One of the most important aspects of the Affordable Care Act, or Obamacare as it is commonly known, is the right to seek independent review of a health benefit denial. The notion of an independent review of an insurance company’s decision may seem to be a fair and objective way to resolve a dispute over […]
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 […]
A new court ruling is the first to recognize a fiduciary breach claim against a health insurer when misinformation given by its representative cost an employee his benefits.
The U.S. Supreme Court recently issued a significant ruling on the rights of health benefit plans to recoup payments out of personal-injury settlements. U.S. Airways Inc. v. McCutchen, 2013 U.S.LEXIS 3156 (April 16, 2013) involved James McCutchen, an employee of US Airways and a participant in that organization’s health benefits plan, who was severely injured […]
During the U.S. Supreme Court’s upcoming term, the court is scheduled to hear the case of U.S. Airways v. McCutchen, 663 F.3d 671 (3d Cir. 2011), which was the subject of an earlier article of mine (“McCutchen may influence other court decisions,” Nov. 25, 2011). McCutchen will address the complex question of whether equitable principles […]
The recent 3rd U.S. Circuit Court of Appeals ruling in U.S. Airways, Inc. v. McCutchen, 2011 U.S.App.LEXIS 22883 (3d Cir. Nov. 16, 2011) dealt with the question of whether the equitable doctrine of unjust enrichment could be used to mitigate an ERISA benefit plan’s claim for reimbursement. McCutchen involved a claim brought by a medical […]