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Employee Retirement Income Security Act (ERISA) › Appeals › Insurance Litigation

Carlton Fields

Eleventh Circuit Vacates Jury Award in Favor of Insurer Where Unjust Enrichment Claim Is Subject of Express Insurance Contract

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In MONY Life Insurance Co. v. Perez, the Eleventh Circuit Court of Appeals set aside a jury verdict in favor of MONY Life Insurance Co. on its unjust enrichment claim against policyholder Bernard Perez, holding that an...more

King & Spalding

Fifth Circuit Finds No Private Right of Action for Providers to Enforce Surprise Billing Awards

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On Thursday, June 12, 2025, a panel of the United States Court of Appeals for the Fifth Circuit issued two rulings construing parts of the No Surprises Act (NSA) to limit judicial review of arbitration awards issued under the...more

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

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

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

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

Verrill

Surprise Medical Bills: Texas District Court Vacates Portion of Independent Dispute Resolution (IDR) Process in Agency Rule

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The U.S. District Court for the Eastern District of Texas recently vacated a portion of the Requirements Related to Surprise Billing, Part II, Interim Final Rule (the “Rule”) regarding the independent dispute resolution (IDR)...more

Hinshaw & Culbertson LLP

The LHD/ERISA Advisor - October 2020: Ninth Circuit Finds ERISA Complaint Sufficiently Alleges Insurer had Waived Anti-Assignment...

Hinshaw & Culbertson LLP on

In Cal. Spine & Neurosurgery Inst. v. Blue Cross of Cal., 2020 U.S. App. LEXIS 20533 (9th Cir. June 20, 2020), the Ninth Circuit held that a surgical provider's complaint sufficiently alleged that Blue Cross of California...more

Winstead PC

Bullet Proofing Your Claims Procedures

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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

Seyfarth Shaw LLP

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

Seyfarth Shaw LLP on

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

Seyfarth Shaw LLP

ERISA Preemption Trumps State Insurance Law Yet Again: Ninth Circuit Declines to Apply California’s Insurance Notice-Prejudice...

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In a recent decision, the Ninth Circuit Court of Appeals rejected a Plan participant’s attempt to extend California insurance law’s notice-prejudice rule to self-insured ERISA plans. Zagon v. Am. Airlines, Inc., 2015 BL...more

Goodwin

En Banc Sixth Circuit Rules Against Disgorgement Remedy in Benefits Case

Goodwin on

In Rochow v. Life Insurance Company of North America, No. 12-2074 (6th Cir. March 5, 2015), the U.S. Court of Appeals for the Sixth Circuit, sitting en banc, ruled that an insurance company that wrongfully denied benefits to...more

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

Revisiting Rochow: The Sixth Circuit Rejects Earlier $3.8 Million Equitable Award in Recent En Banc Decision

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

Just over a year ago, a panel decision by the Sixth Circuit Court of Appeals in Rochow v. Life Insurance Company of North America, 737 F.3d 415 made big news when the court upheld the district court’s award of $3.8 million in...more

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