AGG Talks: Healthcare Insights Podcast - Episode 4: What to Do When Insurance Companies Deny Behavioral Health Claims
Best Practices for Negotiating Manuscript Exclusions
Coverage Issues Arising Out of Assault and Battery Claims
Long-Term Effects of Russia/Ukraine on Insurance
Mediating Complex Insurance Coverage Disputes Series Part 3 – Breaking the Log Jam
Cyberside Chats: There is a war in Europe. What does that mean for your cyber insurance policy?
Mediating Complex Insurance Coverage Disputes Series Part 2 – What Goes on in Mediation?
Mediating Complex Insurance Coverage Disputes Series Part 1 – Preparing For The Mediation
Out With a Bang: Current State of Play on Coverage for COVID-Related Losses
Settling a Claim: Get Comfortable With Being Uncomfortable
NGE OnDemand: The Importance of Timely Reporting Occurrences, Claims and Suits to Insurers with Paul Walker-Bright
Lowenstein’s New Insurance Recovery Podcast Series, “Don’t Take No for an Answer”
Ledgers and Law: Roadblocks Facing the Cannabis Industry
Subro Sense - The ABC's of RCV and ACV
WEBINAR: COVID-19 Insurance Coverage Class Actions
What to Do When Your Insurance Carrier Says No: How to Protect Yourself from Coverage Denials
Welcome to the inaugural issue of Insurance Insights, a gathering of notable legal developments and trends relevant to the insurance industry. In this issue, the California Supreme Court covers COVID-19 claims, Georgia...more
The U.S. Department of Labor (DOL) announced two settlements with major insurance companies this month that highlight the importance of employers avoiding the collection of group life insurance premiums from employees until...more
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
The DRI Life, Health, and Disability Committee is once again sponsoring a program aimed at providing a basic understanding of the concepts applicable to life, health, and disability litigation. The program, which receives...more
In Steigleman v. Symetra Life Ins. Co., 2023 WL 7413668 (D. Ariz. 2023), a court considered whether a package of various welfare benefit insurance policies an individual business owner arranged for herself and her employees...more
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
The U.S. Department of Labor (“DOL”) recently filed a lawsuit against UMR, Inc., a third-party administrator and UnitedHealth Group, Inc. subsidiary. The lawsuit alleges that UMR denied thousands of claims based on diagnosis...more
In the case of Frank Blankenship, a dispute arose over the denial of his long term disability benefits by Metropolitan Life Insurance Company (MetLife), which is a provider of long term disability insurance....more
Last week, the US Court of Appeals for the Ninth Circuit, in its third opinion in the case, reversed a lower court’s decision allowing patients challenging United Behavioral Health’s (UBH) internal mental health coverage...more
This week, the Ninth Circuit considers ERISA claims alleging that a plan administrator unlawfully utilized internal guidelines more stringent than the terms of plaintiffs’ plans and the statute of limitations for an action by...more
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
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
We continue to see an increase in fiduciary litigation involving employer-sponsored group health plans, particularly litigation involving mental health. A recent New York Federal District Court case, Collins et al. v....more
In Calkin v. United States Life Ins. Co., 2021 U.S. Dist. LEXIS 82110 (S.D. TX., April 29, 2021), a Texas district court affirmed the insurer’s denial of LTD benefits, holding that while a claimant established diagnoses, he...more
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
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
In a June 14, 2021 information letter, the US Department of Labor (DOL) opined that a claimant appealing an adverse benefit determination under a plan covered by the Employee Retirement Income Security Act of 1974, as amended...more
As some states make headlines for so-called “anti-trans” laws, the Washington state legislature rejected a bill designed to limit youth participation in sports based on their gender as assigned on a birth certificate and...more
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
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
Plaintiff Doug Heckman participated in Nike's employee welfare benefit plan (the "Plan"), which was funded by UnitedHealthcare Insurance Co. ("UHC"), and included healthcare benefits. Mr. Heckman's wife was covered under the...more
In Cal. Spine & Neurosurgery Inst. v. Blue Cross of Cal., 2020 U.S. App. LEXIS 20533 (9th Cir. June 20, 2020), the Ninth Circuit held that a surgical provider's complaint sufficiently alleged that Blue Cross of California...more
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
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