‘Crime’ Ruling in Car Death Highlights ERISA Review Standard
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
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
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
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 […]
New ERISA Ruling May Cut Claimants’ Timeliness Guesswork
What is the statute of limitations for filing a lawsuit in relation to benefit claim under the Employee Retirement Income Security Act? It’s a trick question because the ERISA statute does not prescribe a statute of limitations for claims seeking recovery of benefits under Section 502(a)(1)(B) of the act.[1] Consequently, in determining the […]
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 […]