insurance Run into Policy Lapse, COVID-19, and Conflict of Interest...

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Life Policy Lapse Shortly Before Insured’s Death - In Simon v. USAA Life Insurance Co. (Mar. 29, 2024), the insurer denied death benefits under a term life insurance policy, which had lapsed for nonpayment of premium two...more

McDermott Will & Emery

[Webinar] Gender-Affirming Benefits: Best Practices for Group Health Plans - February 29th, 1:00 pm - 1:30 pm EST

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Employers and plan sponsors are facing growing – and often conflicting – pressures related to the coverage of gender-affirming care. Join McDermott lawyers Sarah G. Raaii and Alden J. Bianchi for a webinar to review recent...more

Hall Benefits Law

United Behavioral Health Files Cert Petition Over Mental Health Coverage Loss

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United Behavioral Health (UBH) and the Alcatel-Lucent Medical Expense Plan, an employee health plan now owned by Nokia, have filed a petition for a writ of certiorari before the U.S. Supreme Court. They are seeking to...more

Saul Ewing LLP

The Friday Five: Five Current ERISA Litigation Highlights - May 2022

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This month’s Friday Five covers cases relating to a claimant’s second chance when a lawyer misses a court deadline, whether certain voluntary benefits fall within a broader ERISA plan, a court deciding that an insurer was...more

Proskauer - Employee Benefits & Executive...

Ninth Circuit Defers to Plan Design and Administrative Discretion on Bounds of Mental Health Coverage

A recent decision by the U.S. Court of Appeals for the Ninth Circuit (Wit et al. v. United Behavioral Health and Alexander et al. v. United Behavioral Health) exemplifies the challenge in balancing a desire to cover evolving...more

Polsinelli

Ninth Circuit Reverses Landmark Wit Case Addressing Behavioral Health Coverage

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The President and his administration continue to tout their efforts to strengthen coverage for behavioral health care, including significantly increasing behavioral health spending and strengthening parity between physical...more

Saul Ewing LLP

The Friday Five: Five Current ERISA Litigation Highlights - April 2022

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This month’s Friday Five covers cases relating to: (1) whether claim administrators can recover overpayments through a breach of contract claim under state law; (2) whether claim administrators can rely solely on a claimant’s...more

Holland & Knight LLP

Circuit Split Remains on Availability of Equitable Relief from ERISA Co-Fiduciaries

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The U.S. Supreme Court has denied a petition for certiorari in First Reliance Standard Life Insurance Company v. Giorgio Armani Corporation. Although the headlines typically come when the Supreme Court issues an opinion, its...more

Alston & Bird

Class Action & MDL Roundup – Fall 2021

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In the fall edition of the Class Action & MDL Roundup, covering notable class actions from the third quarter of 2021, a marriage nearly tears apart a certified class, insurers are vaccinated against more COVID-19 suits, and...more

Rivkin Radler LLP

Insurance Update - December 2021

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Our December Insurance Update features four cases. The Minnesota Supreme Court decides if a resident-relative exclusion violates public policy. A Texas appellate court considers, for a second time, if damage from...more

Hinshaw & Culbertson LLP

The LHD/ERISA Advisor: Court Rejects Insurer's Interpretation of its Own Policy Language on Limitations Period

In Spina v. Metro. Life Ins. Co., 2021 U.S. Dist. LEXIS 114887, (D.N.J. June 21, 2021), the court rejected both an insurer's and insured’s interpretation of when proof of loss was due under a long-term care policy and...more

Ogletree, Deakins, Nash, Smoak & Stewart,...

HHS Proposes Air Ambulance Reporting Details Beginning in 2022

Employer-sponsored health plans can add air ambulance claims reporting to the list of required disclosures that will go into effect in the next several years. Under proposed regulations published September 16, 2021, by...more

Zuckerman Spaeder LLP

[Webinar] A Step-by-Step Strategy for Maximizing Insurance Coverage Under ERISA - July 22nd, 2:00 pm - 3:00 pm ET

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Building on our recent overview presentation “Six Lessons Patients and Providers Need to Know," we invite you to join us as we examine a single medical provider/patient encounter, in order to identify the concrete steps a...more

Alston & Bird

Class Action & MDL Roundup – Spring 2021

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Welcome back to the Class Action & MDL Roundup! Our spring edition covers notable class actions from the first quarter of 2021. In this edition, the courts are beginning to split on COVID-19 cases, privacy litigants can’t...more

Alston & Bird

Class Action & MDL Roundup – Winter 2021

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Welcome back to the Class Action & MDL Roundup! Our winter edition covers notable class actions from the fourth quarter of 2020. In this edition, we find a common theme among COVID-19 class actions, the Tampa 2 defends...more

K&L Gates LLP

Recent District Court Decision Highlights the Importance of Adequate Behavioral Health Claims Processing Guidelines for ERISA...

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On this week’s episode, Carla DewBerry and Sarah Carlins discuss a recent California Federal District Court decision in David Wit v. United Behavioral Health, in which the court found that the defendant insurer violated ERISA...more

Saul Ewing LLP

The Friday Five: Five Current ERISA Litigation Highlights – December 2020

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This month’s Friday Five covers recent cases addressing: (1) the validity of a judgment that includes retroactive “any occupation” benefits where no administrative determination on those benefits has been made; (2) the...more

Wiley Rein LLP

Ninth Circuit: Excess Carrier Not Entitled to Challenge Payment Decisions of Underlying Carriers

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The United States Court of Appeals for the Ninth Circuit, applying California law, has held that an excess insurer could not second-guess the payment decisions of underlying insurers absent a showing of fraud or bad faith, or...more

Carlton Fields

ERISA Disability Plan Insurers Score Important Circuit Court Victories

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In recent months, circuit courts across the country have supported insurers’ discretion to deny long-term disability benefits (LTD) under ERISA. Since the beginning of the year, disability plan insurers have prevailed in the...more

Proskauer - Employee Benefits & Executive...

Fifth Circuit: Plaintiff Not Entitled to Attorneys’ Fees For Obtaining Remand on Appeal

The Fifth Circuit concluded that an individual plaintiff was not entitled to attorneys’ fees, even though she persuaded the Fifth Circuit to vacate and remand a summary judgment decision in favor of the Humana Health Plan,...more

Seyfarth Shaw LLP

Insurers, ERISA Plans and Other Payors: Beware of COVID-19 Fraud Schemes!

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On March 23, 2020, the U.S. Department of Health and Human Services Office of Inspector General (“HHS-OIG”) issued an alert to the public about fraud schemes related to the novel coronavirus (COVID-19)....more

Robinson+Cole ERISA Claim Defense Blog

Remand Directing Change in Standard of Judicial Review Is Not Sufficient Success on the Merits to Support Attorneys’ Fee Award

In Ariana M. v. Humana Health Plan of Texas, Inc., No. 18-20700, 2019 WL 5866677 (5th Cir. Nov. 8, 2019), the Fifth Circuit Court of Appeals rejected a plaintiff’s petition for attorneys’ fees under 29 U.S.C. § 1132(g).  This...more

Carlton Fields

Court Sheds Light on ERISA’s Fiduciary Exception to Attorney-Client Privilege

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A federal district court in Ohio recently attempted to shed some light on when internal communications between an ERISA plan administrator and its in-house counsel are discoverable and when they are protected by the...more

Winstead PC

Another Lesson on Bullet Proofing Your Claims Process

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On July 12, 2018, a previous alert entitled “Bullet Proofing Your Claims Process” discussed lessons learned from a recent 5th Circuit decision in White v. Life Insurance Company of North America, (5th Cir. June 13, 2018,...more

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