News & Analysis as of

Denial of Benefits

Wilson Elser

Colorado Supreme Court Finds One-Year Statute of Limitations Inapplicable to Statutory Bad Faith Claims

by Wilson Elser on

The Colorado Supreme Court has provided some much-needed certainty as to the statute of limitations period for statutory bad faith claims. Chief Justice Nancy Rice, the author of the court’s May 29, 2018, opinion in Rooftop...more

Wilson Elser

Benefits Delayed versus Benefits Denied: No Distinction Says Colorado Supreme Court

by Wilson Elser on

The Colorado Supreme Court recently handed down several significant decisions interpreting the bad faith statutory landscape in Colorado. In American Family Mutual Insurance Co. v. Barriga, penned by Chief Justice Nancy Rice,...more

Rumberger Kirk & Caldwell

Court Construes Pre-Existing-Condition Exclusion To Avoid Illusory Disability Coverage

by Rumberger Kirk & Caldwell on

Rumberger partner Josh Lerner discusses the impact of the Eleventh Circuit's decision in Bradshaw v. Reliance Standard Life Ins. Co., 707 F. App’x 599 (11th Cir. 2017) with regard to pre-existing-condition...more

Hodgson Russ LLP

Employee Benefits Developments - April 2018

by Hodgson Russ LLP on

The Employee Benefits practice is pleased to present the Benefits Developments Newsletter for the month of April 2018. ...more

Hodgson Russ LLP

Fifth Circuit Joins Other Federal Circuit Courts in Applying De Novo Standard of Review to Claim Denials Based on Legal...

by Hodgson Russ LLP on

When minor, Ariana M.’s, claim for partial hospitalization benefits to treat her eating disorder was denied, she sued, claiming that the health insurer, Humana, was not entitled to deference regarding the factual...more

Hodgson Russ LLP

Administrator’s Delay Costs it Deferential Standard of Review

by Hodgson Russ LLP on

The District Court for the Southern District of Florida ruled that an administrator’s delay in rendering a decision on a denied benefit appeal caused it to lose deferential treatment from the reviewing court. ...more

Roetzel & Andress

Ohio Supreme Court Rules On BWC Subrogation Interest In Tort Claim Insurance Settlements

by Roetzel & Andress on

The Supreme Court of Ohio issued an opinion last week that provides a cautionary tale whose main antagonist is the broad reach of Ohio’s automatic subrogation provision set forth in R.C. 4123.931(G). In Bur. of Workers’...more

Bricker & Eckler LLP

Injured workers must inform BWC of third-party settlements

by Bricker & Eckler LLP on

The Ohio Supreme Court recently ruled that the Ohio Bureau of Workers’ Compensation (BWC) must be notified of potential third-party settlements that would compensate an injured worker for an injury, even when an application...more

McAfee & Taft

ERISA Plans: Part-time employee entitled to disability benefits

by McAfee & Taft on

In Van Steen v. Life Insurance Company N.A., the Tenth Circuit Court of Appeals upheld the grant of long-term disability benefits to an employee working part-time....more

Littler

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

Holland & Knight LLP

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

Proskauer - Employee Benefits & Executive...

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

Jackson Lewis P.C.

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

Mintz Levin - Employment Matters

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

Seyfarth Shaw LLP

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

Proskauer - Employee Benefits & Executive...

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

LeClairRyan

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

Bowditch & Dewey

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

Lane Powell PC

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

by Lane Powell PC on

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

Wilson Elser

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

Seyfarth Shaw LLP

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

Proskauer - Employee Benefits & Executive...

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

Jackson Lewis P.C.

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

Carlton Fields

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

Lane Powell PC

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

by Lane Powell PC on

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

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Privacy Officer
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