Although the Supreme Court’s ruling in United States v. Windsor, 133 S.Ct. 2675 (2013), invalidated Section 3 of the federal Defense of Marriage Act (DOMA) that stipulated a marriage may only be between one man and one woman, the ruling left unresolved a number of critical issues.
Although the Employee Retirement Income Security Act (ERISA) clearly delineates the parties who have standing to sue to redress a claimed wrongful benefit denial (employee benefit plan participants and beneficiaries – 29 U.S.C. Section 1132(a)(1)(B)), the statute is silent as to whether insurers that both underwrite and fund employer-sponsored benefits such as disability or health […]
Click Here Despite the applicability of the arbitrary and capricious standard of review, the court granted in substantial part the plaintiff’s motion to compel discovery. Although the court acknowledged that in the Seventh Circuit, the scope of a court’s review of an ERISA benefit denial under a deferential standard of review is limited to the “administrative” […]
Following market conduct investigations performed by the insurance departments of the States of California, Maine, and several other jurisdictions, in May 2013, the CIGNA companies that administer long-term disability insurance benefits (Life Insurance Company of North America, Connecticut General Life Insurance Company, CIGNA Life and Health Insurance Company, and other affiliated companies) entered into a […]
On July 26, 2013, the U.S. Court of Appeals for the Seventh Circuit issued a ruling in Larson v. United Healthcare Insur.Co., No. 12-1256 click here permitting ERISA plaintiffs to sue insurance companies that underwrite and are responsible for paying benefits when claims are asserted that benefits have been wrongfully denied. This ruling marks a […]
A decision by a federal court has expanded the scope of discovery available in ERISA cases. In Williams v. FedEx Corp. Servs., Inc., No. 19 C 5706, 2021 WL 2854244 (N.D. Ill. July 8, 2021), the plaintiff sought to depose a plan administrator, but the defendant argued that the administrator was not a proper deponent because he was not involved in the initial denial of the claim. The court ultimately allowed the deposition, ruling that the administrator had information relevant to the plaintiff’s claim.
DeBofsky & Associates recently won a ruling on the fiduciary exception to attorney-client privilege in an ERISA case.
DeBofsky & Associates recently obtained a favorable court ruling on the standard of review
It is typical that group disability insurance policies limit the duration of disability payments for psychiatric conditions. However, in Reid v. Metropolitan Life Ins. Co., 2013 U.S.Dist.LEXIS 66755 (N.D.Ga. March 29, 2013), an insurer’s reliance on reviewing doctors to evaluate a claim failed to convince a court that the limitation was applicable in the face […]
DeBofsky & Associates recently won a significant court ruling on the ERISA standard of review.
Despite advances in medical science, many medical conditions such as tinnitus – a ringing or buzzing in the ears that afflicts millions of Americans – cannot be objectively diagnosed or verified. The case of Miles v. Principal Life Ins.Co., 2013 U.S.App.LEXIS 13065 (2nd Cir. June 26, 2013), which involved a partner in a major law […]
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?