News & Analysis as of

Employee Retirement Income Security Act (ERISA) › Denial of Insurance Coverage › Employee Benefits

Maynard Nexsen

Can ERISA Plans Avoid California Insurance Code Section 10110.6 with Choice-of-Law Provisions?

Maynard Nexsen on

The Ninth Circuit is considering the enforceability of a choice of law provision in an ERISA plan in William White v. Guardian Life Insurance Company, et al., Case No. 24-2681, appeal pending from the United States District...more

Fishman Haygood LLP

U.S. Fifth Circuit Reverses District Court and Awards Benefits to ERISA Plan Participant for Hospitalization

Fishman Haygood LLP on

Case Background - When she was a preteen, E.D. began experiencing symptoms of anorexia nervosa. Her condition worsened, and her parents, the Dwyers, took her to Avalon Hills, a residential treatment facility....more

Stinson - Benefits Notes Blog

DOL Settlements Remind Employers to Avoid Collecting Premiums Until Evidence of Insurability is Approved

Stinson - Benefits Notes Blog on

The U.S. Department of Labor (DOL) announced two settlements with major insurance companies this month that highlight the importance of employers avoiding the collection of group life insurance premiums from employees until...more

Carlton Fields

Litigation Lineup: Recent Decisions in Life and Disability Insurance Run into Policy Lapse, COVID-19, and Conflict of Interest...

Carlton Fields on

Life Policy Lapse Shortly Before Insured’s Death - In Simon v. USAA Life Insurance Co. (Mar. 29, 2024), the insurer denied death benefits under a term life insurance policy, which had lapsed for nonpayment of premium two...more

Hall Benefits Law

Employer Involvement Rendered Disability Insurance Plan Subject to ERISA, Despite Lack of Intent

Hall Benefits Law on

In Steigleman v. Symetra Life Ins. Co., 2023 WL 7413668 (D. Ariz. 2023), a court considered whether a package of various welfare benefit insurance policies an individual business owner arranged for herself and her employees...more

Proskauer - Employee Benefits & Executive...

Ninth Circuit Defers to Plan Design and Administrative Discretion on Bounds of Mental Health Coverage

Proskauer - Employee Benefits & Executive... on

A recent decision by the U.S. Court of Appeals for the Ninth Circuit (Wit et al. v. United Behavioral Health and Alexander et al. v. United Behavioral Health) exemplifies the challenge in balancing a desire to cover evolving...more

Hinshaw & Culbertson LLP

The LHD/ERISA Advisor: Texas District Court Upholds Denial of LTD Benefits Because Claimant Did Not Prove Functional Limitations...

Hinshaw & Culbertson LLP on

In Calkin v. United States Life Ins. Co., 2021 U.S. Dist. LEXIS 82110 (S.D. TX., April 29, 2021), a Texas district court affirmed the insurer’s denial of LTD benefits, holding that while a claimant established diagnoses, he...more

Eversheds Sutherland (US) LLP

DOL hears an ERISA claimant on access to audio recordings

Eversheds Sutherland (US) LLP on

In a June 14, 2021 information letter, the US Department of Labor (DOL) opined that a claimant appealing an adverse benefit determination under a plan covered by the Employee Retirement Income Security Act of 1974, as amended...more

Hinshaw & Culbertson LLP

The LHD/ERISA Advisor - October 2020: Tenth Circuit Finds District Court Applied Wrong Standard of Review in Evaluating Plan...

Hinshaw & Culbertson LLP on

In Lyn M. v. Premera Blue Cross, 2020 U.S. App. LEXIS 23395 (10th Cir. July 24, 2020), the Tenth Circuit held that a district court had applied the wrong standard of review and incorrectly evaluated an ERISA plan...more

Hinshaw & Culbertson LLP

The LHD/ERISA Advisor - October 2020: ERISA Plaintiff Has Statutory Standing to Bring Action to Recover Spousal Healthcare...

Hinshaw & Culbertson LLP on

Plaintiff Doug Heckman participated in Nike's employee welfare benefit plan (the "Plan"), which was funded by UnitedHealthcare Insurance Co. ("UHC"), and included healthcare benefits. Mr. Heckman's wife was covered under the...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

Carlton Fields

Court Sheds Light on ERISA’s Fiduciary Exception to Attorney-Client Privilege

Carlton Fields on

A federal district court in Ohio recently attempted to shed some light on when internal communications between an ERISA plan administrator and its in-house counsel are discoverable and when they are protected by the...more

Seyfarth Shaw LLP

Out Of Network Provider’s Claim Against Health Insurer Avoids ERISA Preemption

Seyfarth Shaw LLP on

Seyfarth Synopsis: A provider that is not seeking benefits based upon an assignment of a patient’s claims under ERISA but instead is pursuing state law claims based solely on agreements and representations made directly by...more

Robinson+Cole ERISA Claim Defense Blog

Ninth Circuit "Interprets" Accident Plan; "Direct and Sole Cause" Doesn't Mean What It Says

Robinson+Cole ERISA Claim Defense Blog on

In Dowdy v. Metro. Life Ins. Co., 16-15824, 2018 U.S. App. Lexis 12648 (9th Cir. May 16, 2018), the Ninth Circuit ruled that an accident plan that covers “accidental injury that is the Direct and Sole Cause of a Covered Loss”...more

14 Results
 / 
View per page
Page: of 1

"My best business intelligence, in one easy email…"

Your first step to building a free, personalized, morning email brief covering pertinent authors and topics on JD Supra:
Sign up Log in
*By using the service, you signify your acceptance of JD Supra's Privacy Policy.
- hide
- hide