Undeterred by a federal court’s recent ruling striking down most of a Department of Labor (DOL) regulation that allowed small employers and sole proprietors to band together to form association healthcare plans (AHP), DOL is giving top priority to finalizing a rule that will do much the same thing on the pension side.The proposed pension […]
The Supreme Court agreed Monday, June 10, 2019, to resolve a conflict between the Ninth Circuit and the Sixth Circuit on when ERISA’s three-year statute of limitations begins to run. The statute provides that a fiduciary breach claim may be brought within six years of a breach unless the plaintiff had “actual knowledge” of the […]
In recent years, UnitedHealth Group has ramped up its practice of recovering supposed overpayments to medical providers on claims of plan participants in one healthcare plan by offsetting these “overpayments” against (and therefore often totally disallowing) payments on the claims of participants in an unrelated plan.Keep in mind that the participants in the plans normally […]
In an intensely litigated ESOP (employee stock ownership plan) case involving 14 counts of ERISA violations, on April 22, 2019, Judge Staton, District Judge, Central District of California, certified a class of ESOP participants.The certification came after the court denied the Defendants’ motions to dismiss all 14 counts. The case, as a whole, has many […]
We Have Achieved Tier 1 Ranking in Insurance LawAt Kantor & Kantor, LLP, we are proud to announce that we have recently been named in the latest edition of “Best Law Firms,” a publication of Best Lawyers® and U.S. News & World Report. We were regionally ranked in Tier 1 in insurance law, compared with […]
Making sense of your insurance denial can be very tedious, overwhelming, and stressful — and even more so when you do not understand the “language.” Sifting through confusing legalese (and what seems to be bizarre and unreasonable logic from insurance companies) can make advocating for your health feel unmanageable. Not only are you fighting for […]
There are countless barriers and obstacles to beginning and completing an eating disorder recovery journey. For some, the recovery process can be a constant and unfinished work. A continuous motion. A conscious effort. Our friend and colleague Shannon Cutts spoke on this concept beautifully, “If we want to win the war against Ed, we need […]
1. They utilize internal guidelines. Many insurances companies will make decisions based upon their own internal guidelines. They will deny or approve claims for eating disorder treatment, or deny a specific level of treatment, without providing transparency for how these decisions are being made. For a clear and simple description of what insurers should be […]
It is your right to know who denied your insurance claim.Unfortunately, insurance companies often do not explain who is making the decision to your claim. For example, Anthem Blue Cross of California’s denial letters reference a “medical reviewer” although the letter is signed by an Anthem Medical Director. It can be unclear whether it was […]
The Court of Appeals for the Ninth Circuit has issued a published decision in Pacific Shores Hospital v. United Behavioral Health, et al., an ERISA case in which a severely anorexic 43-year old woman sought benefits under her Wells Fargo employee health benefit plan for inpatient psychiatric treatment.At her admission to Pacific Shores Hospital, the […]
