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 […]
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 […]
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 […]
Can disability be proven by pain symptoms alone or is “objective” medical evidence required? A recent federal court ruling from Maryland, Krysztofiak v. Boston Mutual Life Insurance Co., 2019 WL 6528609 (D. Md., Dec. 4, 2019), offers instructive guidance in answering that question. In the Maryland case, Dana Krysztofiak, a registered nurse, had to quit […]
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., […]
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 […]
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 […]
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 […]
Whether you’re still receiving long term disability benefits or are in the midst of an appeal, it is always a best practice to make sure the insurance company has all evidence that supports your claim. This includes evidence from your Social Security disability claim file. Overview Once you are approved for long-term disability benefits, your […]
What is a crime? Because accidental death policies exclude coverage if death occurs in the course of a commission of a crime, the question can be challenging as a recent decision by the 10th U.S. Circuit Court of Appeals illustrates. The ruling in Caldwell v Unum Life Insurance Company of America, 2019 WL 4463495 (10th […]
The subject of pre-emption under the Employee Retirement Income Security Act is challenging, as illustrated by multiple Supreme Court rulings that have attempted to address pre-emption issues. The general rule is that any state law which relates to employee benefit plans is pre-empted if the law conflicts with the administration of an ERISA claim. However, […]
Obtaining disability insurance is tricky. If you are purchasing coverage to supplement employer-supplied insurance or seeking insurance because you have no other coverage, there are a lot of variables to consider. It’s a sad fact, but many Americans give little thought to disability insurance coverage until it is needed. Understanding the following information will strengthen […]