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Denial of Benefits

Saul Ewing LLP

The Friday Five: Five ERISA Litigation Highlights - March 2024

Saul Ewing LLP on

This month’s Friday Five covers cases relating to an alleged conflict of interest leading to discovery, two courts’ opposite treatments of subjective pain complaints, a decision that claims of fraud and misrepresentation were...more

Hall Benefits Law

United Behavioral Health Files Cert Petition Over Mental Health Coverage Loss

Hall Benefits Law on

United Behavioral Health (UBH) and the Alcatel-Lucent Medical Expense Plan, an employee health plan now owned by Nokia, have filed a petition for a writ of certiorari before the U.S. Supreme Court. They are seeking to...more

Saul Ewing LLP

The Friday Five: Five ERISA Litigation Highlights - February 2024

Saul Ewing LLP on

This month’s Friday Five explores decisions regarding the transfer of an ERISA action that was filed in a state where an insurer did not maintain sufficient minimum contacts, an award of attorneys’ fees, costs, and...more

Stoel Rives - Notice of Appeal

The Mood Swings on Insurer Bad-Faith in Oregon: An Analysis of the Oregon Supreme Court decision in Moody v. Oregon Community...

The Oregon Supreme Court has long held the legislature did not create a private right of action under the Unfair Claims Settlement Practices Act (ORS 746.230). Policyholders could bring a tort claim against their insurance...more

Saul Ewing LLP

The Friday Five: Five ERISA Litigation Highlights - January 2024

Saul Ewing LLP on

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

Marshall Dennehey

A Decision Granting a Claim Petition, but Not Awarding Wage Loss Benefits, Was Supported by Substantial Competent Evidence and,...

Marshall Dennehey on

Marie Dennis v. Inglis House (WCAB); No. 1223 C.D. 2022; filed Oct. 12, 2023; Sr. Judge Leavitt - The claimant, a certified nurse assistant, filed a claim petition alleging multiple work injuries, which occurred on January...more

Saul Ewing LLP

The Friday Five: Five ERISA Litigation Highlights - December 2023

Saul Ewing LLP on

This month’s Friday Five explores a decision ordering an IME prior to a ruling on summary judgment motions, the extent claims reporting records can be sealed, the scope of ERISA preemption in the context of removal, and two...more

Husch Blackwell LLP

When the Payor is Also the Decisionmaker in ERISA Benefits Lawsuits Under 29 U.S.C. § 1132(a)(1)(B)

Husch Blackwell LLP on

When the same health plan administrator both administers a benefit plan and pays the benefits due under the plan, it is considered by courts to have a structural conflict of interest. That conflict of interest is not...more

Littler

Fourth Circuit Establishes New Standards for Plaintiffs Seeking Unjust Enrichment as an Equitable Remedy under ERISA

Littler on

The United States Court of Appeals recently shed light on when—and under what conditions—a plaintiff may seek a monetary recovery under § 502(a)(3) of the Employee Retirement Income Security Act (ERISA). Section 502(a)(3)...more

Rivkin Radler LLP

New York Insurance Coverage Law Update - July 27, 2023

Rivkin Radler LLP on

Southern District Holds That Contractor’s Carrier Has Duty To Defend ConEd Even Though Contractor’s Work Ended Months Before The Accident-A pedestrian tripped and fell on a Bronx sidewalk, and she sued the owner of the...more

Weintraub Tobin

California Medi-Cal Enrollment Appeals: An Uphill Battle but an Essential Tool

Weintraub Tobin on

In our practices, we are seeing an increasing number of denials or de facto denials of Medi-Cal provider enrollments. The consequences of a Medi-Cal enrollment denial can be quite serious. First, a provider may not receive...more

Troutman Pepper

Courts Continue to Scrutinize ERISA Health Plan Benefit Denial Letters

Troutman Pepper on

As discussed here, administrators’ health plan benefit denial letters have recently been under scrutiny by the courts. For example, in D.K. et al. v. United Behavioral Health et al., the Tenth Circuit is reviewing a district...more

Morris James LLP

How do I appeal a workers’ compensation decision?

