Hinshaw & Culbertson - The LHD/ERISA Advisor

In Technibilt Grp. Ins. Plan & Technibilt, Ltd v. Blue Cross & Blue Shield of North Carolina (W.D. N.C., Feb. 3, 2020), a North Carolina district court held that a plan administrator was an ERISA fiduciary for the purpose of…more

Breach of Duty, Employee Retirement Income Security Act (ERISA), Employer Group Health Plans, Fiduciary Duty, Health Insurance

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Peter Felsenfeld

The LHD/ERISA Advisor: ERISA Exhaustion Requirement Not Satisfied by Verbal Appeal When Plan Required Written Appeal

In Ligotti v. United Healthcare Services, 2021 U.S. Dist. LEXIS 106992 (S.D. Fla., June 8, 2021), a Florida district court held that a health care provider challenging claim denials on behalf of his patients cannot satisfy…more

Additional Discovery, Administrative Remedies, Appeals, Discovery, Employee Benefits

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Margarita Gokhberg

The LHD/ERISA Advisor: Court Rules LTD Benefits Properly Terminated After Plaintiff Failed to Undergo Recommended Surgery for Disability

In Hall v. Aetna Life Ins. Co., 2021 U.S. Dist. LEXIS 117331 (N.D. Cal. June 23, 2021), a California district court held that an ERISA claim administrator properly terminated long-term disability (LTD) benefits after the…more

Disability, Disability Benefits, Employee Benefits, Employee Retirement Income Security Act (ERISA), Long Term Disability Insurance

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Jennifer Kalas

The LHD/ERISA Advisor: Texas District Court Upholds Denial of LTD Benefits Because Claimant Did Not Prove Functional Limitations Within Benefit Waiting Period

In Calkin v. United States Life Ins. Co., 2021 U.S. Dist. LEXIS 82110 (S.D. TX., April 29, 2021), a Texas district court affirmed the insurer’s denial of LTD benefits, holding that while a claimant established diagnoses, he…more

Denial of Insurance Coverage, Disability, Employee Benefits, Employee Retirement Income Security Act (ERISA), Long Term Disability Insurance

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Steven Lehner

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

Breach of Duty, De Novo Standard of Review, Denial of Benefits, Disability Benefits, Employee Benefits

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Peter Pederson

The LHD/ERISA Advisor – June 2021: Second Circuit Issues Statute of Limitations Ruling Favorable to Healthcare Plan Administrators

Federal law does not supply a statute of limitations for a claim seeking equitable relief under ERISA, 29 U.S.C. 1132(a)(3), and therefore federal courts borrow the limitations period of the state-law cause of action to which…more

Amended Complaints, Declaratory Judgment Act, Employee Retirement Income Security Act (ERISA), Equitable Relief, Federal Rule 12(b)(6)

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Dennis Rolstad

The LHD/ERISA Advisor - October 2020: Insurance Coverage During Involuntary Legal Holds Under California Law

Mental health patients are sometimes hospitalized under a legal hold allowing their temporary hospitalization. Medical providers seeking payments for services provided to patients subject to a legal hold argue, in both the…more

Arbitration, California, Denial of Insurance Coverage, Health Insurance, Involuntary Legal Holds

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M. Annie Santos

The LHD/ERISA Advisor: Ninth Circuit Joins Fourth Circuit in Holding that Equitable Estoppel is Barred Where Use Would Contradict Express Terms of an ERISA Plan

In Wong v. Flynn-Kerper, 999 F.3d 1205 (9th Cir. 2021), the Ninth Circuit barred the use of equitable estoppel to challenge the purchase price of company shares under an ERISA stock ownership plan when such use would contradict…more

Contract Terms, Employee Benefits, Employee Retirement Income Security Act (ERISA), Equitable Estoppel, ESOP

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Hinshaw & Culbertson - The LHD/ERISA Advisor

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