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Employee Benefits Denial of Benefits

Saul Ewing LLP

The Friday Five: Five ERISA Litigation Highlights - August 2024

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This month’s Friday Five explores decisions from around the country discussing differences between the scope of discovery and ability to add documents to the record on a claim for review challenging the denial of LTD...more

Saul Ewing LLP

The Friday Five: Five ERISA Litigation Highlights - April 2024

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This month’s Friday Five covers the treatment of job-related stress in assessing an attorney’s disability, the requirements surrounding the qualifications of a medical professional to review a claimant’s medical records in...more

Saul Ewing LLP

The Friday Five: Five ERISA Litigation Highlights - February 2024

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This month’s Friday Five explores decisions regarding the transfer of an ERISA action that was filed in a state where an insurer did not maintain sufficient minimum contacts, an award of attorneys’ fees, costs, and...more

Saul Ewing LLP

The Friday Five: Five ERISA Litigation Highlights - January 2024

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On Halloween, the U.S. Department of Health and Human Services (HHS), Office for Civil Rights (OCR) announced a $100,000 settlement under the Health Insurance Portability and Accountability Act (HIPAA) with Doctors’...more

Saul Ewing LLP

The Friday Five: Five ERISA Litigation Highlights - December 2023

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This month’s Friday Five explores a decision ordering an IME prior to a ruling on summary judgment motions, the extent claims reporting records can be sealed, the scope of ERISA preemption in the context of removal, and two...more

Littler

Fourth Circuit Establishes New Standards for Plaintiffs Seeking Unjust Enrichment as an Equitable Remedy under ERISA

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The United States Court of Appeals recently shed light on when—and under what conditions—a plaintiff may seek a monetary recovery under § 502(a)(3) of the Employee Retirement Income Security Act (ERISA). Section 502(a)(3)...more

Troutman Pepper

Courts Continue to Scrutinize ERISA Health Plan Benefit Denial Letters

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As discussed here, administrators’ health plan benefit denial letters have recently been under scrutiny by the courts. For example, in D.K. et al. v. United Behavioral Health et al., the Tenth Circuit is reviewing a district...more

Manatt, Phelps & Phillips, LLP

Wit Redux: Ninth Circuit Issues New Superseding Opinion in Landmark Mental Health Case

The Ninth Circuit has issued a new opinion in the long-running Wit v. United Behavioral Health litigation that changes the legal landscape for ERISA class actions. The Ninth Circuit’s opinion includes significant holdings on...more

McGuireWoods LLP

9th Circuit Rejects Classwide Reprocessing Remedy in ERISA Denial-of-Benefits Claim

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On Jan. 26, 2023, a 9th U.S. Circuit Court of Appeals panel issued an opinion in Wit v. United Behavioral Health, rejecting the plaintiffs’ attempt to meet Rule 23 commonality requirements by seeking reprocessing of claims as...more

Littler

Seventh Circuit Case Confirms that “Full and Fair Review” of Disability Claims Requires Disclosure of New Evidence Before Denying...

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A recent federal appeals court case clarifies that, under ERISA, the regulations governing disability plans’ claims review procedures apply to claims that predate the 2018 changes to the regulations. The decision also serves...more

Seyfarth Shaw LLP

Ninth Circuit Clarifies De Novo Review Standard and Newly-Raised Arguments in ERISA Litigation

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Recently, the Ninth Circuit addressed and further clarified the requirement of a “full and fair review” in the context of a long-term disability benefit case under the Employee Retirement Income Security Act (ERISA). In...more

Carlton Fields

Circuit Courts Continue to Navigate ERISA’s Murky Waters

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The Sixth Circuit Court of Appeals ruled in Fulkerson v. Unum Life Insurance Company of America that the beneficiary of an ERISA-covered life insurance policy was not entitled to accidental death and dismemberment (AD&D)...more

Parker Poe Adams & Bernstein LLP

North Carolina Supreme Court Says Employee Who Left Work Due to Medical Condition Cannot Collect Unemployment Benefits

In general, employees who resign are not eligible to collect unemployment insurance benefits. In North Carolina as with most states, the unemployment compensation law contains an exception for workers who resign for “a good...more

Robinson+Cole ERISA Claim Defense Blog

Second Circuit Clarifies That Reclassification of Health Status That Limits Scope of Disability Benefits Does Not Constitute...

