Court Questions Insurer Behavioral Health Treatment Guidelines
A decision by the U.S. Court of Appeals for the Ninth Circuit questions an insurer’s behavioral health treatment guidelines.
Author: Mark Debofsky
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 […]
Speeding Triggers Crime Exclusion in Life Insurance Policy
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 […]
When ERISA Preempts State Laws for Employee Benefits
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, […]
Doctor’s Visit Without Treatment No Reason to Turn Down Benefits Erisa
The absence of medical treatment during a doctor’s visit does not necessarily mean a claimant is ineligible for benefits.