Appeals

News & Analysis as of

Outside Counsel Should Handle Healthcare.gov Subsidy Appeals

Here’s the coming dilemma: let IRS assess employer mandate taxes based on errant Healthcare.gov subsidy certifications or appeal those errors to prevent those assessments.  “Where’s the dilemma?” you say.  Here:  once you...more

CMS Limits the Scope of Review for Certain Redeterminations and Reconsiderations

For providers who have received inconsistent or varying reasons for denial while navigating through the Medicare appeals process, the Centers for Medicare & Medicaid Services (CMS) has provided much-needed relief in the form...more

Third Circuit – Failure to Identify Plan’s Limitation Period in Denial Letter Precludes Enforcing Deadline

In 2013, the Supreme Court reaffirmed that ERISA plans can impose shorter limitations periods than would otherwise be the case if the plan was silent. Nevertheless, the United States Court of Appeals for the Third Circuit...more

Court of Appeals Hears Michigan’s Compact Election Cases

The long saga of Michigan's Multistate Tax Compact election continued on Wednesday with oral argument before the Michigan Court of Appeals. A packed courtroom witnessed a 1.5 hour proceeding before an active three-judge...more

Eleventh Circuit Finds No Bad Faith in Multiple-Claimant Claims-Handing Situation

In a new decision, Mesa v. Clarendon National Ins. Co., 2015 WL 5059496, 2015 U.S. App. LEXIS 15203 (11th Cir., Aug. 28, 2015), the Court of Appeals found that the insurer’s claims-handling of multiple claimants did not rise...more

Preserving the Corporate Privilege in Internal Investigations: DC Circuit Clarifies Scope of the Privilege in Important Series of...

For the second time in just over a year, the DC Circuit granted the extraordinary remedy of a writ of mandamus to protect a company’s assertion of privilege over materials relating to an internal investigation. In a...more

Employer Is Liable under the WLAD for Refusing to Hire a Truck Driver for Taking a Prescribed Narcotic

Just when is an employer required to hire those taking prescription pain medications? In Clipse v. Commercial Driver Services, Inc., the Washington Court of Appeals held that Commercial Driver Services, Inc. was liable under...more

Appeals Court Upholds USDOL’s New Minimum Wage and Overtime Rules for Home Care Workers Employed by Home Health Care Agencies

Reversing a decision celebrated by employers in the home care industry, the U.S. Court of Appeals has ruled that home health care agencies must comply with the U.S. Department of Labor’s (“DOL”) 2013 domestic service...more

Clean Power Rule Challenges Will Proceed Sooner or Later, But Its Goal May Already Be Close at Hand

Legal challenges filed almost immediately after President Obama announced the Clean Power Rule may be premature. That is what attorneys for EPA told the U.S. Court of Appeals for the District of Columbia Circuit recently in...more

11th, 6th Circuits Rule on TCPA Consent for Autodialed Calls to Cell Phones

The U.S. Courts of Appeals for the 11th and Sixth Circuits recently issued two rulings regarding when a consumer has given “prior express consent” under the Telephone Consumer Protection Act (TCPA) to receive text messages or...more

The Tenth Circuit rejects excess insurers’ implied duty to investigate and initiate settlement negotiations

Interpreting Oklahoma law, the US Court of Appeals for the Tenth Circuit recently held that the duty of good faith and fair dealing does not require that an excess insurer, unlike a primary insurer, affirmatively investigate...more

Obama Board Reaffirms Successor’s Right to Set Initial Terms of Employment when Taking Over Unionized Operation

Last week, the National Labor Relations Board issued a refreshingly employer-friendly decision which allowed a successor company to implement new pay terms without having to first bargain with the labor union. ...more

Third Circuit Rules Failure to Disclose Deadline to File Suit in Denial Letter Warrants Setting Aside Limitations of Suit...

