Since the publication in 1943 of James M. Cain’s noir classic, “Double Indemnity,” there has been a public fascination with accidental death insurance. Surprisingly, even when a sudden and unexpected death occurs other than as a result of a heart attack or other clear-cut medical condition, the issue of whether the death was accidental or […]
Mark D. DeBofsky is a name partner of DeBofsky Sherman Casciari Reynolds P.C. — on the web at debofsky.com. He handles civil and appellate litigation involving employee benefits, disability insurance and other insurance claims and coverage issues. He can be reached at [email protected] Causation is always a key issue in accidental death insurance claims as a recent […]
Litigating health benefit claim denials is extremely challenging for plaintiffs. Especially under the Employee Retirement Income Security Act — where many cases are decided under the arbitrary and capricious standard of review that upholds an insurance claim denial so long as the basis for the claim decision is viewed as reasonable by a court —overturning […]
Mark D. DeBofsky is a name partner of DeBofsky Sherman Casciari Reynolds P.C. He handles civil and appellate litigation involving employee benefits, disability insurance and other insurance claims and coverage, and Social Security law. He can be reached at [email protected] A recent decision issued by the 7th U.S. Circuit Court of Appeals offers valuable insight […]
Purchasers of long term care insurance from MetLife who experienced a hike in premium rates may soon receive relief pursuant to a settlement agreement reached in the case Newman v. Metropolitan Life Ins. Co., No. 1:16-cv-03530 (N.D. Ill). The settlement follows a rare victory in the Seventh Circuit Court of Appeals for aggrieved long term […]
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 […]
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 […]
Disability claims are often denied, but you don’t have to give up. There are steps you can take following a denial of benefits. Many of us will, at some point in our lives, suffer an illness or injury that necessitates being out of work. We may need to recuperate from a sudden illness that left […]
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., […]