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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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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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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Four Common Disability Insurance Provisions and Why They Matter

As with most insurance cases, disputes over disability insurance coverage or benefits frequently turn on the specific insurance policy language at issue.  Insurance policy fine print can often be read in ways that are counterintuitive.  Below are four common policy provisions that are often key to the outcome of disability insurance disputes. 1.     The Definition …

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