This month’s Friday Five covers an appellate ruling on a complicated case raising both state and federal claims, an instance of procedural improprieties in the administrative review process informing the court’s substantive...more
2/10/2025
/ Compensation & Benefits ,
Denial of Benefits ,
Disability ,
Employee Benefits ,
Employee Retirement Income Security Act (ERISA) ,
Fiduciary Duty ,
Insurance Claims ,
Insurance Litigation ,
Plan Administrators ,
Retirement Plan ,
Settlement
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
This month’s Friday Five covers cases relating to a plaintiff’s attempts to seal a complaint seeking disability benefits, an administrator’s uncommunicated decision to discontinue its investigation into certain medical...more
This month’s Friday Five covers cases relating to discovery in ERISA benefits cases, an appellate court strictly interpreting ERISA regulatory deadlines, a district court authorizing an ERISA breach of fiduciary duty claim...more
This month’s Friday Five covers cases relating to the interpretation of time periods for claims under life insurance and disability plans, a situation where three separate administrators handled a disability benefits claim...more
This month’s Friday Five covers cases relating to interpretation of regulatory deadlines, the enforceability of discretionary clauses, circuit courts going both ways on appeals from summary judgment rulings in favor of plans,...more
This month’s Friday Five covers cases relating to a claimant’s second chance when a lawyer misses a court deadline, whether certain voluntary benefits fall within a broader ERISA plan, a court deciding that an insurer was...more
This month’s Friday Five covers cases relating to implied terms in disability definitions, retrieving mistakenly paid pension payments, claims from former beneficiaries who were allegedly and improperly excluded from...more
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
This month’s Friday Five covers cases relating to disputes between beneficiaries to life insurance policy proceeds, an insurer’s use of independent medical reviewers and in-house nurses to evaluate claims, the preexisting...more
This month’s Friday Five covers cases relating to personal liability of medical reviewers, when notice violations arise to a claim for relief, how plans must delegate discretionary authority, the rights of plans to terminate...more
This month’s Friday Five covers cases relating to an incarcerated individual’s entitlement to benefits, the relevance of post-decision evidence, hearsay objections to documents in the administrative record, the requirement of...more
This month's Friday Five covers cases relating to the standard for triggering an administrative appeal, exemptions to the exhaustion of administrative remedies requirement of ERISA, artful pleading in an attempt to avoid...more
This month’s Friday Five covers cases relating to fee shifting in favor of defendants, interpretation of AD&D policy provisions, a strict take on the language required to initiate an administrative appeal, and a reiteration...more
ERISA cases related to life insurance policies and related benefits were the focus of a number of reported decisions at the end of 2017 and continuing into the new year. This month’s issue of The Friday Five highlights four...more