Life, Health, Disability & ERISA Archives - Page 4 of 10

September 16, 2014 Life, Health, Disability & ERISA

Cigna Has Continued its Battle for Coverage of ERISA Class Action

Cigna has continued its fight for coverage again urging the Pennsylvania Superior Court to overturn a decision that let its excess insurers off the hook over an ERISA class action brought by the company’s employees. The dispute centers on changes to the benefit plan, which U.S. District Judge Janet Arterton’s 2012 decision found had been fraudulently altered. Cigna argues that this finding does not qualify as a fact finding, and that the fraud exemption was inaccurately applied.

Cigna’s argument has been that the finding relied …

September 8, 2014 Life, Health, Disability & ERISA

D.C. Court Agrees to Hear Halbig En Banc

On September 4, 2014, the U.S. Court of Appeals for the D.C. Circuit granted the U.S. Government’s petition to re-hear Halbig v. Burwell en banc which means that all active judges on the court will now hear the case.

For a more detailed explanation of the general arguments in Halbig, click here. However, in short, the question is whether the subsidies provided for by the Affordable Care Act for those who purchase health insurance through the exchanges apply to purchases from any exchange or …

August 28, 2014 Life, Health, Disability & ERISA

Health Care Providers Ordered to Pay Insurer $8.4M for Billing Fraud

Three health care providers were forced to pay a judgment for defrauding an insurance company of millions of dollars. A Texas Federal Judge found that the defendant health care providers were wrongfully posing as emergency rooms in order to bill the insurance company at higher rates, in violation of Texas law.

The judge stated that a hospital sold the right to use its license-derived billing codes to various clinics in exchange for 15 percent of each of the clinics’ bills. The clinics then used these …

August 27, 2014 Life, Health, Disability & ERISA

Obama Administration Files Proposed Rules on ACA Preventative Services Coverage–Seeks Input on Logistics

The Obama Administration has filed an Interim Final Rule seeking input on the logistics of obtaining an accommodation and in defining eligible organizations with respect to coverage for preventative services under the ACA.

The new interim final regulations establish another option for an eligible organization to avail itself of the accommodation. Under the IFR, an eligible organization may notify the Department of HHS in writing of its religious objection to contraception coverage. HHS will then notify the insurer for an insured health plan, or the …

August 15, 2014 Life, Health, Disability & ERISA

GAO Issues “Health” Reports

The Government Accountability Office (GAO) has recently issued two important reports discussing important aspects of the roll-out of the federal exchange and cost-effective preventive measures in U.S. healthcare.

The first report, published on July 30, 2014, examines the problematic roll-out of Healthcare.gov. In this report, entitled “HEALTHCARE.GOV – Ineffective Planning and Oversight Practices Underscore the Need for Improved Contract Management,” GAO noted that the Centers for Medicare & Medicaid Services (CMS) made several critical mistakes in the development of Healthcare.gov. Among other things, CMS …

August 5, 2014 Life, Health, Disability & ERISA

Obama Administration Seeking Full D.C. Circuit Rehearing to Address Obamacare Circuit Split; Plaintiffs in Fourth Circuit Seek Cert from Supreme Court

On Friday, August 1, the Obama Administration filed its much anticipatedpetition for rehearing en banc with the D.C. Circuit in Halbig v. Burwell. The petition asks for the full D.C. Circuit bench to reconsider and overturn the original ruling by the three judge panel based on a what the Administration has characterized as a misconstruction of the statutory language at issue.

The D.C. Circuit’s three judge panel determined that the Affordable Care Act provision permitting subsidies unambiguously restricts its applicability only to state-based …

July 2, 2014 Life, Health, Disability & ERISA

Second Circuit: ERISA Claims Raise Reasonable Possibility of Negligence, Trigger Duty to Defend Under EBL Coverage

The plaintiff’s complaint in the underlying action alleged that she had been sexually harassed by a senior executive of the insured and that, when she confronted him about his conduct, she had been wrongfully terminated and coerced into accepting an independent contractor position that disqualified her from receiving certain employee benefits. The insured tendered the defense of the underlying action to the CGL carrier who disclaimed coverage. The underlying action was subsequently settled and the insured then filed a declaratory judgment action seeking defense and …

April 2, 2014 Life, Health, Disability & ERISA

First Circuit: Statute Of Limitations Does Not Apply Separately For Each LTD Benefit Payment

In a recent ERISA disability benefits case, the First Circuit answered the following questions involving a claim for the underpayment of monthly benefits: 1) when does the underpayment claim accrue?; and 2) does each new monthly underpayment give rise to a new claim?

In this case, the LTD claim was approved, but the insurer denied the claimant’s assertion that the benefits amount was inaccurate. Ordinarily, a cause of action for ERISA benefits accrues when a fiduciary denies a participant benefits. In this case, benefits were …

January 15, 2014 Life, Health, Disability & ERISA

West Virginia Hands Down Victory to Life Insurers in 69 Death Master File Actions

From September 30, 2012 to December 28, 2012, the plaintiff, John D. Perdue, Treasurer of the State of West Virginia filed sixty-nine (69) individual civil lawsuits against life insurance companies doing business in the State of West Virginia alleging that the insurers have failed to comply with the requirements of the West Virginia Uniform Unclaimed Property Act (UPA), i.e., that they have failed to turn over unclaimed property to the State Treasurer. The complaints further alleged that the Insurers had breached their statutory duties of …