AGG Talks: Healthcare Insights Podcast - Episode 4: What to Do When Insurance Companies Deny Behavioral Health Claims
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
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
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
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
This month’s Friday Five highlights equitable claims under ERISA, the applicability of an arbitration provision that fails to allow for plan-wide remedies, and the ongoing discretion in interpretation and application of...more
This month’s Friday Five covers federal guidelines for extension of ERISA claim deadlines due to the pandemic, as well as cases relating to: whether an expert witness who changes their opinion throughout the course of the...more
As we look ahead to 2021, we start our second edition of Hinshaw's LHD/ERISA Advisor by reporting on key cases that closed out 2020. Through The Advisor, our team of attorneys nationwide strive to report on legal developments...more
As we enter the final months of 2020, this is a time to reflect on a year of unprecedented challenges. Although Covid-19 changed our lives in many ways, it did not halt new legal developments in the life, health and...more
In Creed v. Hartford Life & Acc. Ins. Co., 2020 U.S. Dist. LEXIS 17613, (S.D. Ohio February 4, 2020), the court applied a "reasoned explanation" approach to hold that the evidence supported an insurer's decision to deny an...more
In Kaviani v. Reliance Std. Life Ins. Co., 2020 U.S. App. LEXIS 3006 (11th Cir. Jan. 31, 2020), the Eleventh Circuit held that an insurer had failed to give sufficient credence to a claimant's self-reports of pain and...more
Ninth Circuit Affirms Decision Rejecting Suit Seeking Early Retirement Benefits - The U.S. Court of Appeals for the Ninth Circuit has affirmed a district court’s decision rejecting a plaintiff’s lawsuit seeking to overturn...more
In recent Employee Retirement Income Security Act of 1974 (ERISA) litigation challenging benefit decisions by plan administrators and fiduciaries, litigants have been pleading closely related claims under multiple ERISA...more
In Fortier v. Hartford Life & Accident Ins. Co., 916 F.3d 74 (1st Cir. 2019) the U.S. Court of Appeals for the First Circuit clarified ERISA's timing requirements with respect to appealing an adverse benefits determination...more
In Rittinger v. Healthy Alliance Life Ins. Co., 914 F.3d 952 (5th Cir. Jan. 31, 2019), and Roebuck v. USAble Life, 380 F. Supp. 3d 852 (E.D. Ark. Mar. 30, 2019), the courts found no abuse of discretion where the ERISA plan...more
In Nichols v. Reliance Standard Life Ins. Co., 924 F.3d 80 (5th Cir. 2019), the U.S. Court of Appeals for the Fifth Circuit held that when an LTD policy funding an ERISA plan defines "regular occupation" as the way the...more
In Gorbacheva v. Abbott Laboratories Extended Disability Plan, et al., 29 U.S. App. LEXIS 36542 (N.D. Cal. Dec. 10, 2019), the Ninth Circuit reversed a district court's award of attorneys' fees to an ERISA claimant as...more
Up to now, our blog series has focused on best practices for implementing a plan’s claims and appeals procedure. We shift gears this week to see how following these best practices pays dividends if a participant’s (or...more
The Second Circuit held that plaintiffs’ allegations that the defendant suffered from a “categorical potential conflict of interest”—because it both funded the plan and was the claim’s decision-maker—did not affect the...more
On September 20, 2018, in Durham v. Martin, et al., 2018 WL 4496404 (6th Cir. 2018), the Sixth Circuit reversed the Middle District of Tennessee’s finding that Jeremy Durham lacked standing to pursue a suit against certain...more
• The U.S. Court of Appeals for the Eighth Circuit has affirmed a U.S. District Court's application of deferential standard to the review of an employee stock ownership plan (ESOP) administrator's decision based on broad...more
The Fifth Circuit adds to the growing body of case law requiring more detailed reviews of claims for life insurance or accidental death and dismemberment benefits following accidents resulting from drunk driving....more
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 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
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