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Breach of Contract Health Insurance

Robinson+Cole ERISA Claim Defense Blog

Ninth and Second Circuit Courts of Appeals Rule that Preauthorization Process Does Not Impose Independent Contractual Liability on...

Within days of one another, the U.S. Court of Appeals for the Ninth and Second Circuits ruled—on issues of first impression for both—that ERISA expressly preempts state law breach of contract and promissory estoppel claims...more

Carlton Fields

Expect Focus - Volume III, September 2023

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Regulators Hit Jackpot: Off-Channel Communications - Several years before announcing the first “off-channel” communications enforcement action, the SEC and FINRA cautioned broker-dealers and investment advisers about...more

Troutman Pepper

California Court of Appeal Affirms Grant of Summary Judgment Against Health Care Provider in Win for Managed Care Payors and...

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The California Court of Appeal, in a major win for managed care payors and claims administrators, affirmed a lower court decision granting summary judgment in favor of United Healthcare (United), finding that United did not...more

Holland & Knight LLP

Religious Institutions: Update June 2023

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In Ratliff v. Wycliffe Assoc., Inc., No. 6:22-cv-1185-PGB-RMN, 2023 WL 3688082 (M.D. Fla. May 26, 2023), the plaintiff, a software developer, sued the defendant, a Bible translation ministry, for sex discrimination under...more

Pullman & Comley - Connecticut Health Law

Notable 2020 Connecticut Decisions Affecting Health Care

Plaintiff Cannot Cure Defective Malpractice Opinion Letter with an Affidavit Connecticut law requires that a plaintiff in a medical malpractice action demonstrate the existence of his or her good faith by obtaining a written...more

Epstein Becker & Green

Third Circuit: Provider’s Out-of-Network Claims not Pre-empted by ERISA

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In an important win for healthcare providers, on July 17, 2020, the Third Circuit determined in a published opinion that an out-of-network provider’s direct claims against in insurer for breach of contract and promissory...more

Rivkin Radler LLP

Employee Benefit Plan Review – From the Courts

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Second Circuit Affirms Decision Rejecting ERISA Claims for Retiree Health Benefits The U.S. Court of Appeals for the Second Circuit has affirmed a district court’s decision dismissing claims under the Employee Retirement...more

Bradley Arant Boult Cummings LLP

CNA Long-Term Care Class Action — Could It Have Long-Term Consequences?

A long-term care insurance class action filed in May 2018 highlights the importance of clearly defined policy language. At dispute in the lawsuit pending in the United States District Court for the Northern District of...more

Bradley Arant Boult Cummings LLP

Long-Term Care and Elder Abuse: Do They Intersect?

In at least one state, California, the answer to the question of “Do issues related to long-term care and elder abuse intersect?” is yes. The California Welfare and Institutions Code defines “financial abuse” of an elder...more

K&L Gates LLP

K&L Gates Triage: Recent Developments in Provider v. Payer Litigation -- Medicare Advantage Disputes

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In this episode, Gary Qualls discusses a recent development in payer litigation, regarding a provider’s recovery of Medicare Advantage payments pursuant to a Medicare Advantage contract. Specifically, a recent federal case...more

Farrell Fritz, P.C.

Congressional Appropriations Riders Suspended Affordable Care Act Mandates On Risk Corridors Program

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In a decision last week that could affect $12 billion that insurers assert is owed by the federal government, the Federal Circuit decided that HHS was not required to pay amounts required by statute because Congress had...more

Mintz - Health Care Viewpoints

Decision Expected Soon in Ongoing Risk Corridors Litigation

Many provisions of the Affordable Care Act (“ACA”) have been the subject of litigation over the last decade, with several high-profile Supreme Court cases including: NFIB v. Sebelius, King v. Burwell, and Burwell v. Hobby...more

Carlton Fields

Humana Bundles Up; Files Suit To Recover Hundreds Of Millions In Risk Corridor Payments From Uncle Sam

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On November 2, Humana filed a lawsuit in the United States Court of Federal Claims to recover approximately $600 million allegedly owed by the United States government. See Humana Inc. v. U.S., case number 1:17-cv-01664. ...more

Carlton Fields

Sticking Firmly to Contract Terms, Court Dismisses Premium and COI Overcharge Claims

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In July, in Hancock v. Americo Financial Life & Annuity Co., Americo achieved a total victory on its motion to dismiss a putative class action in the Eastern District of North Carolina that challenged its premium and COI...more

Patterson Belknap Webb & Tyler LLP

Cyber Briefing: Second “Envelope” Lawsuit Against Aetna, Yahoo to Answer for 1.5 Billion Hacked Accounts and Eighth Circuit...

As we head into the new week, here’s a quick summary of major data security developments from around the country. Aetna Hit With Second “Envelope” Lawsuit - Aetna Inc. is now facing a second lawsuit over the disclosure...more

Baker Donelson

Anthem Terminates Merger Deal with Cigna; Litigation Continues in Delaware Chancery Court

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On May 12, Anthem announced that it was terminating all efforts to complete its proposed merger with Cigna. The deal, announced back in 2015 and valued at $54 billion, would have combined the country's second and fifth...more

Holland & Knight LLP

Religious Institutions Update: August 2016

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When was the last time your organization reviewed your insurance policies? Not all policies are equal. Many religious organizations are underinsured. Most should have general liability, property, professional liability,...more

Proskauer Rose LLP

The ERISA Litigation Newsletter - October 2015

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Editor's Overview - This month, we review the Second Circuit's ruling in New York State Psychiatric Ass'n, Inc. v. UnitedHealth Grp. wherein the Second Circuit ruled that: (i) a provider association has associational...more

Franczek P.C.

Employee Benefits Alert - August 2015

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Retirement Plans - IRS Issues Guidance on Benefit Suspension Voting under MPRA - As we have written in prior alerts, the Multiemployer Pension Reform Act of 2014 (MPRA) permits trustees of financially troubled...more

Seyfarth Shaw LLP

Inevitable Disclosure Doctrine Held Inapplicable To Failed Business Transaction

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An Illinois appellate court recently rejected applying the inevitable disclosure doctrine in a trade secret misappropriation spat arising out of a failed business transaction....more

Manatt, Phelps & Phillips, LLP

Ninth Circuit Holds That Provider Cannot Sue Nonsignatory Insurer for Breach of Contract

On October 10, 2014, the Ninth Circuit affirmed a grant of summary judgment in favor of Manatt client The MEGA Life and Health Insurance Company. In an unpublished memorandum opinion, the Ninth Circuit held that a health care...more

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