Health Benefits

Back to Insights

Health insurer’s three-word denial brings cold shoulder from 2nd Circuit

In Halo v. Yale Health Plan, 2016 WL 1426291 (2nd Cir., April 12, 2016), the 2nd U.S. Circuit Court of Appeals recently addressed whether an Employee Retirement Income Security Act-governed health insurance plan’s failure to issue a benefit determination compliant with federal claims-processing regulations should be penalized and, if so, how. The U.S. District Court […]

Ruling sheds light on reimbursement claims

Reimbursement claims that health insurance plans assert against personal-injury recoveries frustrate the plaintiffs’ bar and tie up the courts. A recent ruling from a federal court in Pennsylvania resolving the issues remaining following a Supreme Court remand is instructive in the manner it addressed some of the thorniest issues presented in such claims. In U.S. […]

U.S. Supreme Court tackles Vermont health plans

The American Benefits Council reports that 93 million Americans get their insurance from self-funded plans. These plans serve as an alternative to employers contracting with insurance companies that assume the risk. On March 1, the U.S. Supreme Court ruled that Vermont data collection law violates the U.S. Employee Retirement Security Act (ERISA). In a 6-2 […]

Quis custodiet ipsos custodes?

Quis custodiet ipsos custodes? -Juvenal, The Satires The translation of the title to this blog is “who watches the watchmen?”  That question needs to be asked in relation to a critical feature of the Affordable Care Act – the availability of independent external review of health benefit claim denials.  See, https://www.healthcare.gov/how-do-i-appeal-a-health-insurance-companys-decision/ The availability of an […]