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Updates on the latest in benefits news and practical pointers for your benefits-related issues.

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What is an interpleader?

A process server comes to your door and delivers a summons, and something called a complaint for interpleader. What does that mean? How do you respond? For most people in that situation, the answer is to put the papers in a drawer and hope the matter goes away. But if you do that, you may […]

Why do health insurers deny claims?

When you are ill and a doctor recommends a course of treatment, you naturally assume that your health insurer will reimburse the cost.  That is not always the case, though, and it is not uncommon for benefits to be denied, especially if the costs are high.  Examples of types of claims that are frequently denied […]

Mental health coverage required under 2008 parity act

Increasing awareness of federal requirements for equal health insurance coverage of mental and physical conditions has led to a spate of litigation relating to health insurance denials. In Christine S. v. Blue Cross Blue Shield of New Mexico, 2019 WL 6974772 (D. Utah, Dec. 19, 2019), the issue was whether the plaintiff pleaded a valid […]

Courts continue to permit plaintiffs to plead simultaneous claims for benefits and breach of fiduciary duty under ERISA

Ever since the Supreme Court’s ruling in Varity Corp. v. Howe, 516 U.S. 489 (1996), courts have grappled with whether plaintiffs who file suit under the Employee Retirement Security Act of 1974 (“ERISA”) can plead simultaneous claims for benefits under § 502(a)(1)(B) along with claims for equitable relief under § 502(a)(3), and if so, under […]

Court questions insurer behavioral health treatment guidelines

Every major insurance company utilizes specific criteria to establish the appropriate medically necessary level of care during behavioral health treatment. But are such guidelines consistent with generally accepted standards for safe and effective treatment for psychiatric conditions? A recent federal court ruling from Connecticut, S.B. v. Oxford Health Insurance Inc., 2019 WL 5726901 (D. Conn., […]

When and why AD&D insurance companies deny claims

According to the Centers for Disease Control and Prevention, accidents are the fifth leading cause of death in the United States. Will your loved ones be financially protected should you succumb to an untimely death due to an accident? Accidental death and dismemberment insurance (AD&D) may be purchased in addition to traditional life insurance or offered by […]

Exercise your COBRA rights without getting snake-bitten

If you lose your health insurance as the result of job loss (resignation or termination), divorce, death of a spouse, or other qualifying event, the Consolidated Omnibus Budget Reconciliation Act of 1985 (“COBRA”) can provide a welcome bridge while you work to secure new health coverage. Yet there are many complexities and pitfalls to COBRA […]

How to dispute an insurance claim denial

If a disability, health or life insurance claim is denied, gathering information, staying within deadlines and communicating with all relevant parties to gather necessary information is essential in order to overturn the decision. When a dispute over any insurance benefits arises, being told “no” is not the final word. If the coverage at issue is […]

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