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Insurance Claims Employee Benefits

Woodruff Sawyer

Health, Wellness, and Workers' Comp: A Promising Cost-Saving Connection

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Employee health and wellness directly influence workers’ compensation costs, especially when comorbid conditions are involved. Implementing targeted wellness programs can help HR leaders reduce these costs and improve overall...more

Epiq

When Treatment Costs Exceed Settlements

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Navigating the complex landscape of lien resolutions in mass torts is a challenge for both plaintiffs’ and defense attorneys. One of the biggest hurdles is complying with federal and state regulations to resolve health care...more

Carlton Fields

Idaho Federal Court Grants Motion to Compel Discovery of Reinsurance Information for Employee Benefit ERISA Plan

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In THC–Orange County LLC v. Regence BlueShield of Idaho Inc., the U.S. District Court for the District of Idaho addressed a motion by plaintiff THC–Orange County LLC, doing business as Kindred Hospital Ontario, to conduct...more

Saul Ewing LLP

The Friday Five: Five ERISA Litigation Highlights - July 2025

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This month’s Friday Five explores recent ERISA disability benefit decisions involving key issues such as when attorney’s fees should be decided and factors used in determining venue transfer. It also explores retroactive...more

Polsinelli

Sixth Circuit Holds TPAs Do Not Get a Free Pass from ERISA’s Fiduciary Duties

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In a decision about ERISA’s fiduciary duties and transparency, the Sixth Circuit in Tiara Yachts, Inc. v. Blue Cross Blue Shield of Michigan held that Blue Cross Blue Shield of Michigan (BCBSM), a third-party administrator...more

King & Spalding

Appeals Court Revives Company’s Suit against Blue Cross for Breach of ERISA Fiduciary Duty

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On May 21, 2025, the Sixth Circuit revived a company’s lawsuit against Blue Cross Blue Shield of Michigan (BCBSM) for breaching its fiduciary duties under ERISA as a third-party administrator (TPA). The plaintiff company,...more

Goldberg Segalla

Court Highlights Distinction Between Pre- and Post-Retirement Benefits and Workers’ Compensation Carrier’s Reimbursement Rights...

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The recent New York Court of Appeals decision in Matter of Schulze v. City of Newburgh Fire Department (April 10) has significant implications for municipal employers and workers’ compensation insurance carriers in New York,...more

Chartwell Law

Connecticut Legislature Enacts Significant Changes to Workers’ Compensation Act

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The Connecticut legislature has passed several important amendments to the Workers’ Compensation Act that will affect how claims are valued and administered statewide. These legislative updates introduce notable changes to...more

ArentFox Schiff

Anthem Set to Settle Five-Year Long Mental Health Coverage Class Action

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Anthem Inc. has agreed to settle a class action lawsuit brought by participants in employee health plans administered by the insurer....more

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

Saul Ewing LLP

The Friday Five: Five ERISA Litigation Highlights - April 2025

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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

Carlton Fields

California Appellate Court Agrees Marijuana Delivery Driver’s Accident Not Covered Under Personal Auto Policy

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A California Court of Appeals decision brought one auto policyholder decidedly down from “cloud nine” in Murphy v. AAA Auto Insurance of Southern California, which found no coverage over a cannabis delivery service employee’s...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

Saul Ewing LLP

The Friday Five: Five ERISA Litigation Highlights - March 2025

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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

Fennemore

Lessons Learned from ERISA Health Plan Representation and Recommendations for Plan Design and Oversight

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ERISA Health Plan clients are engaged in nearly every industry in the United States. There are nearly 139 million Americans covered by ERISA Health Plans and 2.5 million Health Plans. Yet, operating a health plan has become...more

Saul Ewing LLP

The Friday Five: Five ERISA Litigation Highlights - February 2025

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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

Marshall Dennehey

Pennsylvania Bureau of Workers' Compensation Payment Authorization Form

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On October 29, 2024, Pennsylvania Governor Josh Shapiro signed into law Senate Bill 1232, which amended the Pennsylvania Workers’ Compensation Act to require that employers and insurers offer claimants the option to receive...more

Goldberg Segalla

Pennsylvania Department of Labor & Industry Bureau of Workers’ Compensation has created the Direct Deposit Payment Authorization...

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Following the signing of Senate Bill 1232 amending the Pennsylvania Workers’ Compensation Act to require that employers and insurers offer claimants the option to receive their Workers’ Compensation payments by way of direct...more

Saul Ewing LLP

The Friday Five: Five ERISA Litigation Highlights - January 2025

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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

Brooks Pierce

Key Deadlines for Businesses Recovering from Hurricane Helene

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With year-end nearing, this client alert summarizes the extension of important deadlines and rebuild considerations for businesses recovering from Hurricane Helene....more

Rivkin Radler LLP

High-Profile Sports Insurance Fraud Rings: A Recent Conviction

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No health insurance benefit program, no matter how high profile, is immune to the temptations of insurance fraud. In the past, multiple former NFL players pleaded guilty to defrauding the NFL Player Health Reimbursement...more

Goldberg Segalla

Fraud Doesn't Pay in New York – August 2024 Update

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As a part of our Quarterly Practice Group Update, we are pleased to produce our latest installment of our continued success in fraud litigation. This report was originally conceptualized three years ago as a one-time...more

Carlton Fields

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

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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

Hogan Lovells

Sieben Jahre Verjährungsfrist in der betrieblichen Altersversorgung?

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Sind die Ansprüche aus einer Direktversicherung oder einer Pensionskasse verjährt, können Versorgungsberechtigte unter Umständen dennoch Zahlungen direkt vom Arbeitgeber verlangen....more

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

Colorado Gears Up for Sweeping New Paid Family and Medical Leave Insurance Program

​​​​​​​Colorado employers may want to begin preparing for the implementation of Colorado’s new state-run Paid Family and Medical Leave Insurance (FAMLI) program. While Colorado voters approved Proposition 118 nearly two years...more

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