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Hospital and Fixed Indemnity Policies; Excepted Benefits; Supplemental Coverage under Recently Proposed Treasury Regulations; and...

We reported in a recent post on proposed regulations dealing with, among other things, the treatment of hospital indemnity or other fixed indemnity insurance products in the group market. This post takes a closer look at the...more

Michigan Health Insurance Claims Assessment Act is Not Preempted by ERISA

The Sixth Circuit, has decided, on remand from the Supreme Court, that the Michigan Health Insurance Claims Assessment Act (Act) is not preempted by ERISA. The Act imposes a 1 percent tax on all paid claims by insurers or...more

ERISA Preempts State Law Requiring Insurer “Prompt Payment”

Alaska’s prompt pay statute—which requires insurers to pay benefit claims within 30 days of submission—is preempted by federal laws governing employer-provided benefits and benefits for government workers, a federal judge...more

Where Does a Third Party “Stand” on Liens?

Dion v. William Robert Batten, Sr. (8/2/16) Facts and Procedural History: Plaintiff was employed by Neuwirth as a servicing agent. In the course and scope of his employment with Neuwirth, he was involved in a car...more

ERISA: “Key Evidence Needed to Prove the Intoxication Exclusion”

You know that many insurance policies and ERISA-governed plans exclude from coverage disabilities “resulting from, or related to…any accident related to the voluntary influence of any drug, narcotic, intoxicant or chemical….”...more

Bad Faith Actions for Excess Judgments….is There Trouble Brewing for Recalcitrant Primary Insurers

Can an excess carrier go ahead and fund an excess primary limits settlement and then assert a claim for bad faith against the primary insurer who previously refused to accept and fund a prior in-limits policy demand? On...more

Forgery May Not Constitute “Theft” Under an Employee Dishonesty Coverage

Ruling in favor of the insurer on a motion for summary judgment, on July 29, 2016 the Fifth Circuit Court of Appeals held that under the terms of a commercial crime policy, proof of a forgery by the insured’s employee in...more

ERISA — 7th Circuit: Under De Novo Review, the Court “Should NOT Resolve[] Doubts or Gaps in the Evidence in [the Claimant’s]...

You know that claimants have the burden to establish eligibility for ERISA-governed disability benefits. Sometimes gaps in coverage can occur when, for example, a claimant alleges disability while using accrued vacation....more

Tenth Circuit Drills Down Into Roots Of Moral Hazard, Comes Up Dry

Moral hazard (one of this blog’s preoccupations) usually comes up in disputes over the scope of coverage under an insurance policy. But state legislatures often address it, too—for example, by imposing limits on agreements...more

ERISA: 2nd Circuit — Mental Health Provider Lacks Standing to Challenge ERISA Benefit Denial

Who can challenge an ERISA benefit denial? Does a physician have standing to challenge the denial of a patient’s coverage? It depends....more

District Court Finds Forum Selection Clause Unenforceable in ERISA Action

A federal district court in Illinois ruled that a plan’s forum selection was unenforceable because it conflicts with ERISA’s public policy of providing plaintiffs “ready access to the Federal courts.” Darlene Harris...more

Commonsense Misconduct Not so "Common": Illinois Supreme Court Significantly Narrows Use of Commonsense Rationale in Employee...

In the absence of a rule prohibiting specific conduct, employers can no longer rely merely on what one would deem "commonsense" to deny unemployment benefits. In Petrovic v. Department of Employment Security, the Illinois...more

Appellate Division Finds c.78 Health Benefits Contributions Requirements Do Not Apply to Public Sector Disability Retirees

Last month, in Brick Twp. PBA Local 230 v. Twp. of Brick, the Appellate Division of the Superior Court of New Jersey confirmed that N.J.S.A. 40A:10-21.1, P.L. 2011, c. 78, § 42, more commonly known as Chapter 78, does not...more

Life and Annuity Series: Class Certified in an ERISA “Unreasonable Compensation” Case

The Colorado federal court concluded last summer, in Teets v. Great-West Life & Ann. Ins. Co., that an insurer could be subject to ERISA liability for receiving unreasonable compensation in connection with a stable value...more

ERISA: Court’s Short Checklist to Reduce Plaintiff/Claimant Attorney Fees

Attorney fees in ERISA cases continue to be a challenge. What happens when both sides can claim wins during a case? What is a reasonable hourly rate for Plaintiff’s attorneys?...more

Eighth Circuit Finds That Insurance Coverage Extends To Fraudulent Losses Caused By Computer Hacker

On May 20, 2016, the U.S. Court of Appeals for the Eighth Circuit affirmed breach-of-contract claims brought by Minnesota-based State Bank of Bellingham (“Bellingham Bank”) against BancInsure Inc. (“BancInsure”), an insurance...more

ERISA: Reviewing What Needs to Be Proved to Establish the Suicide Exclusion

For many reasons, some of the toughest cases to litigate involve the application of the suicide exclusion. There is a growing body of evidence challenging suicide exclusion determinations....more

Supreme Court Decides Zubik v. Burwell and consolidated cases

Zubik v. Burwell and several consolidated cases challenged a federal regulation requiring employers to cover certain contraceptives as part of their health plans unless they submit a form either to their insurer or to the...more

Basic-Supplemental Life Insurance Plan Pricing Structure Upheld in ERISA Class Action

An employee benefit plan that includes an alleged subsidization component for its basic and supplemental options is neither prohibited by the Employee Retirement Income Security Act of 1974 (ERISA) nor a violation of the plan...more

Supreme Court Limits ERISA Reimbursement Rights: Insurers Will Need to be Diligent

On January 20, 2016, the United States Supreme Court held that an ERISA plan could not satisfy its reimbursement rights from a participant’s general assets. ERISA plans’ reimbursement rights are now so limited that...more

Is Your Workers Compensation Program Unlawful?

A popular workers compensation insurance program offered by Berkshire Hathaway subsidiaries Applied Underwriters Captive Risk Assurance Company (Applied Underwriters) and California Insurance Company may be in trouble. On...more

Leave It to the Policyholder Professionals – Do Not Try This at Home

Recently, I was asked to look at coverage for a case where the insurer had denied a duty to defend several years before. We concluded that the insurer should have been defending based on certain allegations in the complaint...more

SCOTUS ERISA Cases, Part Two: Preemption of State Healthcare Claims Database

This is the second article of a three part series summarizing employee benefit issues that are being argued in front of the U.S. Supreme Court during the current October 2015 term. Part One provided an outline of Montanile v....more

Using Insurance to Counter the Wage-and-Hour Threat

Yesterday, businesses and their executives face an increased threat given the personal liability for officers, directors, managing agents and others as discussed in our recent alert, “California’s Fair Day’s Pay Act May...more

Supreme Court Exempts ERISA Plans from a State Reporting Law

In Gobeille, Chair of the Vermont Green Mountain Care Board v. Liberty Mutual Insurance Co., decided on March 1, 2016, the Supreme Court held that the Employee Retirement Income Security Act of 1974 (“ERISA”) preempts...more

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