Appeals, Summary Judgment, Health Insurance

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

Ogletree, Deakins, Nash, Smoak & Stewart,... on 2/27/2025

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

Fifth Circuit Upholds ACA Risk Adjustment Program

Sheppard Mullin Richter & Hampton LLP on 3/25/2022

Various smaller health insurance issuers have challenged the risk-adjustment program under the Patient Protection and Affordable Care Act (ACA), alleging, among other things, that its underlying methodology favors larger...more

The LHD/ERISA Advisor - October 2020: Summary Judgment in Favor of Insurer Reversed by California Appellate Court in Application...

Hinshaw & Culbertson LLP on 10/9/2020

Under the "genuine dispute" doctrine, an insurer is not liable for bad faith if its denial of a claim was reasonable. In Ghazarian v. Magellan Health, Inc., 53 Cal. App. 5th 171 (2020), a California appellate court reversed a...more

Remand Directing Change in Standard of Judicial Review Is Not Sufficient Success on the Merits to Support Attorneys’ Fee Award

Robinson+Cole ERISA Claim Defense Blog on 12/17/2019

In Ariana M. v. Humana Health Plan of Texas, Inc., No. 18-20700, 2019 WL 5866677 (5th Cir. Nov. 8, 2019), the Fifth Circuit Court of Appeals rejected a plaintiff’s petition for attorneys’ fees under 29 U.S.C. § 1132(g). This...more

Seventh Circuit OKs Exclusive Network Agreements Between “Must-Have” Hospital and Health Insurers

Mintz on 6/12/2017

In an opinion written by Judge Posner, the Seventh Circuit on Friday gave its stamp of approval to a “must-have” hospital’s bargaining to exclude competitors from certain narrow-network payor contracts in and around Peoria,...more

When Is a Hospital Not a Hospital?

Faegre Drinker Biddle & Reath LLP on 8/1/2015

Rebecca was a nurse at North Cypress Medical Center, in Texas. Back in 2011 she was treated for an eating disorder at Timberline Knolls Residential Treatment Center, in Illinois. When she sought reimbursement under the...more