ERISA Insurer’s Hiding Doctor’s Opinions Results in Appellate Win for Claimant

On December 11, 2019, the Ninth Circuit Court of Appeals (the federal appeals court with jurisdiction over Washington and other coastal and western states) decided Wagenstein v. Cigna Life Insurance Company. The decision is unpublished, meaning it is not binding on lower courts but may still be used as persuasive authority. Lea Wagenstein sued to challenge …

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Insurance Company’s Duty to Reasonably Investigate Claims Under Washington law

The Washington State Association for Justice recently published McKean Evans' article regarding insurers' duty to reasonably investigate claims. The article, entitled Insurance Company’s Duty to Reasonably Investigate Your Client’s Claim a Powerful Tool for Making Client Whole, discusses the legal basis for insurers' duty to reasonably investigate claims. Evans discusses how insurers' breach of this …

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Court Rejects ERISA Insurer’s Effort to Discredit Treating Physicians in Awarding Disability Benefits

A recent decision from federal court in Oregon is an interesting example of how ERISA disability benefit disputes can arise where the claimant suffers from complex and hard-to-diagnose conditions such as fibromyalgia. Since conditions like fibromyalgia defy easy identification, these cases often turn on the claimant's treating doctor's documentation of the claimant's symptoms. Jane Medefesser …

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Ninth Circuit Emphasizes Importance of ERISA Claims-Handling Regulation in Reversing LTD Benefit Denial

ERISA-governed disability benefit claims are subject to the Department of Labor's regulation requiring full and fair investigation of claims. The regulation includes rules requiring claims administrators apply plan provisions correctly and thoroughly investigate claims. A claims administrator's failure to adhere to the rules expressed in the regulation can be the difference-maker if the benefit dispute …

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Wildfires Making Insurance Coverage Hard to Get – California Expands State Coverage Fund

California recently announced new wildfire insurance rules that might be a glimpse into the future for Washington State homeowners having trouble getting insurance coverage in wildfire-prone parts of Washington. California's new rules help people who can no longer get homeowner's insurance coverage due to increased wildfire risk. The new rules expand a California state-run program …

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