Court Emphasizes Importance of Making Insurance Claims Promptly in ERISA Disability Dispute

A recent decision from our neighbors in the Portland, Oregon federal courts emphasizes that insurance policyholders should always strive to submit claims as soon as possible - especially where the insurance policy is covered by ERISA. Often, it's not practical to submit insurance claims as soon as the loss occurs.  When your house burns down, …

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Does ERISA Apply to COBRA Coverage?

ERISA applies to most insurance obtained through an employer. "COBRA" coverage is insurance coverage you get after your employment ends.  So it's understandable if you assume that COBRA coverage isn't ERISA-governed. Surprisingly, many courts have held that ERISA governs COBRA coverage after all. ERISA generally applies to any insurance procured by an employer for the …

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UnitedHealth Unlawfully Denied Mental Health Treatment, Judge Finds

One of the ways in which ERISA protects insureds is by imposing a fiduciary duty on certain decision makers, requiring that decisions about coverage and benefits be made in the best interests of the plan participants and not in the best interests of an insurer's profits.  A recent federal court ruling highlights the importance of …

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Can the Insurance Company Retroactively Deny Your Claim On A New Basis After You File A Lawsuit?

Let's say you make an insurance claim, and the insurance company denies the claim for reason A.  You think they're wrong, so you take them to court and argue reason A is invalid and the company should have paid your claim.  In response, the insurance company admits reason A didn't apply but now argues your …

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Aetna Settles Wrongful Depression Treatment Denial Allegations

On February 15, 2019, Aetna Inc. announced a settlement of allegations Aetna wrongfully denied mental health treatment.  The plaintiff and a group of Aetna insureds had filed a class action lawsuit under ERISA alleging Aetna wrongfully denied health insurance for a specific treatment for major depression called Transcranial Magnetic Stimulation ("TMS"). The lawsuit alleges Aetna …

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