News & Analysis as of

Denial of Benefits

A Uniform Standard of Review in ERISA Benefit Denial Cases: The Fifth Circuit Overrules Itself to Fall in Line with Other Courts

by Littler on

With its en banc decision in Ariana v. Humana Health Plan of Texas, the Fifth Circuit reconsidered the standard of review in an ERISA denial of benefits case. ...more

New ERISA Claims Procedures for Plans Providing Disability Benefits Effective April 1, 2018

by Holland & Knight LLP on

• Administrators of employee benefit plans governed by ERISA should make sure now that the claims procedures contained in their affected benefit plans comply with new regulations applicable to disability benefits. • The...more

Plan Participant Waived Remedy for Untimely Benefits Determination

The Seventh Circuit rejected a disability plan participant’s argument that an untimely decision denying his claim for long-term disability benefits warranted changing the standard of review from arbitrary and capricious to de...more

Changes To ERISA’s Disability Claims Regulations Coming April 1

by Jackson Lewis P.C. on

New handling regulations for ERISA disability claims will go into effect on April 1, 2018, the Department of Labor (DOL) has announced. The agency confirmed that the regulations are final, without changes. The regulations...more

No More Delays! New Disability Claims Rules to Take Effect April 2, Says DOL

On April 2, 2018, significant changes to ERISA’s disability claims procedures will take effect. These new rules will require all ERISA-covered plans which provide disability benefits to make significant modifications to the...more

DOL’s New Disability Plan Claims Regulations To Become Effective

by Seyfarth Shaw LLP on

The Department of Labor’s new regulations governing disability claims and appeals published on December 19, 2016 will go into effect on April 1, 2018, as announced by the DOL on January 5, 2018. ...more

District Court Applies Texas Ban on Discretionary Clauses in Insurance Contracts

A federal district court in Louisiana upheld a Texas state law prohibiting insurers from granting themselves discretion to interpret benefit plans when deciding benefit claims. These so-called “discretionary clauses” are...more

Social Media – “Exhibit A” in Litigation

by LeClairRyan on

A recent case from the Commonwealth Court of Pennsylvania illustrates in vivid detail the potentially disastrous litigation consequences for employees of making ill-advised postings on social media, including Facebook. It...more

Is a Dependent’s Gender Reassignment Covered Under Employer-Sponsored Benefits Plans?

by Bowditch & Dewey on

In Tovar v. Essentia Health (U.S. 8th Circuit Court of Appeals, 2017), Brittany Tovar sought and was denied benefits needed for her son’s gender reassignment based on a diagnosis of gender dysphoria, as the Essentia health...more

ERISA: Can a Court Invalidate the Social Security Offset Provision Because Benefits Were “Wrongfully Denied”?

You know that most ERISA plans, and most supporting insurance policies, have provisions that allow for an offset of Social Security disability benefits. Can the court invalidate these offset provisions because of...more

Is There a Silver Lining with Hurricane Irma?

by Wilson Elser on

On September 10-11, 2017, Florida was pounded by Hurricane Irma. It appears that only northwest Florida was spared the wrath of this storm. Landfall occurred near Cudjoe Key in south Florida and for the next 24 hours the...more

Ninth Circuit Holds that ERISA Preempts State Insurance Law Bans on Discretionary Clauses for Self-Funded ERISA Plans

by Seyfarth Shaw LLP on

Seyfarth Synopsis: The Ninth Circuit Court of Appeals recently confirmed that ERISA preempts state insurance law bans on discretionary clauses for self-funded ERISA plans....more

Disability Claims Procedures Should be Updated for New Regulations

As open enrollment approaches for many benefit plans, employers and plans sponsors should check to make sure their claims procedures for disability claims are consistent with regulations that become effective for plan years...more

The Full Fifth Circuit Will Re-Visit The Standard Of Review In Denial Of Benefits Cases

by Jackson Lewis P.C. on

On July 10, the Fifth Circuit Court of Appeals announced that the full Court would re-hear a recent case concerning the applicable standard of review in an ERISA denial of benefits case – which is often outcome-determinative...more

