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Pennsylvania Court Holds Disputed Allegations In Complaint Do Not Negate Duty to Defend

In its recent decision in Navigators Ins. Co. v. Amsterdam, 2015 U.S. Dist. LEXIS 64385 (E.D. Pa. May 18, 2015), the United States District Court for the Eastern District of Pennsylvania had occasion to consider whether an...more

RMF Litigators Obtain Reversal Of Denial Of Long-Term Disability Benefits

When a private insurance company denies a claim for long-term disability benefits, one appeals that decision through that same insurance company’s appeal process. This does not bode particularly well for the appealing...more

Insurance Recovery Law - May 2015

California Appellate Court: All Claims “Arising From” Ponzi Scheme Are Precluded - Why it matters: Concluding that any claims related to a Ponzi scheme—even if they involved different investors, investments, or...more

Federal Court Changes the Playing Field on ‘Agreed’ Civil Penalties in Regulatory Proceedings

The very recent decision of the Full Court of the Federal Court (handed down on 1 May 2015) in Director, Fair Work Building Industry Inspectorate v CFMEU [2015] FCAFC 59 has changed the law in relation to the Court’s approach...more

En Banc Mississippi Court of Appeals Affirms Summary Judgment for Insurer, Adjuster and Employer on Bad Faith Claims Arising from...

Chapman v. Coca-Cola Bottling Co., No. 2013-CA-01883-COA (Miss. Ct. App. Mar. 17, 2015). Ruling en banc, court affirms grant of summary judgment for insurer, adjuster and employer on bad faith claims brought by former...more

ERISA: Public School Teacher’s Employee Benefits Governed by ERISA? Yes!

When you see a claim for disability or life insurance benefits by a public school teacher, you might assume the claim is not governed by ERISA because of the governmental plan exception....more

All “Intentional Tort” Claims By Employees May Now Be Uninsurable

On March 12, 2015, the Supreme Court of Ohio issued a decision in Hoyle v. DTJ Enterprises, Inc., holding that an insurance provision that excludes coverage for acts committed with the “deliberate intent to injure an...more

Bad Faith Sentinel - April 2015

In This Issue: - En Banc Mississippi Court of Appeals Affirms Summary Judgment for Insurer, Adjuster and Employer on Bad Faith Claims Arising from Denial of Coverage and Benefits for Work-Related Injury -...more

Participant’s Estate Fails to Show a Claim For Failure to Give Notice of Right to Continue Life Insurance Coverage: Estate of...

Providing a practical lesson on determining a duty to give notice to ERISA participants, the U. S. District Court for the Middle District of Florida dismissed the claim by the estate of an ERISA group life insurance plan...more

More ERISA Complications

In passing the Employee Retirement Security Act of 1974 (“ERISA”), Congress sought to make it as easy and economical as possible for employers to provide benefits to their workers; for example, pensions, health insurance,...more

Motor Carriers Are Liable For Injuries to Drivers of Leased Vehicles Who Are Classified As Independent Contractors

Jose Vargas v. FMI, Inc. et al. - In Vargas, California’s Second Appellate District held that the Privette doctrine does not shield a motor carrier operating under a federal franchise from liability for tort injuries...more

Kentucky Court: Depreciating Labor to Get Actual Cash Value Is Like Making the Insured Use a Very Old Roofer With Debilitating...

Surprisingly few states have addressed the question of whether an insurer can depreciate labor – as opposed to materials – to arrive at actual cash value (ACV). ...more

Recent Federal Court Ruling: No ERISA Preemption of Texas Prompt Pay Law Regarding Payment Deadlines; Texas Legislature May Act on...

What's new. A Texas federal district court has ruled that ERISA does not preempt or prohibit application of the Texas Prompt Pay ("TPP") law to Third Party Administrators ("TPAs") of self-funded benefit plans. Judge Lynn...more

First Circuit’s RAA-Friendly Ruling Stands

The class plaintiffs’ challenge to a group life insurer’s use of so-called retained asset accounts (RAAs) in Merrimon v. Unum Life Insurance Company of America has come to an unsuccessful end. On January 26, the United...more

En Banc Sixth Circuit Rules Against Disgorgement Remedy in Benefits Case

In Rochow v. Life Insurance Company of North America, No. 12-2074 (6th Cir. March 5, 2015), the U.S. Court of Appeals for the Sixth Circuit, sitting en banc, ruled that an insurance company that wrongfully denied benefits to...more

Disgorgement of Profits Not Available for Arbitrary and Capricious Benefits Denial – This Time

Wrongful denial of employee benefits will not expose plan fiduciaries to equitable remedies – such as disgorgement of profits – where restoration of benefits is adequate to make the claimant whole, says the Sixth Circuit in...more

Ninth Circuit Rules That Harmless Procedural Violation Does Not Alter Standard of Review

The Ninth Circuit held that a plan administrator’s failure to render a decision on a long-term disability benefits claim within the period mandated by the plan and ERISA did not alter the standard of review that the court...more

The Sixth Circuit Vindicates the Fourth and Eleventh.

The en banc Sixth Circuit reaffirmed what the Fourth and Eleventh Circuits knew all along. Ever since Cigna v.Amara, 131 S. Ct. 1866 (2011), in which the United States Supreme Court provided fresh theories (e.g.,...more

ERISA: 6th Circuit — Plop Plop, Fizz Fizz: Oh What A RELIEF It Is: No Disgorgement For Arbitrary Denial Of Benefits

Does an arbitrary and capricious denial of ERISA governed disability benefits create a right to disgorgement of profits? NO....more

Sixth Circuit Overturns the Lower Court’s Award of $3.8 Million in Alleged Profits Arising From a Denial of Benefits

The U. S. Court of Appeals for the Sixth Circuit, sitting en banc, has overturned the decision of a divided three-judge Sixth Circuit panel which had affirmed the district court’s award of $3.8 million of “disgorged” profits,...more

Could Eight Words Spell the End of “Obamacare” ?

The Supreme Court heard arguments yesterday in the latest challenge to federal health care reform. And this challenge, though highly technical, is anything but minor – it could unravel the entire infrastructure of federal...more

King v. Burwell: What a Subsidy Shutdown Would Mean for Consumers, Insurers, Providers and States

Editor’s Note: On Wednesday, March 4, the Supreme Court heard oral arguments in King v. Burwell, a case that will determine whether the Affordable Care Act (ACA) permits individuals who buy individual health insurance...more

Manatt on Health Reform: Weekly Highlights - March 2015

Media is abuzz with speculation on the potential impact of King v. Burwell—arguments begin tomorrow, March 4th, at 10 a.m. Many consider the case the greatest threat to the Affordable Care Act since SCOTUS upheld the...more

Has the Supreme Court Given Advance Notice How It Will Decide King v. Burwell?

On Wednesday, March 4, 2015, the Supreme Court will hear argument in King v. Burwell, the most publicized case in some time. Most readers are aware that the issue is whether certain tax subsidies essential to the proper...more

District of Arizona: Employee’s Intentional, Incorrect, and Unreasonable Handling of Claim Subjects Insurer to Finding of Bad...

Haney v. ACE Am. Ins. Co., No. CV-13-02429-PHX-DGC, 2015 WL 58670 (D. Ariz. Jan. 5, 2015). District of Arizona: Court grants partial summary judgment on bad faith claim for failure of insurer to make retroactive...more

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