Articles

High Court Social Security Ruling’s Implications for ERISA

by Mark Debofsky | May 5, 2021 | ERISA

It is a generally accepted tenet in litigation under the Employee Retirement Income Security Act that claimants challenging benefit denials must first exhaust prelitigation claim appeals as a condition precedent to filing suit. While an administrative exhaustion requirement applies to claim exhaustion, whether ERISA claimants are barred from raising new issues in court that were not previously asserted in their claim appeals remains open to question. […]

What Should I Expect When I File a Disability Insurance Claim?

by Mark Debofsky | Apr 28, 2021 | Disability Benefits

What Should I Expect to Happen When I File a Disability Insurance Claim. Filing a disability insurance claim is stressful but having an understanding of the course of a claim and knowing what to expect can help relieve that stress […]

‘Crime’ Ruling in Car Death Highlights ERISA Review Standard

by Mark Debofsky | Apr 22, 2021 | ERISA

A recent ruling from the U.S. Court of Appeals for the Eighth Circuit involving accidental death insurance addressed the meaning of the word “crime” in a policy exclusion. […]

When to Hire a Health Insurance Claim Denial Lawyer

by Matthew Maloney | Apr 22, 2021 | Health Benefits

Navigating a denial of your private health insurance claim at a time when your focus is on receiving the medical care you need can seem like an uphill battle with your insurance company. Healthcare claims are often complex. It is important to consult with a lawyer who focuses on health insurance claims and possesses the expertise and knowledge to get your claim approved and prevent you from being stuck with a medical bill that your health insurer should pay. […]

Court Gives OK to Discovery in Case Involving Fibromyalgia Claim

by Mark Debofsky | Apr 19, 2021 | ERISA

One of the most challenging aspects of litigating cases under ERISA is that unlike other civil cases, in ERISA litigation courts usually disallow discovery. The ostensible reason for denying discovery is that in many instances, the case is being resolved based on a review of a record. […]

How Denial of Autism Care Coverage Can Breach ERISA Duty

by Mark Debofsky | Apr 8, 2021 | ERISA, Fiduciary Duties, Health Benefits, Mental Health Parity

According to statistics compiled by the Centers for Disease Control and Prevention, about one in 54 children has been diagnosed with autism spectrum disorder, which is considered a developmental disability associated with social, communication and behavioral issues. Although there is no known cure for autism, children with autism may be helped with behavioral treatment such as applied behavioral analysis, or ABA, and early intensive behavioral intervention, or IBT, a subtype of ABA treatment. […]

What Are the Reasons Why Life Insurance Payments Are Denied?

by Mark Debofsky | Mar 29, 2021 | Life Insurance

Life insurance seems like a no-brainer. If you buy life insurance and die, your beneficiary receives a payout, right?  Not necessarily. There can be several reasons why life insurance is not paid. All policies contain an exclusion that would preclude payment or state grounds that can cause coverage to lapse […]

How Long Does It Take to Get Approved for Long-Term Disability Benefits?

by William Reynolds | Mar 26, 2021 | Disability Benefits, Long Term Disability

The timeline from application to a decision on a long-term disability claim is generally set by the terms of the plan itself. But disability policies that are governed by the Employee Retirement Income Security Act of 1974 (ERISA) must adhere to the Department of Labor’s ERISA claims regulations, which include timelines for issuing a decision […]

What Is Accidental Death Insurance?

by Mark Debofsky | Mar 24, 2021 | Accidental Death

Accidental death insurance, also known as accidental death & dismemberment (AD&D) insurance, is a type of insurance that supplements basic life insurance coverage. AD&D insurance pays benefits in addition to life insurance if the insured dies as a result of an accident or suffers a catastrophic injury that results in limb amputation or loss of […]

Judge Casts Doubt Over Administrative Exhaustion Doctrine for ERISA Claims

by Mark Debofsky | Mar 21, 2021 | ERISA

One of the major differences between insurance litigation in general and litigation of disputes involving health, life or disability insurance under the ERISA law is in relation to preconditions to bringing suit. Even though ERISA cases are not subject to administrative law, federal courts have incorporated the doctrine of administrative […]

Can I Qualify for Disability Benefits Due to COVID-19?

by Mark Debofsky | Mar 16, 2021 | COVID-19, Short Term Disability

The COVID-19 pandemic which began in early 2020 has caused over 500,000 deaths in the United States by March 2021, along with over 28 million cases of infection. For most individuals who have contracted COVID-19, the symptoms they have experienced have been relatively mild, but a huge number of COVID patients have required […]

How Ambiguity Can Expand Employee Insurance Coverage

by Mark Debofsky | Mar 16, 2021 | ERISA Standard of Review, Long Term Disability

What is contra proferentem? Carlile v. Reliance Standard Life Insurance Co.[1] is a textbook illustration of the doctrine that construes ambiguities in insurance policies in favor of the insured and against the insurer. In February, the U.S. Court of Appeals for the Tenth Circuit affirmed a ruling by the U.S. District Court for the District […]