M&As – Novation and Recertification
Pepsi-Cola Metro. Bottling Co. v. Emp’rs Ins. Co., 2022 Wisc. App. LEXIS 598 (Wisc. Ct. App. July 8, 2022) - Wisconsin Court of Appeals (in a divided decision) holds that a “post-loss” assignment of rights under a...more
Recently, a three-judge panel in the Court of Appeals for the Ninth Circuit overturned a district court dismissal of an out-of-network provider’s claims against Blue Cross and Blue Shield of Illinois (“BCBSIL”). The unanimous...more
In Cal. Spine & Neurosurgery Inst. v. Blue Cross of Cal., 2020 U.S. App. LEXIS 20533 (9th Cir. June 20, 2020), the Ninth Circuit held that a surgical provider's complaint sufficiently alleged that Blue Cross of California...more
Synopsis: Two Courts of Appeal reach opposite results on ERISA preemption, thus continuing the judicial quest for a definitive meaning of ERISA preemption. Stay tuned for more such decisions, and yet more Supreme Court...more
The US Court of Appeals for the Third Circuit recently confirmed that “anti-assignment” provisions — provisions prohibiting insureds from assigning their rights under a health plan to third parties, including medical...more
Third-party litigation funding has received increased scrutiny over the past several years, particularly in the context of mass torts, class actions, and multidistrict litigation. Most of this scrutiny has focused on...more
On April 26, 2019, the Third Circuit Court of Appeals reversed in part and affirmed in part a district court order purporting to void cash advance agreements entered into by and between class members and litigation funding...more
Can a profit-sharing provision in a commercial lease survive assumption and assignment by a debtor? Analyzing such a provision, the Third Circuit answered “no,” finding the provision to constitute an unenforceable...more
Florida's Fourth District Court of Appeal (DCA) ruled on Sept. 5, 2018, that an insurer's anti-assignment provision was not prohibited. The Court disagreed with the Fifth DCA's decision in December 2017 prohibiting any such...more
The Holding - In Farmers Ins. Exchange v. The Honorable David Udall, 2018 WL 2931906 (June 12, 2018), the Arizona Court of Appeals accepted special action jurisdiction to hold that Insureds validly assigned post-loss...more
In Eden Surgical Ctr. v. Cognizant Tech. Sols. Corp., No. 16-56422, 2018 U.S. App. LEXIS 10597 (9th Cir., Apr. 26, 2018), the U.S. Court of Appeals for the Ninth Circuit upheld the District Court’s Order dismissing the...more
U.S. Courts of Appeals in all but four Circuits have now held that anti-assignment provisions in health insurance plans governed by ERISA are enforceable. In American Orthopaedic & Sports Medicine v. Independence Blue Cross...more
SEYFARTH SYNOPSIS: The Ninth Circuit recently dealt another major blow to healthcare providers that attempt to bring suits as assignees of their individual patients, holding that an ERISA plan’s anti-assignment provision bars...more
Relying on Federal Court precedent, a Pennsylvania intermediate appellate court resolved whether the plain language of Section 916 of the Longshore and Harbor Workers’ Compensation Act (“LHWCA”) prohibits the assignment of...more
Over the past couple years, more and more of my clients with self-funded plans have received letters from out-of-network providers appealing denied claims. The letters are usually 20 to 30 pages long, not very specific, and...more