The April Friday Five covers cases determining futility of exhausting administrative remedies, the nuances of the pre-existing condition exclusion, ERISA preemption, and genuine issue of material fact over an employee’s...more
4/4/2025
/ Administrative Remedies ,
Disability ,
Disability Benefits ,
Employee Benefits ,
ERISA Litigation ,
Fiduciary Duty ,
Insurance Claims ,
Insurance Litigation ,
Motion to Dismiss ,
Policy Exclusions ,
Preemption ,
Summary Judgment
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
2/10/2025
/ Compensation & Benefits ,
Denial of Benefits ,
Disability ,
Employee Benefits ,
Employee Retirement Income Security Act (ERISA) ,
Fiduciary Duty ,
Insurance Claims ,
Insurance Litigation ,
Plan Administrators ,
Retirement Plan ,
Settlement
This month’s Friday Five explores recent decisions including the standard of review for ERISA benefit denials, whether structural conflict entitles a claimant to conflict-of-interest discovery, whether a “relative value...more
This month’s Friday Five explores recent decisions with issues spanning physician power of attorney to preexisting exclusions and the fiduciary duty of an insurance company....more
6/7/2024
/ Compensation & Benefits ,
Disability ,
Disability Benefits ,
Employee Benefits ,
Employee Retirement Income Security Act (ERISA) ,
Employer Group Health Plans ,
ERISA Litigation ,
Fiduciary Duty ,
Health Insurance ,
Insurance Industry ,
Power of Attorney ,
Reimbursements
This month’s Friday Five covers cases relating to potential impacts of COVID-19, full and fair review of the claim file, an attempt to use an insurer’s internal policy against itself, and a “second bite at the apple” by...more
This month’s Friday Five covers cases relating to discovery in ERISA benefits cases, an appellate court strictly interpreting ERISA regulatory deadlines, a district court authorizing an ERISA breach of fiduciary duty claim...more
This month’s Friday Five addresses cases considering: (1) whether monetary relief in the amount of lost benefits is an available remedy for breach of fiduciary duty; (2) the validity of an ex-spouse’s beneficiary designation...more
This month’s Friday Five covers cases relating to: (1) whether an insurer may seek reimbursement of LTD benefits after a plaintiff obtains a tort settlement, and the scope of discovery on class claims regarding the same; (2)...more
This month’s Friday Five explores two decisions concerning claims for breach of fiduciary duty arising from subrogation, exhaustion of administrative remedies, a challenge to the calculation of benefits and alleged violation...more
This month's Friday Five covers recent cases addressing: (1) the scope of ERISA’s administrative exhaustion requirement; (2) whether ERISA permits a claim for “equitable estoppel through silence”; (3) the reasonableness of an...more
This month's Friday Five covers recent cases addressing: (1) the propriety of a remand for an administrative determination regarding a claimant's "any occupation" disability claim; (2) the viability of breach of fiduciary...more
This month’s Friday Five covers recent cases relating to interpretation of the term, "own occupation," the appropriate remedy for termination of benefits where the administrator’s review was limited to the "own occupation"...more
This month’s Friday Five covers cases that explore a variety of situations where courts consider what level of deference, if any, they must provide in reviewing decisions made by ERISA fiduciaries....more
This month’s Friday Five covers cases relating to claims handling and the standard of review, as well as the proper parties to litigation.
Does using the same physician for initial claim review and appeal violate ERISA...more
ERISA cases related to life insurance policies and related benefits were the focus of a number of reported decisions at the end of 2017 and continuing into the new year. This month’s issue of The Friday Five highlights four...more
Invasion of Privacy Claim Preempted by ERISA. A Western District of Pennsylvania court granted the administrator’s Rule 12(b)(6) motion to dismiss the plaintiff’s invasion of privacy claim as preempted by ERISA. ...more