In Ligotti v. United Healthcare Services, 2021 U.S. Dist. LEXIS 106992 (S.D. Fla., June 8, 2021), a Florida district court held that a health care provider challenging claim denials on behalf of his patients cannot satisfy...more
An ERISA plan administrator must, if requested by a claimant contesting an adverse benefits determination, produce a copy of an audio recording or transcript of a telephone conversation between the claimant and a plan...more
Hinshaw's LHD/ERISA Advisor remains committed to bringing you recent legal developments that may guide your life, health, and disability litigation strategy and claims decisions.
In this edition, we cover a recent DOL...more
In Nathan W. v. Anthem Bluecross Blueshield of Wisconsin, 2021 U.S. Dist. LEXIS 42127 (M (D. Utah Mar. 5, 2021), a federal court held that conclusory allegations of discriminatory medical necessity criteria were sufficient to...more
The extent to which a health plan may exclude coverage for mental health treatment modalities has become an active area in ERISA litigation. In Doe v. United Behavioral Health, 2021 U.S. Dist. LEXIS 43146 (N.D. Cal. March 5,...more
Hinshaw's LHD/ERISA Advisor remains committed to bringing you recent legal developments that may guide your life, health, and disability litigation strategy and claims decisions....more
In Gill v. Unum Life Ins. Co. of Am., 2020 U.S. Dist. LEXIS 219416 (N.D. Cal. Nov. 23, 2020), a California federal court held that an ERISA claim administrator properly limited benefits to 24 months under the plan's mental...more
In Jessica U. v. Health Care Service Corp., a Montana district court held that an ERISA plan administrator improperly denied benefits for mental health residential treatment based solely on so-called "Milliman Care...more
In Religious Sisters of Mercy v. Azar, 2021 U.S. Dist. LEXIS 9156 (D.N.D. Jan. 19, 2021), a district court awarded a group of plaintiffs permanent injunctive relief against a provision of the Affordable Care Act ("ACA") that...more
In Perez v. Lincoln Nat'l Life Ins. Co., 2021 U.S. App. LEXIS 1495 (9th Cir. Jan. 20, 2021), the Ninth Circuit held that a district court reviewing a denial of disability benefits under ERISA may consider a Social Security...more
In Davis v. Hartford Life & Accident Life Ins. Co., 2020 U.S. App. LEXIS 36360 (6th Cir. Nov. 19, 2020) the Sixth Circuit held that a district court properly applied the abuse of discretion standard when reviewing the denial...more
As we look ahead to 2021, we start our second edition of Hinshaw's LHD/ERISA Advisor by reporting on key cases that closed out 2020. Through The Advisor, our team of attorneys nationwide strive to report on legal developments...more
As we enter the final months of 2020, this is a time to reflect on a year of unprecedented challenges. Although Covid-19 changed our lives in many ways, it did not halt new legal developments in the life, health and...more
In Raymond M. v. Beacon Health Options, Inc., 2020 U.S. Dist. LEXIS 94615 (D. Utah, May 29, 2020), a Utah district court held that an ERISA plan improperly applied acute-level criteria when denying benefits for a...more
In Lyn M. v. Premera Blue Cross, 2020 U.S. App. LEXIS 23395 (10th Cir. July 24, 2020), the Tenth Circuit held that a district court had applied the wrong standard of review and incorrectly evaluated an ERISA plan...more
10/14/2020
/ Appeals ,
Denial of Insurance Coverage ,
Dependents ,
Employee Benefits ,
Employee Retirement Income Security Act (ERISA) ,
ERISA Litigation ,
Medical Necessity ,
Mental Health ,
Plan Administrators ,
Reversal ,
Reversible Error ,
Standard of Review ,
Summary Judgment
In Julie L. v. Excellus Health Plan, Inc., 2020 U.S. Dist. LEXIS 47734 (W.D.N.Y. March 19, 2020), a New York district court rejected the plaintiff's claims that a health insurer improperly imposed stricter medical necessity...more
In McClure v. Country Life Ins. Co., 795 Fed. Appx. 548 (9th Cir. 2020), the Ninth Circuit affirmed a $6.5 million bad faith verdict against a disability insurer that included a $1.29 million award for emotional distress...more
In Fortier v. Hartford Life & Accident Ins. Co., 916 F.3d 74 (1st Cir. 2019) the U.S. Court of Appeals for the First Circuit clarified ERISA's timing requirements with respect to appealing an adverse benefits determination...more
2/12/2020
/ Administrative Appeals ,
Adverse Employment Action ,
Appeals ,
Denial of Benefits ,
Employee Retirement Income Security Act (ERISA) ,
Employer Group Health Plans ,
Equitable Relief ,
Exhaustion Doctrine ,
Long Term Disability Insurance ,
Motion to Dismiss ,
Notice Prejudice Rule ,
Plan Administrators ,
Reaffirmation ,
Right To Appeal ,
Statute of Limitations ,
Substantial Compliance
In Gorbacheva v. Abbott Laboratories Extended Disability Plan, et al., 29 U.S. App. LEXIS 36542 (N.D. Cal. Dec. 10, 2019), the Ninth Circuit reversed a district court's award of attorneys' fees to an ERISA claimant as...more
2/5/2020
/ Abuse of Discretion ,
Appeals ,
Attorney's Fees ,
Calculation of Damages ,
Denial of Benefits ,
Disability Benefits ,
Disability Insurance ,
Employee Retirement Income Security Act (ERISA) ,
ERISA Litigation ,
Motion for Summary Judgment ,
Plan Administrators ,
Prevailing Party ,
Rejection of Settlement Offers ,
Remand ,
Reversal ,
Settlement Offer
SCOTUS Reviews "Blissful Ignorance" as Statute of Limitations Defense -
On December 4, 2019, the U.S. Supreme Court heard oral argument in Intel Corp. Inv. Policy Comm. v. Sulyma, 139 S. Ct. 2692 (2019). The question...more