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Insurance & ERISA Litigation Blog
California to Announce New Rules for HMO Members
On Wednesday, the California Department of Managed Health Care (“CDMH”) is scheduled to roll out new regulations that limit HMO members’ wait times for an appointment with a physician or…
House Committee Votes to Strip Health Insurance Industry of Exemption from Federal Antitrust Laws
As reported by the Associated Press, a House committee has voted to strip the health insurance industry of its exemption from federal antitrust laws as senators announced plans to take the…
No More Gender Rating in California
The practice of paying different rates based on gender for the same insurance is called gender rating. Effective January 1, 2010, health insurance companies and HMO’s writing insurance in California will…
District Court Applies Abuse of Discretion Standard of Review After Montour
Recently, in Montour v. Harford Life & Accident, 582 F.3d 933 (9th Cir. 2009), the Ninth Circuit Court of Appeals, in one of its most important cases, adopted a new…
ERISA Authorizes Breach of Fiduciary Duty Action for Misconduct When it Impairs Plan Assets in Participant’s Individual Account
Can a plan participant sue for breach of fiduciary duty when his individual account is diminished by a failure of the administrator to follow his investment instructions? The U.S. Supreme…
“Top Hat” ERISA Plans Are Not Entitled To Special Treatment
The Ninth Circuit recently addressed, for the first time, whether the standard of review analysis for “top hat”ERISA plans is the same as for other ERISA plans. InSznewajs v. U.S….
Ninth Circuit Clarifies Application of Abuse of Discretion Review When Insurer Has a Conflict of Interest
After the United States Supreme Court decided MetLife Ins. Co. v. Glenn in which the Court held that a reviewing court must consider the conflict of interest arising from the…
Under Abatie, Discovery of Profitability Reports is Not Allowed
One of the most interesting questions in ERISA litigation is: What constitutes the administrative record for purposes of determining whether the administrator abused its discretion in making a claim determination? …
Health Care Provider Claims Against Employer Not Preempted by ERISA
In Marin General Hospital v. Modesto & Empire Traction Co., 581 F.3d 941 (9th Cir. 2009), the Ninth Circuit Court of Appeals held that section 502(a)(1)(B) of ERISA did not…
Will Healthcare Reform Affect the Rate of Claim Denials?
On Monday October 19, 2009, Lisa Girion of the Los Angeles Times reported on the healthcare reform bills being debated in Congress and their potential impact on claim denials by…
