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Insurance Claims Employee Benefits Insurance Litigation

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

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

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

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

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

Saul Ewing LLP

The Friday Five: Five Current ERISA Litigation Highlights - April 2022

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This month’s Friday Five covers cases relating to: (1) whether claim administrators can recover overpayments through a breach of contract claim under state law; (2) whether claim administrators can rely solely on a claimant’s...more

Carlton Fields

ERISA Disability Plan Insurers Score Important Circuit Court Victories

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In recent months, circuit courts across the country have supported insurers’ discretion to deny long-term disability benefits (LTD) under ERISA. Since the beginning of the year, disability plan insurers have prevailed in the...more

Carlton Fields

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

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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

Robinson+Cole ERISA Claim Defense Blog

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

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

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