News & Analysis as of

Denial of Insurance Coverage Abuse of Discretion

Ogletree, Deakins, Nash, Smoak & Stewart,...

Ninth Circuit Affirms ERISA Plan Administrator’s Decision, Validates Use of Industry Guidelines and Medical Evidence

On March 5, 2019, Magistrate Judge Joseph C. Spero of the U.S. District Court for the Northern District of California issued his opinion in Wit v. United Behavioral Health, in which he attempted to significantly change how...more

K&L Gates LLP

K&L Gates Triage: Michael P. V. BCBS Of Texas

K&L Gates LLP on

In this week’s episode, Gary Qualls discusses a recent case decided in the Western District of Louisiana, which highlights how the application of the arbitrary and capricious standard as applied to payor coverage...more

Maynard Nexsen

Fourth Circuit Affirms Abuse of Discretion Finding in Denial of Coverage for Long Term Disability Claim

Maynard Nexsen on

In an unpublished decision issued last month, the Fourth Circuit Court of Appeals affirmed a lower court’s ruling ordering the reinstatement of long-term disability and life insurance benefits....more

King & Spalding

Federal District Court Rules United Unlawfully Denied Coverage for Mental Health and Substance Use Disorder Services Based on...

King & Spalding on

On March 5, 2019, Chief Magistrate Judge Joseph C. Spero of the U.S. District Court for the Northern District of California ruled that United Behavioral Health (UBH), a subsidiary of UnitedHealth Group, violated its fiduciary...more

Winstead PC

Bullet Proofing Your Claims Procedures

Winstead PC on

Managing your plan’s claims procedures to avoid successful challenges requires careful attention to all of the requirements in the regulations and in the applicable plan’s or policy’s terms and continual review in light of...more

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