Why Do I Have to File a Lawsuit?When an ERISA long-term disability appeal gets denied, the next step is, potentially, to file a lawsuit in federal district court. Some clients already know that they would like to settle their case and ask, why can’t we just negotiate a lump sum settlement with the insurance carrier? […]
The United States Department of Education recently announced it would forgive the student debt of more than 300,000 disabled borrowers. Could this impact your long-term disability benefits?The topic this pertains to is offsets (amounts that can be subtracted). Insurance carriers are allowed to take offsets from their claimants’ benefits. The “Other Income” provision of your […]
Your ERISA Watch – What a Difference Discretion MakesMayer v. Ringler Assocs. Inc., No. 20-1281, __, F.4th __, 2021 WL 3556473 (2d Cir. Aug. 12, 2021) (Before Circuit Judges Walker, Sack, and Menashi).This week’s notable decision demonstrates the uphill battle ERISA claimants face in litigation with insurers over their employee benefits, particularly where courts apply […]
Pension “de-risking” sounds like a fancy term for protecting participants’ interests in their benefits. In other words, take the risk out of pension benefits. Well, not quite. Not even close.Pension de-risking is a scheme to benefit employers who sponsor pension plans. It refers to ways in which the employer can reduce its own risk that […]
Our firm is involved in litigating a proton beam cancer treatment denial case in Georgia, Ghattas v. Blue Cross Blue Shield Health Care Plan of Georgia, Inc., Case No. 1:20-CV-03157-ELR, 2020 WL 6867155 (N.D. Ga. Nov. 18, 2020). Defendants Blue Cross Blue Shield Health Care Plan of Georgia (BCBSGA) answered Plaintiff Christopher Ghattas’ Complaint alleging […]
Kantor & Kantor’s health team recently scored another victory in a matter involving the denial of residential treatment.In Doe v. Blue Cross Blue Shield of Illinois, No. CV-19-05044-PHX-SMB, __F.Supp.3d__, 2020 WL 5891723 (D. Ariz. Oct. 5, 2020), Jane Doe was a dependent beneficiary of an ERISA-governed health plan insured and administered by Defendant Blue Cross […]
As many healthcare providers have experienced, anti-assignment provisions in ERISA health plans can be a full stop to recovering unpaid claims. In good news, the Ninth Circuit Court of Appeals recently decided Martin Luther King, Jr. Community Hospital v. Community Insurance Company dba Anthem Blue Cross Blue Shield, et al., No. 19-55053, __F.App’x__, 2020 WL […]
The Supreme Court handed down a victory on February 26, 2020, to employees whose pension, healthcare, or other benefit plans were mismanaged. Under ERISA, the federal law that governs such plans, those who manage or administer such plans are considered fiduciaries bound by strict standards that require them to act with great care and in […]
The Supreme Court heard arguments yesterday, November 6, 2019, in Retirement Plans Committee of IBM v. Jander, an ERISA case challenging the prudence of fiduciary decisions with respect to an employee stock ownership plan (ESOP). The Court granted certiorari to review whether the Second Circuit correctly applied the Court’s “more harm than good” standard set […]
As we continue to learn about efforts to challenge proton therapy denials by groups such as the Proton Therapy Law Coalition, the fundamental question becomes: Will the insurers actually get the message and change their ways? A recent article suggests that even when a jury awards a large punitive damages figure against a health insurer, […]
