I Understood There Would Be No Math: Audits, Extrapolations, and a New Set of Rules
Employee Retention Credits (ERCs) are critical for many ongoing businesses. Many businesses are still waiting on the IRS to pay out the ERC claims; others anticipate the IRS will attempt to deny or claw back the claims,...more
WHAT: In Aviation Training Consulting, LLC, the Armed Services Board of Contract Appeals (ASBCA) held that it had jurisdiction to hear the contractor’s claim for increased costs to keep its workforce in a ready state during...more
Living with mental illness can make gainful employment impossible. The Social Security Administration (SSA) provides disability benefits to people with certain mental illnesses through two federal programs. Social Security...more
Builders risk policies are a key component to a construction professional’s risk management program. These policies protect owners and construction professionals from losses arising from unexpected events such as fire or...more
Audits that employ statistical extrapolation can turn a handful of claim denials into a liability of hundreds of thousands or millions of dollars. After years of relative quiet, the statisticians are back. The Centers for...more
In one of the more notorious challenges to COVID-19 vaccine mandates, a group of Navy Special Warfare servicemembers filed suit after the Navy denied their requests for religious accommodations. Last week, a federal court...more
Wilderness therapy, also referred to as outdoor behavioral healthcare, is a treatment modality that uses expeditions into the wilderness as a means of addressing behavioral and mental health issues....more
On November 17, 2017, a U.S. district court in Florida narrowly construed personal and advertising injury coverage for data-breach claims under a commercial general liability policy. In Innovak International, Inc., v. The...more
The Department of Labor’s (DOL) Employee Benefits Security Administration has issued final regulations that change the claims and appeals procedures for disability benefits provided by ERISA plans. The final rules are...more
Last month, the U.S. Court of Appeals for the Federal Circuit (CAFC) affirmed a decision of the U.S. Court of Federal Claims upholding and NASA’s denial of a claim in the amount of about $2 million for reimbursement pension...more
The U.S. Department of Labor (USDOL) recently issued a final rule addressing disability benefit claims and appeals (see 81 FR 92316). The rule adds new procedural protections and safeguards meant to ensure disability...more
Over the past decade, health care providers seeking to challenge Medicare claim denials have faced increasing delays in reaching what many consider the most important step in the Medicare appeals process - a hearing before an...more
On February 9, 2016, a three-judge panel of the U.S. Court of Appeals for the District of Columbia Circuit reversed a district court’s dismissal for lack of jurisdiction in the American Hospital Association v. Burwell case. ...more
I recently blogged about a case in which a plan had established a shorter period of time (one year deadline) for filing a lawsuit, rather than relying on the state statute of limitation (six years) which would otherwise have...more
Editor's Overview - It has been a little more than one year since the U.S. Supreme Court altered the legal landscape for litigating ERISA breach of fiduciary duty claims relating to the investment in employer stock...more
ERISA does not have a statute of limitations for lawsuits brought by participants to check claim benefits under the plan. Instead, courts borrow from similar state statutes of limitations. In a decision two years ago, the US...more
Recently, in Mirza v. Insurance Administrator of Am., Inc., __ F.3d__ (3d. Cir. 2015), the United States Court of Appeals for the Third Circuit was asked to determine whether plan administrators are required to include a...more
On August 13, 2015, the Centers for Medicare & Medicaid Services (CMS) issued instructions to Medicare Administrative Contractors (MACs) and Qualified Independent Contractors (QICs) regarding the scope of review for...more
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
The Third Circuit recently held that ERISA administrative appeal denial letters must include plan-imposed time limits for commencing a lawsuit challenging the claim denial, and the failure to provide such notice warranted...more
Eighth Circuit: No Bad Faith Where Insured Failed to Make a Sufficient Demand and Insurer Refused to Entertain Settlement Offer Prior to Completing Investigation - Purscell v. Tico Ins. Co., No. 13-2362, 2015 WL 3855253...more
Last month, a federal trial court in New Jersey shot down an insurer’s arguments that it had unambiguously denied coverage for Superstorm Sandy damage in a letter to the insured. In Liguori v. Certain Underwriters at Lloyds,...more
Boulware v. Liberty Ins. Corp., No. 3:13-CV-1541, 2015 WL 1219283 (M.D. Pa. Mar. 17, 2015). After a portion of the insured’s deck collapsed, the insurer denied coverage based on a brief inspection without hiring an...more
One of the most frustrating aspects of dealing with a food insurance claim can be communicating with your insurance company adjuster. Knowing your insurance company’s obligations to you can help reduce the frustration....more
The Securities and Exchange Commission (SEC) recently further limited the ability of companies to settle claims without admitting to the SEC’s charges. Traditionally, the SEC had allowed defendants to settle enforcement...more