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Denial of Insurance Coverage › Discrimination

Hall Benefits Law

Court Orders Claims Reprocessing After Finding TPA Illegally Excluded Gender-Affirming Care in Violation of ACA Section 1557

Hall Benefits Law on

A federal district court has awarded injunctive relief, including claims processing, after finding that an insurer acting as a third-party administrator (TPA) for a self-insured plan violated Section 1557 of the Affordable...more

Whiteford

New CMS Guidance on Use of Algorithms and AI in Prior Authorizations and Utilization Management

Whiteford on

Use of algorithms and artificial intelligence (AI) in prior authorization and utilization management is facing growing criticism and litigation. Notable lawsuits include alleged automatic authorization denials for tests that...more

Wiley Rein LLP

Revising Prior Order, Georgia Court Holds Two EEOC Charges and Resulting Lawsuit by the Same Claimant Are All Claims “Made or...

Wiley Rein LLP on

The United States District Court for the Northern District of Georgia, applying Georgia law and revising its prior summary judgment order, has held that a restaurant is not entitled to coverage under a...more

Wiley Rein LLP

Court Rules that EEOC Charge for Retaliation Based on Prior Charge for Discrimination Is Separate Claim

Wiley Rein LLP on

A Georgia federal district court has held that a charge filed with the Equal Employment Opportunity Commission (EEOC) was a “claim” and that there was no coverage for a charge first made against an insured during one policy...more

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