Morris James LLP on

In Delaware, employees injured on the job are often entitled to workers' compensation benefits for medical expenses and wages lost by being unable to work during recovery. However, in some cases, the injured worker's claim...more

Manatt, Phelps & Phillips, LLP

Wit Redux: Ninth Circuit Issues New Superseding Opinion in Landmark Mental Health Case

The Ninth Circuit has issued a new opinion in the long-running Wit v. United Behavioral Health litigation that changes the legal landscape for ERISA class actions. The Ninth Circuit’s opinion includes significant holdings on...more

McGuireWoods LLP

9th Circuit Rejects Classwide Reprocessing Remedy in ERISA Denial-of-Benefits Claim

McGuireWoods LLP on

On Jan. 26, 2023, a 9th U.S. Circuit Court of Appeals panel issued an opinion in Wit v. United Behavioral Health, rejecting the plaintiffs’ attempt to meet Rule 23 commonality requirements by seeking reprocessing of claims as...more

Littler

Seventh Circuit Case Confirms that “Full and Fair Review” of Disability Claims Requires Disclosure of New Evidence Before Denying...

Littler on

A recent federal appeals court case clarifies that, under ERISA, the regulations governing disability plans’ claims review procedures apply to claims that predate the 2018 changes to the regulations. The decision also serves...more

Seyfarth Shaw LLP

Ninth Circuit Clarifies De Novo Review Standard and Newly-Raised Arguments in ERISA Litigation

Seyfarth Shaw LLP on

Recently, the Ninth Circuit addressed and further clarified the requirement of a “full and fair review” in the context of a long-term disability benefit case under the Employee Retirement Income Security Act (ERISA). In...more

Carlton Fields

Circuit Courts Continue to Navigate ERISA’s Murky Waters

Carlton Fields on

The Sixth Circuit Court of Appeals ruled in Fulkerson v. Unum Life Insurance Company of America that the beneficiary of an ERISA-covered life insurance policy was not entitled to accidental death and dismemberment (AD&D)...more

Proskauer - Employee Benefits & Executive...

Second Circuit Decision Illustrates Importance of Following Claims Procedures, and Drastic Consequences of Procedural Misstep

In McQuillin v. Hartford Life and Accident Ins. Co., 36 F.4th 416 (2d Cir. 2022), the U.S Court of Appeals for the Second Circuit restored a claimant’s action for disability benefits due to the plan administrator’s failure to...more

Husch Blackwell LLP

Seventh Circuit Issues Decision Addressing Employer Interference With FMLA Leave

Husch Blackwell LLP on

In a recent decision, the United States Court of Appeals for the Seventh Circuit clarified that an employer can violate the Family and Medical Leave Act (“FMLA”) by discouraging an employee from taking FMLA leave, even...more

Cozen O'Connor

Seventh Circuit Clarifies that Denial of Leave is Not Necessary for an FMLA Interference Claim

Cozen O'Connor on

On June 1, 2022, in the case of Salvatore Ziccarelli v. Thomas J. Dart, et al., the Seventh Circuit rendered an opinion clarifying that an employer can violate the Family and Medical Leave Act (FMLA) by discouraging an...more

Constangy, Brooks, Smith & Prophete, LLP

FMLA "interference" doesn't require denial of leave

The court is right, I think. A panel of the U.S. Court of Appeals for the Seventh Circuit issued an opinion on Wednesday that provides helpful clarification for employers and their leave administrators. ...more

Morrison & Foerster LLP - Left Coast Appeals

This Week At The Ninth: Removal Power

This week, the Ninth Circuit considers the President’s authority to remove the Commissioner of Social Security. KAUFMANN V. KIJAKAZI - The Court invalidates that statutory removal provision for the Commissioner of...more

Sheppard Mullin Richter & Hampton LLP

Less is More: Brevity is the Soul of Wit

Last month, a three-judge panel in the Ninth Circuit reversed the Northern District of California’s ruling in Wit v. United Behavioral Health. In Wit, the district court ruled that United Behavioral Health (“UBH”) breached...more

Parker Poe Adams & Bernstein LLP

North Carolina Supreme Court Says Employee Who Left Work Due to Medical Condition Cannot Collect Unemployment Benefits

In general, employees who resign are not eligible to collect unemployment insurance benefits. In North Carolina as with most states, the unemployment compensation law contains an exception for workers who resign for “a good...more

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JD Supra Privacy Policy

Updated: Dec 28, 2021:

JD Supra is a legal publishing service that connects experts and their content with broader audiences of professionals, journalists and associations.

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Privacy Officer
JD Supra, LLC
150 Harbor Drive, #2760
Sausalito, CA 94965

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Privacy Officer
JD Supra, LLC
150 Harbor Drive, #2760
Sausalito, CA 94965

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Changes in Our Privacy Policy

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Contacting JD Supra

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Updates to This Policy

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Contacting JD Supra

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