Administrative Appeals

News & Analysis as of

Illinois Supreme Court Agrees to Decide Breadth of Misconduct Exception for Unemployment Benefits

In the closing days of its January term, the Illinois Supreme Court agreed to hear a case from Division 5 of the First District, Petrovic v. The Department of Employment Security. Petrovic presents an interesting issue on the...more

What can I do if my workers’ compensation has been denied?

It can be an unpleasant shock to discover that your workers’ compensation claim has been denied. As you begin the process of recovering and rebuilding after an accident on the job, it is disturbing to hear a response of “no”...more

Employer May Obtain Judicial Review of California Unemployment Insurance Appeals Board Decision

West Hollywood Community Health and Fitness Center v. California Unemployment Insurance Appeals Board, No. B248641 (December 5, 2014): A California Court of Appeal recently reversed a trial court’s dismissal of a writ of...more

The NC Property Tax Appeal Process: Great Fun Every Eight Years! (Insert Sarcasm)…

As sure as the FIFA World Cup and the Summer and Winter Olympics will occur every four years, every county in North Carolina has its own tradition that will occur every eight years What is that tradition you may ask? Property...more

No Judicial Relief to the ALJ Waiting Game — Yet

In May 2014, the American Hospital Association filed suit against the United States Department of Health and Human Services seeking to compel Administrative Law Judges (ALJs) to comply with applicable statutory deadlines for...more

D.C. District Court Dismisses Lawsuit Challenging Backlog of Medicare Appeals

On December 18, 2014, the U.S. District Court for the District of Columbia dismissed a lawsuit filed by the American Hospital Association (AHA) and others to compel the Secretary of HHS to process Medicare reimbursement...more

K&L Gates Supports Hempel Metallurgical and ECHA in Winning First Data-Sharing Appeal

A much anticipated decision in the first ever data-sharing appeal was announced by ECHA’s Board of Appeal (BoA) this week. The BoA upheld ECHA’s decision taken in July 2013 that the Vanadium Consortium (the Consortium) did...more

No Need to Mail Process to the Government on a Saturday, Even if the Post Office Is Open

In Wisconsin, a party seeking judicial review of an administrative decision must, within 30 days of service of the agency decision, file a petition for review in the trial court and serve the agency with a copy of the...more

AHA Proposes Putting RACs on the Rack

The American Hospital Association formally proposed last week that Recovery Audit Contractors (RACs) be fined when their denials are overturned on appeal....more

Illinois Supreme Court Reinstates Attorney General's Appeal from Illinois Commerce Commission Order

On Thursday morning, the Illinois Supreme Court resolved a confused issue in utilities law, holding unanimously in The People of the State of Illinois ex rel. Madigan v. Illinois Commerce Commission that the 35-day period...more

DOL’s New Audit Focus? Health Plan Claims and Appeals and Hard to Value Assets

In recent talks and appearances, representatives of the U.S. Department of Labor have issued a warning about new areas of focus of DOL audits and enforcement actions. While there are a number of different enforcement...more

Court: USCIS should consider ‘life experience’ for specialized knowledge L-1B visa

In holding that cultural traditions and life experience can be considered “specialized knowledge” for purposes of obtaining an L-1B intracompany transferee visa, a United States appeals court rejected the proposition that a...more

CMS Provides for Greater MAC Involvement in ALJ Hearings

CMS recently issued Transmittal 543, Change Request 8501 in which it instructs Medicare Administrative Contractors (MACs) to, among other things, defend their medical review decisions through the Administrative Law Judge...more

Post-Therasense IC Alive and Kicking at the Federal Circuit

Apotex Inc. v. UCB, Inc. - After finding that a patent owner had made several misrepresentations to the Patent and Trademark Office (PTO) during prosecution, the U.S. Court of Appeals for the Federal Circuit concluded...more

When a Win is Not a Win- Stay Orders

If an injured worker in Nevada successfully convinces a hearing officer to reverse an adjuster's action on a claim, the insurer and/or the employer has the right to file an appeal to an appeals officer. The insurer or...more

CMS Waves Partial White Flag in Appeals of Payment Status Denials

For the last several years, hospitals, on the one hand, and the Centers for Medicare and Medicaid Services and its contractors (collectively, CMS), on the other, have been engaged in a spirited dispute over claims denials for...more

D.C. Circuit Rules That "Exhaustion of Administrative Remedies" Is Not Required For Violations of ERISA’S Statutory Guarantees:...

The U. S. Court of Appeals for the District of Columbia Circuit has joined five other federal circuits to rule that pension plan participants need not exhaust a plan’s internal remedial procedures before they file suit in...more

Self-Insured Health Plans May Be Required To Allow Health Care Providers Access To Their Claims And Appeals Process

In a precedent-setting case, a district court in the Northern District of Illinois recently ruled that in-network chiropractors were considered “beneficiaries” under the Employee Retirement Income Security Act of 1974 (ERISA)...more

Is the Claimant entitled to attorney fees when the government asserts an unreasonable position?

In Tobeler v. Colvin, 2014 DJDAR 4845 (2014), the United States Court of Appeal for the Ninth Circuit overturned the trial court’s decision rejecting a claim for attorney fees. ...more

Royal Charter Appeal Dismissed

On 18 March 2013, the government, following the recommendations of the Leveson report, proposed a Royal Charter on press regulation. The Press Standards Board of Finance Limited (PressBoF), the body charged with raising a...more

Bakorp: Appeal Dismissed For Failure To Comply With Large Corporations Rules

In Bakorp Management Ltd. v. The Queen (2014 FCA 104), the Federal Court of Appeal upheld a decision of the Tax Court dismissing the taxpayer’s appeal for failure to comply with the rules relating to objections and appeals...more

Court of Appeals Rules 23-Day Notice Requirement for Third Party Summonses is Mandatory in Tenth Circuit

In Jewell v. U.S., Taxpayer Sam Jewell was the subject of an IRS investigation which resulted in third party summonses being issued to banks located in both the Eastern and Western Districts of Oklahoma. Mr. Jewell challenged...more

Medicare Audit and Appeals: A Study in Utter Dysfunction

Facing a backlog of over 350,000 appeals from payment demands issued by Recovery Audit Contractors (RAC's), the Center for Medicare and Medicaid Services ("CMS") has effectively given up and announced that its Office of...more

Third Court of Appeals Invalidates City’s Civil-Service Appeal Deadline

The Third Court of Appeals has reversed a summary judgment granted to the City of Killeen on the sole ground that a police officer’s administrative appeal to the City’s Civil Service Commission was untimely....more

NC Medicaid Providers, Are You Required to Seek an Informal Appeal Prior to Filing a Contested Case at OAH?

Recently, numerous clients have come to me asking whether they have the right to appeal straight to the Office of Administrative Appeals or whether they have to attend informal appeals first, whether the informal appeal is...more

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