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Insurance Claims Employee Retirement Income Security Act (ERISA) Employee Benefits

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

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

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

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 - 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

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

Saul Ewing LLP

The Friday Five: Five Current ERISA Litigation Highlights – December 2020

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This month’s Friday Five covers recent cases addressing: (1) the validity of a judgment that includes retroactive “any occupation” benefits where no administrative determination on those benefits has been made; (2) the...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

Proskauer - Employee Benefits & Executive...

Fifth Circuit: Plaintiff Not Entitled to Attorneys’ Fees For Obtaining Remand on Appeal

The Fifth Circuit concluded that an individual plaintiff was not entitled to attorneys’ fees, even though she persuaded the Fifth Circuit to vacate and remand a summary judgment decision in favor of the Humana Health Plan,...more

Seyfarth Shaw LLP

Insurers, ERISA Plans and Other Payors: Beware of COVID-19 Fraud Schemes!

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On March 23, 2020, the U.S. Department of Health and Human Services Office of Inspector General (“HHS-OIG”) issued an alert to the public about fraud schemes related to the novel coronavirus (COVID-19)....more

Robinson+Cole ERISA Claim Defense Blog

Remand Directing Change in Standard of Judicial Review Is Not Sufficient Success on the Merits to Support Attorneys’ Fee Award

In Ariana M. v. Humana Health Plan of Texas, Inc., No. 18-20700, 2019 WL 5866677 (5th Cir. Nov. 8, 2019), the Fifth Circuit Court of Appeals rejected a plaintiff’s petition for attorneys’ fees under 29 U.S.C. § 1132(g).  This...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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