News & Analysis as of

Claim Procedures

California’s New Public Works Claims Resolution Process

If you’re a public entity or contractor involved in public works construction, you should be aware of a new law that took effect this year establishing a new mandatory claims resolution process for disputes on public works...more

Updated Health Care Reform Legislation Comparison Chart

The chart below compares key provisions of the Affordable Care Act (ACA), the American Health Care Act (AHCA) and the Better Care Reconciliation Act (BCRA). This chart is current as of July 13, 2017, and as of that date,...more

Hot List – What’s Happening in the California Legislature 4/17-4/21

by Fisher Phillips on

Our weekly California Legislature “hot list” provides you with a preview of the bills that are up (as well as other important legislative action) the following week...more

What to do when insurance companies insist on their case manager

by Michigan Auto Law on

An insurance company claim adjuster cannot override a car accident victim’s right to choose his or her own case manager. But that doesn’t mean some Michigan auto insurance companies won’t try to push hard to control an...more

Labor Department Boosts Disability Claimant Protections

by Fisher Phillips on

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

Final Disability Claims and Appeals Regulations – Be Prepared to Comply

by Foley & Lardner LLP on

In December 2016, the Department of Labor issued final regulations under ERISA governing claims procedures for group disability plans, which will become effective January 1, 2018. Generally, these regulations were drafted to...more

Health Care Reform in Transition While Congress Deliberates

by Ballard Spahr LLP on

Changes are imminent for the Affordable Care Act and a range of other laws and regulations affecting the health care industry. Ballard Spahr attorneys established a Health Care Reform Initiative in 2008 to monitor and analyze...more

You Mean It’s Un-American to Hire Only Americans? DOJ Issues Final Rule on Unfair Immigration-Related Employment Practices

If you thought it would be safer to require every new hire to be an American citizen—think again. The U.S. Department of Justice (DOJ) has a new rule revising its prior regulations on Section 274B of the Immigration and...more

Medical Claims and Nursing Homes:  The Struggle to Apply the Protections of Ohio Rev. Code § 2305.113 to Long Term Care Facilities

by Reminger Co., LPA on

Due to the restrictions and limitations placed on plaintiffs filing “medical claims”—i.e., a one-year statute of limitations, filing an affidavit of merit, and caps on certain damages—an important battle has arisen regarding...more

Grower Security and Payment Protection Legislation Awaits Senate Approval

by Varnum LLP on

On May 5, the Senate Commerce Committee approved Senate Bills 899 and 900. The legislation would strengthen Michigan's Grain Dealer's Act and Farm Produce Insurance Act should a licensed grain dealer end up insolvent or...more

Medicare Launches Home Health Pre-Claim Review Demonstration in Five States

by Robinson & Cole LLP on

The Centers for Medicare and Medicaid Services (CMS) recently announced it will implement a pre-claim review demonstration for home health services. The three-year demonstration will apply to home health services performed in...more

Second Circuit Applies Stricter Rules for a Plan Administrator’s Noncompliance with Benefit Claims Regulations

by McDermott Will & Emery on

In Depth - On April 12, 2016, the US Court of Appeals for the Second Circuit in Halo v. Yale Health Plan, 2016 WL 1426291 (2d Cir. Apr. 12, 2016), addressed various issues that could arise during a plan administrator’s...more

OMHA Expands Settlement Conference Facilitation Program to Part A Appeals: 10 Things to Know

by Polsinelli on

On Feb. 25, 2016, the Office of Medicare Hearings and Appeals (OMHA) conducted a teleconference to address Phase III of the Settlement Conference Facilitation (SCF) project, which also became effective on Feb. 25, 2016. SCF,...more

Too Little, Too Late: The Harsh Bright Line of Suit Limitation Provisions

by Carlton Fields on

Approximately twenty percent of Americans have been classified as chronic procrastinators, which means one in five policyholders faces a potential problem when suing for coverage. While the statute of limitations for breach...more

DOL Proposes More Robust Claims Procedures for ERISA Disability Claims

by Franczek Radelet P.C. on

The Department of Labor (DOL) recently issued proposed regulations that would strengthen claim procedures for disability claims made under retirement and welfare plans subject to the Employee Retirement Income Security Act of...more

DOL Tightens Disability Claim Processing Rules

by Balch & Bingham LLP on

“Isn’t this an ACA blog?” Yes, it is. “So, why are you writing about disability plan administration?” Because they said so. The preamble to the proposed rules explains – Inasmuch as disability and lost earnings can be sources...more

Natural Disasters in Latin America: Reinsurance Issues

by Zelle LLP on

According to initial reports, Hurricane Patricia didn't end up causing nearly the damage that the world’s most powerful hurricane could have caused. It is a good reminder, however, for reinsurers of how sudden and...more

A Claim Is In the House: What To Do

by Ward and Smith, P.A. on

Our clients take very seriously the legal duty to insure or self-insure for workers' compensation. In the wake of reportage that was critical of everybody involved in the noninsured phenomenon, employers are aware that civil...more

Seventh Circuit Reverses Injunctive Relief for Chiropractic Association

by Buchalter on

On October 1, 2015, the United States Court of Appeals for the Seventh Circuit reversed what was previously regarded as a victory for the Pennsylvania Chiropractic Association. The case, Pennsylvania Chiropractic Association...more

Project In(Site): Legal Developments Impacting Construction & Government Contract Industries

by Seyfarth Shaw LLP on

Welcome to the inaugural issue of Project In(Site), Seyfarth’s Construction and Government Contracts practice groups’ publication focusing on decisions or other items of interest for construction and government contract...more

Catching Up To Insurers’ Use of Big Data

by Carlton Fields on

Various groups within the NAIC are beginning to study the way in which insurers are using big data. On the property and casualty front, the Market Regulation (D) (Market Reg) Committee is reviewing the use of big data in...more

The CHRO Complaint Process Needs A Reboot

by Shipman & Goodwin LLP on

Lately, I’ve been hearing a lot of complaints about the Connecticut Commission on Human Rights & Opportunities from both attorneys and clients. And I’ve come to one conclusion: The CHRO Complaint Procedure needs a...more

ERISA: When Does A Claimant Get To “Augment” The Administrative Record?

You already know that judicial review of ERISA claims generally will be limited to the administrative record considered by the claim administrator. But the courts will allow claimants to augment the record if ERISA...more

New Restrictions: CMS Limits Scope of Review on Redeterminations and Reconsiderations for Certain Audit Appeals

by Polsinelli on

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

HUD’s Proposal to Terminate FHA Insurance Policies Could Terminate the FHA Program

by K&L Gates LLP on

If there is anything that galls servicers of government-insured loans, it is the forfeiture or curtailment of all accrued interest from mortgage insurance claims resulting from the failure to foreclose fast enough within...more

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