UnitedHealth ERISA ruling exposes faults in health coverage

The availability of health insurance coverage for treatment of mental health conditions recently took a huge step forward with the entry of judgment by the U.S. District Court for the Northern District of California in Wit v. United Behavioral Health.[1] After the issuance of a ruling in 2019 finding United Behavioral Health, or UBH — a UnitedHealth Group […]

ERISA ruling shows reluctance for disability claim remand

Employee Retirement Income Security Act civil procedure often departs in significant respects from the normal civil procedure utilized uniformly by federal courts in all civil actions in accordance with the Federal Rules of Civil Procedure. One aspect of ERISA civil procedure that is especially questionable despite its near-uniform acceptance by the federal judiciary is the […]

1st Circuit ERISA benefit ruling misapplies review standard

How should federal courts conduct a de novo review of Employee Retirement Income Security Act benefit claims? One approach was delineated by the U.S. Court of Appeals for the Seventh Circuit in 2009 in Krolnik v. Prudential Insurance Company of America.[1] There, the court pronounced the phrase “de novo review” as “misleading” and explained the de novo review standard […]

ERISA ruling shows daunting review standard for claimants

The most critical issue in Employee Retirement Income Security Act benefits litigation is the standard of judicial review applied by the courts. Under the deferential arbitrary and capricious standard of review, the court reviews a claim record compiled by the insurance company[1] to determine whether a claim denial was “downright unreasonable”[2] and not merely wrong. Because […]