The Supreme Court will hear a case questioning the timeline for ERISA cases involving a fiduciary’s duty to monitor investments. SCOTUS, or the Supreme Court of the United States, has agreed to hear a case that questions the extent of an employer’s fiduciary duty to monitor the ERISA plans they sponsor. ERISA, or the Employee […]
Fiduciary DutiesBack to Insights
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, […]
Can an employee’s obligation to provide evidence of insurability to secure life insurance be excused by the doctrine of incontestability or by an ERISA claim for breach of fiduciary duty?
A recent life insurance case involving the issue of incontestability caught our attention. Patterson v. Reliance Standard Life Ins.Co., 2013 U.S.Dist.LEXIS 171873 (C.D.Cal. December 4, 2013)(Issue: Incontestability). This case involved life insurance – the plaintiff’s sister was an employee of Redlands Community Hospital who was offered the opportunity to purchase $260,000 in voluntary group life […]
Killian v. Concert Health Plan, 2013 U.S.App.LEXIS 22657 (7th Cir. November 6, 2013). Most private insurance plans require pre-certification before hospital admissions; and a major cost-savings method used by insurers is to negotiate rates with “preferred” providers. The utilization of a preferred provider network encourages plan participants to utilize the services of the preferred providers […]
In Krase v. Life Ins.Co. of North America, 11 C 7659, 2013 U.S.Dist.LEXIS 100302 (N.D.Ill. July 18, 2013), Judge John Grady upheld DeBofsky Law’s challenge to an insurer’s assertion of attorney-client privilege over emails generated by an in-house attorney during the course of administering an appeal of the denial of a life insurance claim. The […]
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? […]