In Ruderman v. Liberty Mut. Grp., Inc., No. 21-817, 2022 WL 244086 (2d Cir. Jan. 27, 2022), the U.S. Court of Appeals for the Second Circuit ruled that reclassification of a claimant’s disability from one that is...more

Jackson Lewis P.C.

Eighth Circuit: District Court Improperly Resolved Factual Disputes on Summary Judgment in ERISA Benefits Case, But Error Harmless

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In Avenoso v. Reliance Standard Life Insurance Company, No. 21-1772, 2021 U.S. App. LEXIS 35264 (8th Cir. Nov. 30, 2021), the Eighth Circuit clarified its position in a circuit split over the proper judicial procedure for...more

Jackson Lewis P.C.

Eighth Circuit: Procedural Irregularity Not a “Gateway” to De Novo Review of Administrator’s Decision to Deny Benefits

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In McIntyre v. Reliance Standard Life Insurance Company, 972 F.3d 955 (8th Cir. 2020), the United States Court of Appeals for the Eighth Circuit clarified the standard of review to apply where there has been a denial of...more

Saul Ewing LLP

The Friday Five: Five Current ERISA Litigation Highlights - November 2021

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This month’s Friday Five highlights equitable claims under ERISA, the applicability of an arbitration provision that fails to allow for plan-wide remedies, and the ongoing discretion in interpretation and application of...more

Hinshaw & Culbertson - The LHD/ERISA Advisor

The LHD/ERISA Advisor: Fifth Circuit Holds Amputation Not An Accident Under AD&D Policy Where Employee’s Underlying Medical...

In Byerly v. Std. Ins. Co., 2021 U.S. App. LEXIS 2937 (5th Cir. Feb. 2, 2021), the Fifth Circuit determined that a claimant, whose leg was amputated after he stubbed his toe, did not suffer a qualifying loss under his group...more

Hinshaw & Culbertson - The LHD/ERISA Advisor

The LHD/ERISA Advisor: District Court Finds Reduction in Monthly LTD Benefit Due to IRA Rollover Appropriate Under Plan Terms

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

Saul Ewing LLP

The Friday Five: Five Current ERISA Litigation Highlights - July 2021

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This month’s Friday Five covers cases relating to the exhaustion of administrative remedies set forth only in a denial of benefits letter, the scope of information required to be provided to medical reviewers, whether...more

Hinshaw & Culbertson - The LHD/ERISA Advisor

The LHD/ERISA Advisor – June 2021: Sixth Circuit Upholds Denial of Accidental Death Benefits Under "Substantial Factor" Test

In Duncan v. Minnesota Life Ins. Co., 2021 U.S. App. LEXIS 4069 (6th Cir. Feb. 10, 2021), the Sixth Circuit held that an insurer properly denied accidental death benefits on the grounds that a patient's leukemia caused the...more

Jackson Lewis P.C.

Administrative Exhaustion Is Required Even When Not Mentioned In Plan

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The Eastern District of Missouri recently examined whether administrative exhaustion is a prerequisite to an ERISA suit alleging a wrongful denial of employee benefits, where the benefit plan’s language did not include an...more

Hinshaw & Culbertson - The LHD/ERISA Advisor

Remand Order Constitutes Sufficient Degree of Success on the Merits to Justify Attorneys' Fees Award- May 24 2021

In Fisher v. Aetna Life Ins. Co., 2020 U.S. Dist. LEXIS 184024 (S.D.N.Y. Oct. 5, 2020), the court held that a remand order requiring the claim administrator to reassess its denial of benefits constituted a sufficient degree...more

Hinshaw & Culbertson - The LHD/ERISA Advisor

Ninth Circuit Affirms District Court May Consider Social Security Administration Ruling That Was Not Before the Plan Administrator

In Perez v. Lincoln Nat'l Life Ins. Co., 2021 U.S. App. LEXIS 1495 (9th Cir. Jan. 20, 2021), the Ninth Circuit held that a district court reviewing a denial of disability benefits under ERISA may consider a Social Security...more

Hinshaw & Culbertson - The LHD/ERISA Advisor

Sixth Circuit Upholds Denial of LTD Benefits by Decision Makers Employed by Another Entity Within the Plan Administrator's...

In Davis v. Hartford Life & Accident Life Ins. Co., 2020 U.S. App. LEXIS 36360 (6th Cir. Nov. 19, 2020) the Sixth Circuit held that a district court properly applied the abuse of discretion standard when reviewing the denial...more

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