Defining “Full and Fair” Review of Disability Benefits Claim
In order to ensure justice, the full and fair review process in disability benefits claims must be clearly defined.
Insurers Send Payments Directly to Patients Depriving Providers of Reimbursement for Services
America’s healthcare system is complex. Unlike single-payer systems that exist in virtually all other industrialized countries, the U.S. relies on private health insurers to cover healthcare costs, many of which are for-profit companies. The way health insurance typically works in the U.S. is that when a patient sees a doctor or goes to the hospital […]
Insurer’s Exclusion for Outdoor Mental Health Programs Rejected
One of the hottest current topics in Employee Retirement Income Security Act litigation concerns medical insurance coverage for residential treatment of behavioral health disorders. A recent Utah federal court ruling, Michael D. and Madeline D. v. Anthem Health Plans of Kentucky Inc., 2019 WL 586673 (D. Utah, Feb. 13, 2019), is a prime example. The […]
Disability Claims Denials: Next Steps
If you’ve been injured in an accident, diagnosed with an illness or had to deal with the prospect of a long recovery following surgery, you might need to be out of work to focus on your health. You could be worried more about the hit your finances will take during a work absence than your recovery. If you need time away from your job for a short-term or long-term disability, you may choose to file a claim with your disability insurer to make up some or all of the income you’ll lose.
Scope of ERISA and Occupation-Specific Disability
A new ruling from the 3rd U.S. Circuit Court of Appeals raises a number of interesting issues regarding the limits of coverage under the Employee Retirement Income Security Act as well as how occupation-specific disability is analyzed.
Federal Court Argues for Right to Jury to Pursue ERISA Claims
While it’s generally accepted that Employee Retirement Income Security Act benefit claimants are not entitled to jury trials, rarely does anyone question the reason why.