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Insurance & ERISA Litigation Blog
Ninth Circuit Holds Tight to ERISA Interpretation Rule That Courts Will “Not Artificially Create Ambiguity Where None Exist”
In 1987 Robert Fier started working for the Boyd Group (“Boyd”) as a casino slot repairman. After a promotion to management, Fier subsequently enrolled into Boyd’s two benefits programs: a…
California’s Largest Health Insurers are Fined by California Department of Managed Health Care for Inadequate Claims Practices
In today’s Los Angeles Times Business Section, Duke Helfand writes about an 18-month investigation by the California Department of Managed Health Care into the payment practices of Aetna Inc.,…
Commissioner Poizner Releases Results of His Second Preferred Provider Organization Quality of Care Report Card (And it is Not Good)
Last week, Commissioner Poizner released the results of his second Preferred Provider Organization (“PPO”) quality of care report card. The results are not good news for consumers, and show that…
Court of Appeal Holds that Insurance Companies Are Not Required to Disclose the Lowest Premium They Would Accept But Reaffirms Insurers’ Duty to Disclose Material Facts as to Coverage
Understanding modern day insurance contracts is no easy task, even for experienced attorneys. The wording is dense and the language is often archaic and hard to comprehend. As a result,…
ERISA Claimant Retains Burden of Proof For Establishing Disability Under a De Novo Standard of Review
The question of who has the burden of proof can often decide the outcome of litigation. Given its importance, it is common to see litigants attempt to shift that burden…
Under ERISA , Procedural Deficiencies Not Considered When the Standard of Review is De Novo
Litigation pursuant to the Employee Retirement Income Security Act (“ERISA”) is rather unique. Unlike most cases, ERISA disputes are based on a limited scope of permissible evidence. The range of…
Governor Schwarzenegger Vetoes AB 1868 That Would Have Banned Discretionary Clauses in Group Insurance Policies
Today Governor Schwarzenegger vetoed AB 1868 that would have banned discretionary clauses in group insurance policies. This is a disappointment to consumer groups but not to insurers who rely on…
Certain Health Insurance Reforms Go Into Effect as of September 23
On September 23, 2010, the Patient Protection and Affordable Care Act, part of the recently enacted health care reform law, went into effect for insurance plans that begin on or…
Disability Policy Discretionary Clauses Come Under Congressional Attack
Policyholder/Employee groups who have group disability insurance coverage through their employers and who find themselves operating in the byzantine world of ERISA have long criticized discretionary clauses contained in such…
The Waiver Doctrine, Alive And Well in ERISA Cases
The Wednesday August 11, 2010 edition of the Los Angeles Daily Journal featured my article, entitled “The Waiver Doctrine, Alive And Well in ERISA Cases,” in the Perspective column. It explains a…
