AGG Talks: Healthcare Insights Podcast - Episode 4: What to Do When Insurance Companies Deny Behavioral Health Claims
This month’s Friday Five covers recent decisions on credibility pertaining to long COVID symptoms, weighing of disability evidence, overpayment accounting, preemption of state law claims, and a motion to compel discovery on...more
This month’s Friday Five explores decisions reviewing what evidence is necessary to prove that a condition like long COVID is “sufficiently disabling”, what standard of review applies to benefits under FEGLI, whether an...more
In most cases, denials of ERISA plan benefits by administrators who have been granted discretionary authority to interpret and apply the plan are reviewed under an abuse of discretion standard, and may only be reversed if the...more
This month's Friday Five explores the plaintiff's burden of establishing a continuing disability, when state law claims are expressly preempted by ERISA, and the reasonableness of an administrator's interpretation of a...more
Peralta v. Silver Line Bldg. Prods., No. A-0370-24 (September 24, 2025) - The respondent, Andersen/Silver Line Windows, appealed a decision that granted the petitioner’s motion for medical and temporary benefits. On July 16,...more
Physicians generally do not have direct standing to bring a claim for benefits under an ERISA group health plan. Rather, a physician’s standing derives from the patient’s status as a plan participant and must be assigned....more
This month’s Friday Five addresses cases covering ERISA preemption, the viability of a claim for benefits where the claimant alleges to have not received notice of a prior claim denial, an affirmance by the Circuit Court of a...more
This month’s Friday Five covers an appellate ruling on a complicated case raising both state and federal claims, an instance of procedural improprieties in the administrative review process informing the court’s substantive...more
This month’s Friday Five explores decisions from around the country discussing differences between the scope of discovery and ability to add documents to the record on a claim for review challenging the denial of LTD...more
Ferraro v. O’Malley, 2024 WL 920056 - The plaintiff was involved in a motor vehicle accident that caused her to be out of work for six months. While the plaintiff did continue working after her alleged disability onset date,...more
In this episode, AGG Healthcare Litigation co-chair Jason Bring is joined by AGG Healthcare Litigation partners Rich Collins and Damon Eisenbrey to discuss what you can do when insurance companies deny behavioral health...more
Testa-Carr v. Sallie Mae, N23A-04-004 CEB (Del. Super. Feb. 8, 2024) - Ms. Testa-Carr worked as a customer service representative for Sallie Mae. On March 21, 2022, she was fell down some stairs and was injured while...more
This month’s Friday Five covers the treatment of job-related stress in assessing an attorney’s disability, the requirements surrounding the qualifications of a medical professional to review a claimant’s medical records in...more
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
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
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
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
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
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
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
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
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
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
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
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