AGG Talks: Healthcare Insights Podcast - Episode 4: What to Do When Insurance Companies Deny Behavioral Health Claims
In DeBold v. Liberty Life Assur. Co. of Bos., 2021 U.S. Dist. LEXIS 120153 (D. Mass, June 28, 2021), a district court held that an ERISA plan administrator could reduce an insured's monthly long-term disability (LTD) benefit...more
In Western v. Unum Life Insurance Company of America, 798 F.App'x 154, 2020 U.S. App. LEXIS 8362 (9th Cir. March 17, 2020), the Ninth Circuit affirmed Unum Life's determination that an aerospace engineer diagnosed with...more
In recent Employee Retirement Income Security Act of 1974 (ERISA) litigation challenging benefit decisions by plan administrators and fiduciaries, litigants have been pleading closely related claims under multiple ERISA...more
In Ariana M. v. Humana Health Plan of Texas, Inc., No. 18-20700, 2019 WL 5866677 (5th Cir. Nov. 8, 2019), the Fifth Circuit Court of Appeals rejected a plaintiff’s petition for attorneys’ fees under 29 U.S.C. § 1132(g). This...more
The Tenth Circuit upheld a claims administrator’s decision denying a claim for residential mental health treatment as not medically necessary...more
With its en banc decision in Ariana v. Humana Health Plan of Texas, the Fifth Circuit reconsidered the standard of review in an ERISA denial of benefits case. ...more
The Seventh Circuit rejected a disability plan participant’s argument that an untimely decision denying his claim for long-term disability benefits warranted changing the standard of review from arbitrary and capricious to de...more
The stories of an employer and a long-term disability insurer and claims fiduciary for an ERISA plan, defendants in two recent cases, ring so true. In the first case, the insurer was designated as claims fiduciary for an...more
Seyfarth Synopsis: In a decision with wide ranging implications, the Ninth Circuit has ruled that a discretionary clause in an employer drafted plan document is subject to, and invalidated by, California’s insurance...more
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
On September 4, 2015, the U.S. Court of Appeals for the Seventh Circuit ruled in Fontaine v. Metropolitan Life Insurance Company that the Employee Retirement Income Security Act of 1974, as amended (ERISA), does not preempt...more