Fifth Circuit’s Pierre Deference In ERISA Cases Trumps Texas’s Anti-Discretionary Language Statute

by DeWitt Law, LLC on

In Ariana M. v. Humana Health Plan of Texas, Inc., No. 16-20174, 2017 U.S. App. LEXIS 7072(5th Cir. Apr. 21, 2017), which involved a claim for benefits under an ERISA-governed health policy, the Fifth Circuit held that...more

Court Vacates Arbitration Award For Arbitrator’s Evident Partiality

by Carlton Fields on

A New York Court vacated an arbitration award, finding that a party appointed arbitrator’s undisclosed relationships with the appointing party amounted to a relatively infrequent instance in which such nondisclosure...more

ERISA: 4 Quick Responses to Claimant’s Typical Challenges to Disability Benefit Denials

How do you respond to typical arguments by those seeking ERISA-governed disability benefits that the claim administrator: -“cherry-picked the record”; -ignored the social security disability determination; -improperly...more

Unemployment Benefits Cannot Be Denied Based on Eight Cash Transaction Inadvertent Errors Out of 80,000 Transactions in a 21-Month...

by Ruder Ware on

The Wisconsin Supreme Court has interpreted the meaning of “substantial fault” in an unemployment insurance case, which will be applicable in worker’s compensation cases, as well. The case is Operton v. Labor and Industry...more

Three Things Health Care Employers Should Know About Affordable Care Act Section 1557

by Baker Ober Health Law on

Health care providers are likely familiar with the Affordable Care Act's (ACA) prohibitions on discriminating against the recipients of their services, but providers also must be mindful that the ACA may also make them...more

The Fifth Circuit Calls Into Question Its Standard Of Review In ERISA Denial Of Benefits Cases

by Jackson Lewis P.C. on

Explaining that “[a]s any sports fan dismayed that instant replay did not overturn a blown call learns, it is difficult to overcome a deferential standard of review,” a panel of the Fifth Circuit Court of Appeals has called...more

Back to Basics – Costly Consequences of Ignoring Process in Benefits Administration

The stories of an employer and a long-term disability insurer and claims fiduciary for an ERISA plan, defendants in two recent cases, ring so true. In the first case, the insurer was designated as claims fiduciary for an...more

Grounding Deferential Review in California – No Preemption for Discretionary Clause Ban

by Seyfarth Shaw LLP on

Seyfarth Synopsis: In a decision with wide ranging implications, the Ninth Circuit has ruled that a discretionary clause in an employer drafted plan document is subject to, and invalidated by, California’s insurance...more

Halo looms over new decision that adds to ERISA risks for claims administrators

by Thompson Coburn LLP on

The latest decision to rely on the influential Halo v. Yale Health Plan decision from the 2nd Circuit adds to a worrisome pattern of courts applying the strictest possible review to lawsuits brought by aggrieved plan...more

Labor Department Boosts Disability Claimant Protections

by Fisher Phillips on

The U.S. Department of Labor (USDOL) recently issued a final rule addressing disability benefit claims and appeals (see 81 FR 92316). The rule adds new procedural protections and safeguards meant to ensure disability...more

Final Disability Claims and Appeals Regulations – Be Prepared to Comply

by Foley & Lardner LLP on

In December 2016, the Department of Labor issued final regulations under ERISA governing claims procedures for group disability plans, which will become effective January 1, 2018. Generally, these regulations were drafted to...more

122 Results
View per page
Page: of 5

"My best business intelligence,
in one easy email…"

Your first step to building a free, personalized, morning email brief covering pertinent authors and topics on JD Supra:
Sign up using*

Already signed up? Log in here

*By using the service, you signify your acceptance of JD Supra's Privacy Policy.
*With LinkedIn, you don't need to create a separate login to manage your free JD Supra account, and we can make suggestions based on your needs and interests. We will not post anything on LinkedIn in your name. Or, sign up using your email address.