The Third Circuit ruled on August 26, 2015, that if a claim administrator fails to disclose in its final denial letter any plan-imposed deadline to challenge the denial in court, then that deadline will be set aside in favor...more

Sixth Circuit Tackles “Metaphysical Quandary” Of Design Separability: Rules That Cheerleader Uniform Graphics Are Protected By...

Varsity Brands, Inc. v. Star Athletica, LLC, Case No. 14-5237, 2015 WL 4934282 (6th Cir. Aug. 19, 2015). Addressing a subtle issue of copyright law that has perplexed other district and appeals courts, the U.S. Court of...more

The Second Circuit Court of Appeals Affirms Ruling That New York State’s Moratorium on Hydraulic Fracturing Did Not Extend the...

New York’s 2010 moratorium on hydraulic fracturing, culminating in Governor Andrew Cuomo’s formal ban of the practice in his state on December 17, 2014, made many large waves in the political, legal, and public arenas, the...more

Common Sense Rulings on the Meaning of “Prior Express Consent”

On August 20, 2015, the United States Court of Appeals for the Eleventh Circuit issued an opinion in Murphy v. DCI Biologicals Orlando, LLC, No. 14-10414, 2015 U.S. App. LEXIS 14632 (11th Cir. Aug. 20, 2015), affirming an...more

FTC Can Regulate Cybersecurity Practices, Third Circuit Rules

The Federal Trade Commission (FTC) can regulate cybersecurity policies and procedures as “unfair” acts or practices under Section 5 of the FTC Act, the U.S. Court of Appeals for the Third Circuit has ruled in a very important...more

Seventh Circuit Reverses Summary Judgment Ruling in RMBS Case

On August 21, 2015, a three-judge panel of the United States Court of Appeals for the Seventh Circuit reversed a Wisconsin federal judge’s ruling granting summary judgment to RBS Securities Inc. (“RBS”) dismissing all but one...more

Special Alert: Third Circuit Gives FTC Green Light to Continue Enforcing Corporate Data Security

Last week, the U.S. Court of Appeals for the Third Circuit affirmed the Federal Trade Commission’s authority to hold companies accountable for their data security practices under Section 5 of the FTC Act (15 U.S.C. § 45(a)),...more

Bridging the Week - August 2015 #5

Charles Schwab Fined US $2 Million by FINRA for Net Capital Deficiencies: Charles Schwab & Co. agreed to pay US $2 million to the Financial Industry Regulatory Authority to resolve allegations that it had net capital...more

Express Waiver of Assumption of Risk – Gross Negligence Exception

Stacey Chavez, et al. v. 24 Hour Fitness USA, Inc. - Court of Appeal, Sixth Appellate District (July 8, 2015) - California’s public policy in favor of sporting and leisure activities provides strong support for...more

3rd Circuit Affirms FTC’s Cybersecurity Oversight

If you read one thing: - The Federal Trade Commission (FTC) secured a major appellate victory in its quest to challenge lax corporate cybersecurity practices - In light of the 3rd Circuit’s decision,...more

Death Threats Lead To Employer's ADA Victory

It is rare that the most employee-friendly of all federal appellate courts cites “common sense” in support of one of its decisions. The 9th Circuit Court of Appeals recently did just that, however, dismissing a disability...more

“Not the Stuff of Science”: “Differential Etiology” Causation Opinions Fail Daubert in 7th Circuit Toxic Tort Case

The Seventh Circuit Court of Appeals has affirmed a district court’s grant of summary judgment in an environmental toxic tort case, holding that the testimony of all three of plaintiffs’ causation experts – James Dahlgren,...more

In FTC v. Wyndham Worldwide, Third Circuit Upholds FTC Authority to Enforce Flawed Cybersecurity Measures

In a much anticipated decision, the Third Circuit Court of Appeals affirmed the authority of the Federal Trade Commission (FTC) to enforce actions against companies who have been subject to a data breach. The FTC sued...more

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