Articles

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

Back to Insights

Accidental death ruling highlights flaw in ERISA deference

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 […]

Behavioral health ruling supports benefit claim appeals

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 […]

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., […]

Get the Help You Need

Whether this is your first filing or you need an appeal, we'll review your case, and work with you to get it resolved in your favor. It's your money. Let's get you justice.

Contact Us