Insurer’s Misreading of Policy Terms Results In Win For Policyholder

A cardinal principle of insurance law is that the fine print in an insurance policy must be interpreted consistent with the reasonable expectations of an ordinary person purchasing insurance. The Washington Court of Appeals recently emphasized that rule in its April 8, 2019 decision in Feenix Parkside LLC v. Berkley Nort Pacific.  In the Feenix the Court …

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Know Your Rights – Long Term Care Insurance

Many people have long term care insurance, especially when they get older, because the cost of prolonged individual care due to an injury or illness can be significant.  For that reason, Long Term Care insurance is often part of people's estate plan. Long Term Care insurance can be subject to problems because the premiums get …

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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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MetLife Pays Over $200 Million in Regulatory Investigation Over Pension Benefits

A common issue with life insurance benefits is a deceptively simple one: what if the beneficiary doesn't know that they are named in the life insurance policy?  In such cases, life insurers are typically obligated to advise the unknowing beneficiary of the insured's death and their entitlement to death benefits under the insurance policy.  But …

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