Fiduciary Duties

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A lesson in disgorgement

The Employee Retirement Income Security Act law creates a number of perverse incentives for insurers that administer benefit claims. Without the availability of remedies beyond the restoration of benefits due, insurers can earn significant profits on delayed payments. A recent 6th U.S. Circuit Court of Appeals ruling, Rochow v. Life Ins. Co. of North America, […]

Equity Provides a Way to Right a Wrong

If a health insurer mistakenly advises a patient that a surgical procedure is covered by its policy – and in reliance on that advice, the patient proceeds with the surgery, can the patient recoup the expenses incurred in undergoing the procedure from the insurance company if the insurer maintains that its prior advice was mistaken?