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Employee Benefits › Appeals › Insurance Industry

Wiley Rein LLP

Fifth Circuit Holds Carve-Back Provision Could Not Overcome Breach of Contract Exclusion for Louisiana Wage Payment Act Claim

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The United States Court of Appeals for the Fifth Circuit, applying Louisiana law, has held that a breach of contract exclusion barred coverage for a judgment awarded to two employees who were not paid severance as required...more

Goldberg Segalla

Georgia Court's Ruling on Rycroft Defense Signals Key Limitation for Employers

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Unfortunately, not everything is always peachy in the Peach State. Historically, the Rycroft defense has allowed employers to deny workers’ compensation benefits when a worker makes false representations about their physical...more

Seyfarth Shaw LLP

A New Standard For Full and Fair Review

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Seyfarth Synopsis: The 7th Circuit recently held that insurers and administrators must provide claimants an opportunity to respond to new information relied on for adverse benefit determinations, even if the claim predated...more

Bass, Berry & Sims PLC

Action Needed by Certain ERISA Plans – New Disability Claims Procedures Apply Beginning April 2018

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In January 2018, the U.S. Department of Labor (DOL) announced that final regulations affecting how some ERISA plans process claims and appeals will apply beginning April 1, 2018. As explained below, the final regulations...more

Seyfarth Shaw LLP

Timing is Everything: Tenth Circuit Overturns Insurer’s Disability Decision as Arbitrary and Capricious

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Even when a claims administrator approves a claim for disability benefits, its job is not done. That principle was again demonstrated in the recent case Owings v. United of Omaha Life Insurance Co., No. 16-3128 (10th Cir....more

Proskauer - Employee Benefits & Executive...

Oregon State Court of Appeals Recognizes Federal Slayer Law

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Oregon, like many states, has on its books a “slayer statute,” which generally prohibits a slayer or abuser of a decedent from obtaining benefits by virtue of the death of the decedent. The parents of Julianne Herinckx...more

Baker Donelson

Court of Appeals to Plan Administrators: Inform Claimants of Time Limits on Front End of Discussions

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Recently, in Mirza v. Insurance Administrator of Am., Inc., __ F.3d__ (3d. Cir. 2015), the United States Court of Appeals for the Third Circuit was asked to determine whether plan administrators are required to include a...more

Eversheds Sutherland (US) LLP

Insurance Industry Sweeps Retained Asset Account Doubleheader

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On August 26, the U.S. Court of Appeals for the First Circuit held in Vander Luitgaren v. Sun Life Ass. Co. of Canada, No. 13–2090, 2014 WL 4197947 (1st Cir. Aug. 26, 2014), that an insurer, acting as a claims administrator,...more

K&L Gates LLP

In an Opinion with Far-Reaching Implications, the Second Circuit Finds Insurance Coverage for an ERISA Claim

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When a general liability policy expressly provides coverage for employee benefits liability and the plaintiff in the underlying suit alleges a violation of the Employee Retirement Income Security Act of 1974 (“ERISA”), does...more

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