Disabled NFL Players Face the Same ERISA Hurdles as Everyday Workers: Plans that Use Biased Physicians and that Deny Disability Claims without a Fair and Full Review

National Football League (“NFL”) players are covered by an employer-sponsored long-term disability (“LTD”) policy called the Bert Bell/Pete Rozelle NFL Player Retirement Plan (“Plan”).  This NFL Plan, like most employer long-term disability plans, is governed by ERISA.  Therefore, disabled NFL players face many of the same evidential challenges as company-bound employees when filing a claim …

Read moreDisabled NFL Players Face the Same ERISA Hurdles as Everyday Workers: Plans that Use Biased Physicians and that Deny Disability Claims without a Fair and Full Review

Court Rules Insurers Cannot Hide Behind Biased Expert Consultants to Dispose of Bad Faith Claims

Insurance companies owe a duty of good faith and fair dealing to the persons they insure. This duty is often referred to as the “implied covenant of good faith and fair dealing” which automatically exists by law in every insurance contract. They often defend “bad faith” litigation by invoking a what is known as the …

Read moreCourt Rules Insurers Cannot Hide Behind Biased Expert Consultants to Dispose of Bad Faith Claims

When Can a Disability Claimant Obtain Discovery in an ERISA Suit When the De Novo Review Standard Applies?

When it Goes to the Bias of an Insurer’s Consultants, that’s When a claimant who challenges a denial of disability or life insurance benefits by filing a court action under ERISA is generally not able to present evidence to the court that is not in the administrative record. The administrative record consists of all the …

Read moreWhen Can a Disability Claimant Obtain Discovery in an ERISA Suit When the De Novo Review Standard Applies?

Court Rejects Third Party Administrator’s Demurrer to Insurance Bad Faith Claim Based on Plaintiffs’ Theory of Joint Venture Liability

Implied in every insurance contract is a promise of “good faith and fair dealing,” which means that the insurer must not take unreasonable steps to prevent an insured’s right to receive benefits under the policy. To comply with its promise to act in good faith, the insurer must adhere to certain duties, such as the …

Read moreCourt Rejects Third Party Administrator’s Demurrer to Insurance Bad Faith Claim Based on Plaintiffs’ Theory of Joint Venture Liability

9th Circuit puts final nail in coffin for discretionary clauses in insurer-funded ERISA plans

Disability and life insurers frequently include clauses in their insurance policies affording them complete discretion to decide whether a claim has merit.  The clauses usually state the insurer has total discretion to decide whether the claimant is eligible for the policy’s benefits, to decide the amount, if any, of benefits to which they are entitled, …

Read more9th Circuit puts final nail in coffin for discretionary clauses in insurer-funded ERISA plans

Life Insurer on the Hook for Breaching Terminated Contract

Life, health and disability insurers, whether governed by ERISA or state insurance bad faith laws, often do not have your best interests in mind, despite what the law requires of them.  Insurers, like other businesses, are motivated by profits.  Sometimes that drive leads to crossing legal, ethical or moral lines to improve the bottom-line.  That …

Read moreLife Insurer on the Hook for Breaching Terminated Contract

Good News for Policyholders: The Insurance Commissioner has Broad Authority to Regulate Insurers

We all know that insurance companies are good at trying to find any way possible to deny claims, whether they be long-term disability claims, life insurance claims, health insurance claims or homeowner’s claims. To curtail their ability to do so, the Legislature enacted the Unfair Insurance Practices Act (“UIPA”) to regulate unfair or deceptive acts …

Read moreGood News for Policyholders: The Insurance Commissioner has Broad Authority to Regulate Insurers

Insureds May Still Have a Claim for Insurance Bad Faith Even If Their Insurer Offered to Pay the Policy Limits

Under California law, an insurer has an obligation to, among other things, make reasonable efforts to settle a third party’s lawsuit against an insured.  As a recent decision rendered by the California Court of Appeals illustrates, “reasonable efforts” entail more than timely offering the policy limit to settle a claim from a third party.  The …

Read moreInsureds May Still Have a Claim for Insurance Bad Faith Even If Their Insurer Offered to Pay the Policy Limits

Have “Quack” Medical Reviewers Caused Denial of Your Long-Term Disability Claim? California Court of Appeal Berates Insurance Company for Controlling Medical Peer Reviews

During their Presidential election campaigns, Donald Trump and Hillary Clinton spotlighted for America flaws in our criminal justice system.  They raised questions about whether the criminal probe into Ms. Clinton’s private email server was handled honestly or politically.  Conservatives bitterly complained that FBI director Jim Comey’s recommendation not to prosecute Ms. Clinton was inconsistent with …

Read moreHave “Quack” Medical Reviewers Caused Denial of Your Long-Term Disability Claim? California Court of Appeal Berates Insurance Company for Controlling Medical Peer Reviews

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