On December 1, 2014, the U.S. Court of Appeals heard oral argument in the case of Mary C. Fontaine v. Metropolitan Life Insurance Company. The issue before the court was whether an Illinois insurance regulation banning discretionary clauses in health and disability insurance policies survives ERISA preemption claims. The lower court ruled in Fontaine’s favor.
The oral argument may be heard at
The Employee Retirement Income Security Act judicial standard of review applied by a court in a denial-of-benefits claim is often the decisive factor in determining the outcome of the litigation. A July 2 ruling from the U.S....
Under the best of circumstances, plaintiffs face a difficult challenge when they seek to overturn health benefit claim denials. But recent developments in litigation involving health benefits — specifically benefits for mental health treatment — have sent a message to health insurers that they need to be more transparent in adjudicating claims. […]
Acting in response to consumer complaints about surprise medical bills, Congress enacted a law known as the No Surprises Act,[1] which went into effect on Jan. 1, 2022.[2] The law’s intent was to prevent surprise billing by requiring nonnetwork health providers to provide patients with an advanced explanation of benefits containing a good faith estimate of anticipated charges. […]
The Employee Retirement Income Security Act (ERISA) is a landmark piece of legislation enacted in 1974 to safeguard the interests of employees who participate in retirement and health benefit plans offered by their employers. ERISA sets standards for these plans, ensuring transparency, fiduciary responsibility, and fairness in their administration. […]
Although mental health parity claims have been proliferating in federal courts for more than a decade, it wasn't until last year that a federal appeals court laid out pleading standards for mental health parity cases.[1] Another appellate decision has now joined the...
Many U.S. citizens and foreign nationals working abroad find themselves navigating the complex landscape of long-term disability (LTD) benefits. But does the ERISA law apply to U.S. residents living abroad or to non-U.S. residents living outside the United States? […]