AGG Talks: Healthcare Insights Podcast - Episode 4: What to Do When Insurance Companies Deny Behavioral Health Claims
This month’s Friday Five explores decisions from around the country discussing differences between the scope of discovery and ability to add documents to the record on a claim for review challenging the denial of LTD...more
Ferraro v. O’Malley, 2024 WL 920056 - The plaintiff was involved in a motor vehicle accident that caused her to be out of work for six months. While the plaintiff did continue working after her alleged disability onset date,...more
In this episode, AGG Healthcare Litigation co-chair Jason Bring is joined by AGG Healthcare Litigation partners Rich Collins and Damon Eisenbrey to discuss what you can do when insurance companies deny behavioral health...more
Testa-Carr v. Sallie Mae, N23A-04-004 CEB (Del. Super. Feb. 8, 2024) - Ms. Testa-Carr worked as a customer service representative for Sallie Mae. On March 21, 2022, she was fell down some stairs and was injured while...more
This month’s Friday Five covers the treatment of job-related stress in assessing an attorney’s disability, the requirements surrounding the qualifications of a medical professional to review a claimant’s medical records in...more
This month’s Friday Five covers cases relating to an alleged conflict of interest leading to discovery, two courts’ opposite treatments of subjective pain complaints, a decision that claims of fraud and misrepresentation were...more
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
This month’s Friday Five explores decisions regarding the transfer of an ERISA action that was filed in a state where an insurer did not maintain sufficient minimum contacts, an award of attorneys’ fees, costs, and...more
The Oregon Supreme Court has long held the legislature did not create a private right of action under the Unfair Claims Settlement Practices Act (ORS 746.230). Policyholders could bring a tort claim against their insurance...more
On Halloween, the U.S. Department of Health and Human Services (HHS), Office for Civil Rights (OCR) announced a $100,000 settlement under the Health Insurance Portability and Accountability Act (HIPAA) with Doctors’...more
Marie Dennis v. Inglis House (WCAB); No. 1223 C.D. 2022; filed Oct. 12, 2023; Sr. Judge Leavitt - The claimant, a certified nurse assistant, filed a claim petition alleging multiple work injuries, which occurred on January...more
This month’s Friday Five explores a decision ordering an IME prior to a ruling on summary judgment motions, the extent claims reporting records can be sealed, the scope of ERISA preemption in the context of removal, and two...more
When the same health plan administrator both administers a benefit plan and pays the benefits due under the plan, it is considered by courts to have a structural conflict of interest. That conflict of interest is not...more
The United States Court of Appeals recently shed light on when—and under what conditions—a plaintiff may seek a monetary recovery under § 502(a)(3) of the Employee Retirement Income Security Act (ERISA). Section 502(a)(3)...more
Southern District Holds That Contractor’s Carrier Has Duty To Defend ConEd Even Though Contractor’s Work Ended Months Before The Accident-A pedestrian tripped and fell on a Bronx sidewalk, and she sued the owner of the...more
In our practices, we are seeing an increasing number of denials or de facto denials of Medi-Cal provider enrollments. The consequences of a Medi-Cal enrollment denial can be quite serious. First, a provider may not receive...more
As discussed here, administrators’ health plan benefit denial letters have recently been under scrutiny by the courts. For example, in D.K. et al. v. United Behavioral Health et al., the Tenth Circuit is reviewing a district...more
In Delaware, employees injured on the job are often entitled to workers' compensation benefits for medical expenses and wages lost by being unable to work during recovery. However, in some cases, the injured worker's claim...more
The Ninth Circuit has issued a new opinion in the long-running Wit v. United Behavioral Health litigation that changes the legal landscape for ERISA class actions. The Ninth Circuit’s opinion includes significant holdings on...more
On Jan. 26, 2023, a 9th U.S. Circuit Court of Appeals panel issued an opinion in Wit v. United Behavioral Health, rejecting the plaintiffs’ attempt to meet Rule 23 commonality requirements by seeking reprocessing of claims as...more
A recent federal appeals court case clarifies that, under ERISA, the regulations governing disability plans’ claims review procedures apply to claims that predate the 2018 changes to the regulations. The decision also serves...more
Recently, the Ninth Circuit addressed and further clarified the requirement of a “full and fair review” in the context of a long-term disability benefit case under the Employee Retirement Income Security Act (ERISA). In...more
The Sixth Circuit Court of Appeals ruled in Fulkerson v. Unum Life Insurance Company of America that the beneficiary of an ERISA-covered life insurance policy was not entitled to accidental death and dismemberment (AD&D)...more
In McQuillin v. Hartford Life and Accident Ins. Co., 36 F.4th 416 (2d Cir. 2022), the U.S Court of Appeals for the Second Circuit restored a claimant’s action for disability benefits due to the plan administrator’s failure to...more
In a recent decision, the United States Court of Appeals for the Seventh Circuit clarified that an employer can violate the Family and Medical Leave Act (“FMLA”) by discouraging an employee from taking FMLA leave, even...more