News & Analysis as of

Reversal Denial of Benefits

Morrison & Foerster LLP - Left Coast Appeals

This Week at the Ninth: Long Arms and Sore Backs

This week, the Ninth Circuit explains when courts have personal jurisdiction over foreigners who contract with U.S.-based businesses, and whether severe pain can qualify as a disability under the Longshore and Harbor Workers’...more

Hinshaw & Culbertson LLP

The LHD/ERISA Advisor: Courts Say Abuse of Discretion Standard is "Highly Deferential" to Plan Administrator's Denial of Benefits

In Rittinger v. Healthy Alliance Life Ins. Co., 914 F.3d 952 (5th Cir. Jan. 31, 2019), and Roebuck v. USAble Life, 380 F. Supp. 3d 852 (E.D. Ark. Mar. 30, 2019), the courts found no abuse of discretion where the ERISA plan...more

Hinshaw & Culbertson LLP

The LHD/ERISA Advisor: Fifth Circuit Defines Meaning of "Regular Occupation" Under LTD Policy

In Nichols v. Reliance Standard Life Ins. Co., 924 F.3d 80 (5th Cir. 2019), the U.S. Court of Appeals for the Fifth Circuit held that when an LTD policy funding an ERISA plan defines "regular occupation" as the way the...more

Hinshaw & Culbertson LLP

The LHD/ERISA Advisor: Ninth Circuit Reverses Award of Attorneys' Fees

In Gorbacheva v. Abbott Laboratories Extended Disability Plan, et al., 29 U.S. App. LEXIS 36542 (N.D. Cal. Dec. 10, 2019), the Ninth Circuit reversed a district court's award of attorneys' fees to an ERISA claimant as...more

Littler

New Mexico Supreme Court Holds Tribal Casino Immune from Workers’ Compensation Claims

Littler on

On January 16, 2020, the New Mexico Supreme Court issued its decision in Mendoza v. Isleta Resort and Casino, holding that a tribe does not waive its sovereign immunity to workers’ compensation claims merely by committing in...more

Faegre Drinker Biddle & Reath LLP

Supreme Court Decides Culbertson v. Berryhill

On January 8, 2019, the Supreme Court of the United States decided Culbertson v. Berryhill, No. 17-773, holding that the Social Security Act permits an attorney fee award greater than 25 percent of the claimant’s past-due...more

Butler Snow LLP

All Rise, Sixth Circuit on Standing

Butler Snow LLP on

On September 20, 2018, in Durham v. Martin, et al., 2018 WL 4496404 (6th Cir. 2018), the Sixth Circuit reversed the Middle District of Tennessee’s finding that Jeremy Durham lacked standing to pursue a suit against certain...more

Seyfarth Shaw LLP

More Trouble For Plan Administrators In Drunk Driving Cases

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The Fifth Circuit adds to the growing body of case law requiring more detailed reviews of claims for life insurance or accidental death and dismemberment benefits following accidents resulting from drunk driving....more

McAfee & Taft

ERISA Plans: Part-time employee entitled to disability benefits

McAfee & Taft on

In Van Steen v. Life Insurance Company N.A., the Tenth Circuit Court of Appeals upheld the grant of long-term disability benefits to an employee working part-time....more

Ruder Ware

Wisconsin Court of Appeals Rejects Labor and Industry Review Commission's Worker's Compensation Determination as Unreasonable

Ruder Ware on

Circuit courts and appellate courts commonly apply “great weight deference” to worker’s compensation benefit determinations made by the Labor and Industry Review Commission (“LIRC”), but not this time. In an unpublished...more

Foley & Lardner LLP

Second Circuit Reinstates Mental Health Parity Case Against UnitedHealth

Foley & Lardner LLP on

In late August the U.S. Court of Appeals for the Second Circuit reinstated a lawsuit by a physician association against a third-party plan administrator. The case against UnitedHealth Group and related entities (United) had...more

Seyfarth Shaw LLP

The Third Circuit Requires Benefit Denial Letters to Contain Plan Limitations Period

Seyfarth Shaw LLP on

In Mirza v. Insurance Administrator of America, Inc., No. 13-3535 (3d Cir. August 26, 2015), the Third Circuit became the latest Court to require benefit denial letters to include a notification of the plan’s limitations...more

King & Spalding

CMS Issues Refunds For Collections Made On Incorrectly Identified Incarcerated Beneficiary Overpayments

King & Spalding on

Medicare does not cover supplies or services for persons who are incarcerated at the time the services are rendered. However, Medicare had purportedly paid providers in error for many such claims and sought to recover those...more

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