ERISA

High court social security ruling’s implications for ERISA

by Mark Debofsky | May 5, 2021 | ERISA

It is a generally accepted tenet in litigation under the Employee Retirement Income Security Act that claimants challenging benefit denials must first exhaust prelitigation claim appeals as a condition precedent to filing suit. While an administrative exhaustion requirement applies to claim exhaustion, whether ERISA claimants are barred from raising new issues in court that were not previously asserted in their claim appeals remains open to question. […]

‘Crime’ ruling in car death highlights ERISA review standard

by Mark Debofsky | Apr 22, 2021 | ERISA

A recent ruling from the U.S. Court of Appeals for the Eighth Circuit involving accidental death insurance addressed the meaning of the word “crime” in a policy exclusion. […]

Court gives OK to discovery in case involving fibromyalgia claim

by Mark Debofsky | Apr 19, 2021 | ERISA

One of the most challenging aspects of litigating cases under ERISA is that unlike other civil cases, in ERISA litigation courts usually disallow discovery. The ostensible reason for denying discovery is that in many instances, the case is being resolved based on a review of a record. […]

How denial of autism care coverage can breach ERISA duty

by Mark Debofsky | Apr 8, 2021 | ERISA, Fiduciary Duties, Mental Health Parity, Vocational Issues

According to statistics compiled by the Centers for Disease Control and Prevention, about one in 54 children has been diagnosed with autism spectrum disorder, which is considered a developmental disability associated with social, communication and behavioral issues. Although there is no known cure for autism, children with autism may be helped with behavioral treatment such as applied behavioral analysis, or ABA, and early intensive behavioral intervention, or IBT, a subtype of ABA treatment. […]

Judge casts doubt over administrative exhaustion doctrine for ERISA claims

by Mark Debofsky | Mar 21, 2021 | ERISA

One of the major differences between insurance litigation in general and litigation of disputes involving health, life or disability insurance under the ERISA law is in relation to preconditions to bringing suit. Even though ERISA cases are not subject to administrative law, federal courts have incorporated the doctrine of administrative […]

Top ten things to look for in a disability benefit/ERISA lawyer

by Mark Debofsky | Mar 18, 2021 | Disability Benefits, ERISA

The following guide to hiring a lawyer is based on positive feedback we have received from our clients. These suggestions are based on our primary practice area but are mostly applicable any time you need to hire a disability lawyer. 1. Knowledgeable In hiring an ERISA lawyer, a potential client should know the lawyer they […]