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Employer Group Health Plans › Denial of Benefits

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

Hinshaw & Culbertson - The LHD/ERISA Advisor

The LHD/ERISA Advisor: Fifth Circuit Holds Amputation Not An Accident Under AD&D Policy Where Employee’s Underlying Medical...

Hinshaw & Culbertson - The LHD/ERISA Advisor on

In Byerly v. Std. Ins. Co., 2021 U.S. App. LEXIS 2937 (5th Cir. Feb. 2, 2021), the Fifth Circuit determined that a claimant, whose leg was amputated after he stubbed his toe, did not suffer a qualifying loss under his group...more

Hinshaw & Culbertson - The LHD/ERISA Advisor

The LHD/ERISA Advisor - October 2020

Hinshaw & Culbertson - The LHD/ERISA Advisor on

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

Hinshaw & Culbertson LLP

The LHD/ERISA Advisor: First Circuit Clarifies ERISA's Timing Requirements for Appealing Adverse Benefits Determination

Hinshaw & Culbertson LLP on

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

Hinshaw & Culbertson LLP

The LHD/ERISA Advisor: Courts Say Abuse of Discretion Standard is "Highly Deferential" to Plan Administrator's Denial of Benefits

Hinshaw & Culbertson LLP on

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

Bowditch & Dewey

Is a Dependent’s Gender Reassignment Covered Under Employer-Sponsored Benefits Plans?

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

Baker Donelson

Three Things Health Care Employers Should Know About Affordable Care Act Section 1557

Baker Donelson on

Health care providers are likely familiar with the Affordable Care Act's (ACA) prohibitions on discriminating against the recipients of their services, but providers also must be mindful that the ACA may also make them...more

Foley & Lardner LLP

Final Disability Claims and Appeals Regulations – Be Prepared to Comply

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In December 2016, the Department of Labor issued final regulations under ERISA governing claims procedures for group disability plans, which will become effective January 1, 2018. Generally, these regulations were drafted to...more

U.S. Equal Employment Opportunity Commission...

Mon General Hospital to Settle Discrimination Charge Filed By Female Employee Denied Benefits For Same-Sex Spouse

U.S. Equal Employment Opportunity Commission... on

Employee Benefits No Longer Exclude Coverage for Same-Sex Spouses - MORGANTOWN, W.V. -- Mon General Hospital has agreed to conciliate a charge of sex discrimination filed by its employee, Kathy McIntire, alleging that...more

Foley & Lardner LLP

Second Circuit Reinstates Mental Health Parity Case Against UnitedHealth

Foley & Lardner LLP on

In late August the U.S. Court of Appeals for the Second Circuit reinstated a lawsuit by a physician association against a third-party plan administrator. The case against UnitedHealth Group and related entities (United) had...more

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