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ERISA Litigation Alert: Check Your Plan Subrogation and Reimbursement Language to Eliminate “Contractual Gaps”

In U.S. Airways v. McCutchen, the U.S. Supreme Court upheld the ability of U.S. Airways’ health plan to recover medical expenses that it previously paid to the injured party from a third party settlement, but remanded the...more

Supreme Court “Dooms” Equitable Defenses to Plan’s Reimbursement Provisions

In a prior blog, I discussed the importance of including unambiguous reimbursement rights in health plan documents in order to manage healthcare costs. The enforceability of such rights was confirmed by the United States...more

High Court Rules Equitable Defenses Don’t Override ERISA Plan Terms

On April 16, 2013, the U.S. Supreme Court issued its decision in US Airways, Inc. v. McCutchen (No. 11–1285), deciding the issue of whether equitable defenses, such as the principle of unjust enrichment, can override the...more

U.S. Supreme Court: Equity Cannot Trump ERISA Plan Terms in ERISA Reimbursement Case

The U.S. Supreme Court yesterday strengthened the ability of employer health insurance plans to recoup payments for medical expenses paid for an injured plan participant who later sues to recover damages from a third...more

Attorneys' Fees Reduce ERISA Plan's Recovery From Common Fund

The United States Supreme Court ruled today that absent an express provision to the contrary, the amount an ERISA plan can recover from a plan participant’s lawsuit against a third-party tortfeasor must be reduced...more

ERISA Does Not Preempt State Court Order Requiring Beneficiary to Renounce Right to Employee’s Plan Benefits, Fourth Circuit Rules

The scenario is not difficult to imagine: An employee designates her spouse as the primary beneficiary under her employer’s life insurance and retirement benefit plans. Years later, the couple divorces, and in the marital...more

Patton Boggs Reinsurance Newsletter- March 2013: Second Circuit Holds That Federal Common Law Governs the Interpretation of the...

In an insurance coverage dispute over disability insurance, the Second Circuit has joined the majority of federal circuit courts in holding that the question of whether a clause in a contract provides for arbitration is...more

California Supreme Court Holds Suits Against Dissolved Foreign Corporations Subject to Survival Statutes of State of Incorporation

Greb v. Diamond International Corp., __ Cal.4th __, __ Cal. Rptr.4th __ (February 21, 2013) In a victory for liability insurers against the asbestos plaintiffs’ bar, the California Supreme Court ruled in Greb v. Diamond...more

Employees Who Smoke (Part II) – The Exception for Health Insurance Plans

So yesterday, I made a convincing case that employees who smoke outside the workplace can’t be treated differently than your non-smokers. ...more

Washington Supreme Court: FAA Does Not Preempt State Law Prohibiting Arbitration Agreements in Insurance Contracts

The Washington Supreme Court has ruled that the Federal Arbitration Act (FAA) does not preempt a state statute that prohibits binding arbitration agreements in insurance contracts....more

Courts Take Divergent Positions on "Disparagement" Under Advertising Injury Coverage

Within the last four months, two divisions of the California Court of Appeal’s Second Appellate District have taken different positions on the requirements for “disparage,” as that term is used in commercial liability...more

Seventh Circuit Rules that Medical Necessity Trumps State-Imposed Cap on “Optional” Medicaid Coverage

In a class action lawsuit, the U.S. Court of Appeals for the 7th Circuit recently affirmed a lower court decision granting a preliminary injunction that prevented the state of Indiana from enforcing a $1,000 annual cap on...more

Illinois Supreme Court Refuses to Invalidate Policy Deadline for Uninsured Motorist Claims

Can an insurance policy be rendered unenforceable by Illinois public policy because of a conflict with another state's law? This morning, in an opinion by Justice Lloyd A. Karmeier for a 6-1 majority, the Illinois...more

Federal District Court Holds Federal Law Preempts Massachusetts’ Statutory Limits On Mortgage Insurance

On September 21, the U.S. District Court for the District of Massachusetts held that the Federal Homeowners Loan Act preempted a Massachusetts law that forbids lenders from requiring borrowers to purchase insurance greater...more

Letters of Protection- A Hobson’s Choice for Patient, Doctor and Attorney A Personal Injury Lawyer/ Medical Practice...

A “Hobson’s Choice” is a choice that appears to give you more than one option, but in fact only offers one option. So it is with the Letter of Protection (LOP). You, the patient, doctor or attorney, think...more

Hall v. Sebelius

Brief of the CATO Institute as Amicus Curiae in Support of Petitioners

When Brian Hall, former House Majority Leader Dick Armey, and other over-65 retirees requested to opt out of Medicare's hospital insurance coverage (because they preferred their existing private coverage), the Social Security...more

The ERISA Litigation Newsletter - September 2012

In This Issue: - Editor's Overview - ERISA Preemption in Provider Misrepresentation Claims: An Overview of the Jurisprudence Leading Up to the Fifth Circuit's En Banc Review of Access Mediquip and What Lies...more

Affordable Care Act Runs Into Religious Freedom Issues in Court

Although the Supreme Court, in a landmark decision earlier this summer, affirmed the constitutionality of the Patient Protection and Affordable Care Act (ACA), the challenges to and controversies surrounding that Act are far...more

Federal-Mogul Court Confirms That Bankruptcy Law Trumps Anti-Assignment Provisions in Insurance Policies

On May 1, 2012, the United States Court of Appeals for the Third Circuit in In re Federal–Mogul Global, Inc. confirmed that anti-assignment provisions in a debtor’s insurance liability policies are preempted by the Bankruptcy...more

Fifth Circuit Rejects Expansive Reading of Texas Law Regarding an Insured’s Right to Independent Counsel

Under Texas law, “when the facts to be adjudicated in [a] liability lawsuit are the same facts upon which coverage depends, the conflict of interest will prevent the insurer from conducting the defense.” N. Cnty. Mut. Ins....more

The Supreme Court’s Immigration Decision May Give Clues On The Upcoming Decision On The Affordable Care Act’s Individual Mandate

Casey Stengel once advised that it is best not to make predictions, particularly about the future. So we will step into ill-advised territory with caution. Nevertheless, the Supreme Court’s decision in Arizona v. United...more

When Are Short Term Disability Claims NOT Governed by ERISA — This Case Explains When State Law Claims Are Not Preempted

When does ERISA govern short term disability payments? Take a look at this recent case, Behjou v. Bank of America et. al, [PDF] __ F.Supp. 3d __ (N.D. California May 1, 2012). FACTS: Behjou brought short term...more

State Claims Related to Renewal of FEMA "Write Your Own" Floor Insurance Programs are Federally Preempted

The U.S. Court of Appeals for the Fifth Circuit last week held that any state claim related to the Federal Emergency Management Agency’s (FEMA) “Write Your Own” (WYO) flood insurance program is preempted by federal law if it...more

Iran-Related Investment Bill Clears Committee

On May 2, 2012, the California Assembly Insurance Committee approved a bill that would direct the insurance commissioner to treat a domestic insurer’s investment in a company that has business operations in Iran as a...more

Insurance Business & Regulatory News - Spring 2012

In This Issue: - NAIC Changes Target Insurance Holding Company System - Delaware Series LLC Captive Insurance Programs - State Spotlights - Insurance Business and Regulatory Law Excerpt from State...more