Those diagnosed with cancer are fighting many battles. They not only have to deal with their health, but they also have to deal with paying for healthcare. Cancer patents rely on their health insurance to provide coverage for effective healthcare. Unfortunately, some insurance carriers sidestep their responsibilities when it comes to patient care for those […]
The recent case of Gooden v. Unum Life Ins. Co. of Am., 2016 WL 3059752 (E.D. Tenn. March 30, 2016) involved a familiar scenario – whether a “list bill” arrangement constitutes an ERISA plan.
Claims for employee benefits brought under the Employee Retirement Income Security Act are subject to very strict rules regarding time limits for deciding claims. However, neither the ERISA statute, nor the claim regulations found at 29 C.F.R. Section 2560.503-1 prescribe specific penalties for violating the rules.
DeBofsky, Sherman & Casciari attorneys Mark DeBofsky and Martina Sherman recently won the case of Wonsowski v. United of Omaha Life Ins. Co., 2016 WL 3088141 (N.D. Ill. June 2, 2016) following a bench trial before Magistrate Judge Geraldine Soat Brown in the federal court in Chicago. The case involved Shellie Wonsowski, who had worked […]
Many disability insurance policies require a showing of an inability to perform each and every regular job duty. Does that mean you can’t be considered disabled if you are unable to perform some but not all of the required job duties? In most jurisdictions, the answer is yes – you need not prove an inability […]
In reviewing disability determinations, a number of problematic issues appear with relative frequency. The recently issued ruling in Groth v. Centurylink Disability Plan, 2016 WL 1621724 (S.D. Ohio, April 25, 2016), contains a potpourri of such issues. Plaintiff Stacie Groth claimed she was disabled due to lumbar degenerative disk disease, fibromyalgia, depression and anxiety. Despite […]
When you purchase a long-term care insurance policy, you are buying peace of mind. You know that the cost of various assisted-care living options range from expensive to astronomical. Even if you have a reasonably large portfolio of assets, and potentially could afford to the monthly costs of an assisted living or nursing home, you […]
A recent report by the Centers for Disease Control found that Hepatitis C-related deaths are at an all-time high in the United States. As reported by the Washington Post, the report found that more Americans die from the disease than from 60 other infectious diseases combined. Approximately 3.5 million Americans are thought to have the disease, although many may be unaware due to the initial slow and silent damage it inflicts upon the liver.
Because federal courts generally consider the scope of their review of an ERISA benefit denial as being limited to review of a record, what happens if significant material evidence such as a Social Security determination becomes available only after the claim appeals are exhausted. If the standard of judicial review is arbitrary and capricious, it […]
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 […]
The scope of pre-emption of state laws under the Employee Retirement Income Security Act (ERISA) is so broad that it generally precludes recovery of any damages or remedies beyond the limited remedies enumerated in 29 U.S.C. Section 1132(a). Thus, the availability of any recompense in a denial of benefits case beyond the benefits claimed, plus […]
A recent ruling from the U.S. Court of Appeals for the Sixth Circuit, Zuke v. American Airlines, Inc., 2016 WL 1258220 (6th Cir. March 31, 2016)(unpublished), was extremely critical of an insurer’s termination of disability payments that had been ongoing for thirteen years due to the claimant’s severe degenerative arthritis of the claimant’s entire spine.