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Insurance Claims Employee Retirement Income Security Act (ERISA)

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

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

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

ArentFox Schiff

Navigating Out-of-Network Claims: Key Takeaways for Providers From Surgery Center Case in New York Federal Court

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The US District Court for the Eastern District of New York in Manalapan Surgery Ctr., et al. v. 1199 SEIU National Benefit Fund, No. 23-CV-03525 (EDNY March 12, 2025), recently granted a motion to dismiss a complaint filed by...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

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

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

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

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

Fennemore

Regulatory Landscape of Insurance Claims Denial Practices and Suggestions for a Path Forward to a Sustainable Healthcare Future

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In the wake of the December 4, 2024 fatal shooting of UnitedHealthcare’s CEO Brian Thompson, questions were raised about insurance claim denial practices. Several news outlets noted that UnitedHealth Group’s profits have been...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

Insurance Update - May 20 2024

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Careening race cars, missing diamonds, and gold treasure provide some of the backdrop for insurance issues that courts had to decide this past month. We begin in Pennsylvania where the state’s high court reined in some loose...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

McDermott Will & Schulte

[Webinar] Gender-Affirming Benefits: Best Practices for Group Health Plans - February 29th, 1:00 pm - 1:30 pm EST

Employers and plan sponsors are facing growing – and often conflicting – pressures related to the coverage of gender-affirming care. Join McDermott lawyers Sarah G. Raaii and Alden J. Bianchi for a webinar to review recent...more

Hall Benefits Law

United Behavioral Health Files Cert Petition Over Mental Health Coverage Loss

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United Behavioral Health (UBH) and the Alcatel-Lucent Medical Expense Plan, an employee health plan now owned by Nokia, have filed a petition for a writ of certiorari before the U.S. Supreme Court. They are seeking to...more

Saul Ewing LLP

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

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This month’s Friday Five covers cases relating to a claimant’s second chance when a lawyer misses a court deadline, whether certain voluntary benefits fall within a broader ERISA plan, a court deciding that an insurer was...more

Proskauer - Employee Benefits & Executive...

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

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

Polsinelli

Ninth Circuit Reverses Landmark Wit Case Addressing Behavioral Health Coverage

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The President and his administration continue to tout their efforts to strengthen coverage for behavioral health care, including significantly increasing behavioral health spending and strengthening parity between physical...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

Holland & Knight LLP

Circuit Split Remains on Availability of Equitable Relief from ERISA Co-Fiduciaries

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The U.S. Supreme Court has denied a petition for certiorari in First Reliance Standard Life Insurance Company v. Giorgio Armani Corporation. Although the headlines typically come when the Supreme Court issues an opinion, its...more

Alston & Bird

Class Action & MDL Roundup – Fall 2021

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In the fall edition of the Class Action & MDL Roundup, covering notable class actions from the third quarter of 2021, a marriage nearly tears apart a certified class, insurers are vaccinated against more COVID-19 suits, and...more

Rivkin Radler LLP

Insurance Update - December 2021

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Our December Insurance Update features four cases. The Minnesota Supreme Court decides if a resident-relative exclusion violates public policy. A Texas appellate court considers, for a second time, if damage from...more

Hinshaw & Culbertson LLP

The LHD/ERISA Advisor: Court Rejects Insurer's Interpretation of its Own Policy Language on Limitations Period

In Spina v. Metro. Life Ins. Co., 2021 U.S. Dist. LEXIS 114887, (D.N.J. June 21, 2021), the court rejected both an insurer's and insured’s interpretation of when proof of loss was due under a long-term care policy and...more

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

HHS Proposes Air Ambulance Reporting Details Beginning in 2022

Employer-sponsored health plans can add air ambulance claims reporting to the list of required disclosures that will go into effect in the next several years. Under proposed regulations published September 16, 2021, by...more

Zuckerman Spaeder LLP

[Webinar] A Step-by-Step Strategy for Maximizing Insurance Coverage Under ERISA - July 22nd, 2:00 pm - 3:00 pm ET

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Building on our recent overview presentation “Six Lessons Patients and Providers Need to Know," we invite you to join us as we examine a single medical provider/patient encounter, in order to identify the concrete steps a...more

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