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Retail and Consumer Products Law Roundup - February 2016

Be Still, My Heart: New Suit Says Fitbits Fail to Track Heartbeats as Promised - Why it matters - Fitbit has been hit with another consumer class action asserting false advertising claims, this time alleging that...more

Florida’s Workers’ Comp System Goes Back to the Future . . . at the Expense of Your Premiums

On April 16, 2016, the Florida Supreme Court will hear another in a long line of cases brought by plaintiffs’ lawyers trying to turn the clock back on Florida’s Workers’ Compensation Law. Before 2003, employers in Florida had...more

Do Your Assignment of Benefits Clauses Need a Check-up? Recent Southern District of Florida Decision Highlights the Importance of...

A frequently litigated issue in reimbursement cases brought by in- and out-of-network healthcare providers against insurers under the Employee Retirement Income Security Act of 1974 (“ERISA”) is provider standing. Because...more

How Does the Supreme Court’s Obergefell Decision Affect Your Employee Benefit Plans?

The short answer: No plan amendments are required, but certain plan amendments and operational changes are permitted, and certain operational changes may be required....more

Double-check existing policies for whistleblower coverage

Whistleblower lawsuits under the False Claims Act, also known as qui tam actions, have become more common in recent years. This is particularly so in heavily regulated industries and those in which the government routinely...more

Summary of California Appellate Decisions - January 2016

Insurance Coverage; Vandalism and Malicious Mischief Exclusion - Hung Van Ong v. Fire Insurance Exchange (2015) 235 Cal.App.4th 901, 185 Cal.Rptr.3d 524 - Facts: The insured had a vacant apartment building....more

Supreme Court Update: Kansas V. Carr (14-449) And Order List

Wiggin and Dana just opened a shiny new office Washington, D.C., but it seems our arrival has been eclipsed by that of another force of nature in the nation's capital. Perhaps anxious to skip town before it's buried, the...more

Transportation Newsletter - January 2016

Illinois Appellate Court: A Contingent Automobile Liability Policy Is Not an Excess Policy - The Appellate Court of Illinois, First Judicial District, was recently confronted with the interpretation of a Contingent...more

May Vermont Apply Its Health Care Database Law to the Third-Party Administrator for a Self-Insured ERISA Plan?

Vermont requires all public and private entities that pay for health care services provided to its residents to supply data to its "all-payer database." The requirements apply to insurers and third-party administrators, among...more

Another Post-Tackett Ruling Denying Retiree Health Benefits

A district court in West Virginia recently held that retirees were not entitled to lifetime health benefits under the clear and unambiguous language of the relevant collective bargaining agreements. Shortly after Constellium...more

Fourth Circuit Says Insurance Investigators Do Not Qualify for Overtime Exemption

Property and liability insurance carriers typically employ inspectors whose jobs involve investigations in support of their claims adjustment functions. Last month, the Fourth Circuit Court of Appeals (which includes North...more

Avoiding ERISA Medical Treatment Class Actions with Arbitration Provisions?

Insurers are getting hit with more class actions regarding the denial of medical treatments, like behavioral therapy treatments for autism spectrum disorders. These can be expensive: In May 2015 ConAgra Foods Inc. and Blue...more

Signs of (American United) Life for Independent Contractor Status in Massachusetts

Independent contractor misclassification claims have become an epidemic — nationally and especially in Massachusetts. Under most tests for independent contractor status, whether an individual’s services are within the usual...more

Employee Exclusion Applies to Independent Contractor Truck Driver

An auto insurer had no duty to defend a trucking company against an injured driver’s claim because the insurance policy excluded claims by “employees,” notwithstanding that the driver was technically an independent...more

Supreme Court Agrees to Hear Contraceptive Mandate Cases

As part of its requirement that non-grandfathered group health plans provide benefits for certain preventive care without cost sharing, the Affordable Care Act (“ACA”) requires these plans to cover at least one form of...more

Second Circuit Reminds Healthcare Providers to Seek Relief from Insurance Companies Under Their Own Contracts, Not the Insureds’...

In Rojas v. Cigna Health and Life Ins. Co., 793 F.3d 253, 258 (2d Cir. 2015), the Second Circuit joined several other circuits in holding that “healthcare providers are not ‘beneficiaries’ of an ERISA welfare plan by virtue...more

DOL Issues Proposed Revisions to Disability Plan Claims Regulations

The Department of Labor published proposed changes to its regulations governing disability claims and appeals in the Federal Register on November 18, 2015, and invited comments. The stated purpose of the proposed changes is...more

Group Life Insurance Claims by a Teacher’s Beneficiary Are Subject to ERISA Preemption: Woods v. American United Life Insurance...

On ERISA preemption grounds, a federal court has ruled against state law claims asserted by the beneficiary of a former school teacher who sought benefits from a group life insurance policy. Woods v. American United Life...more

Supreme Court Agrees to Review Additional ACA Birth Control Mandate Cases

Last week, the U.S. Supreme Court agreed to hear the consolidated appeals of seven cases involving employer provision of birth control under the Affordable Care Act. In its 2013 Hobby Lobby case, the Court concluded that the...more

Eastern District of New York ultimately arrives at right outcome when interpreting “Employer’s Liability” exclusion in CGL policy

In Hastings Development, LLC v. Evanston Insurance Company, No. 14-cv-6203 (ADS)(AKT) (Oct. 30, 2015), the U.S. District Court for the Eastern District of New York correctly determined that an “Employer’s Liability” exclusion...more

ERISA — ATTORNEY FEES: What Happens When The Plan And The Insurer Don’t Agree On The Benefit Denial?

You already know that under ERISA the court has discretion to award attorney fees to a party that has “some success on the merits.”...more

Michigan Court Dismisses Cross-Claim as Insurer Not Properly Subject to a Claim for Breach of Fiduciary Duty

In Van Loo v. Cajun Operating Co, No. 14-cv-10604 (E.D. Mich. Sept. 17, 2015), the Eastern District of Michigan, a Sixth Circuit district court, held that the requirement for evidence of insurability was triggered based on...more

Seventh Circuit Rules ERISA Does Not Preempt State Law Prohibiting Discretionary Clauses

In Fontaine v. Metropolitan Life Ins. Co., No. 14-1984, 2015 U.S. App. (7th Cir. Sept. 4, 2015), the Seventh Circuit affirmed a U.S. District Court for the Northern District of Illinois decision holding that Illinois’s...more

ERISA — 7th Circuit: Illinois State Law Ban On Discretionary Clauses Upheld

You already know about the big trend in states to ban discretionary clauses in insurance policies that fund ERISA benefits. Chalk up another circuit deciding to enforce the ban....more

Second Circuit Reinstates Mental Health Parity Case Against UnitedHealth

In late August the U.S. Court of Appeals for the Second Circuit reinstated a lawsuit by a physician association against a third-party plan administrator. The case against UnitedHealth Group and related entities (United) had...more

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