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Court of Appeal Complicates the Analysis of Mental and Nervous Disability Claims
Bosetti v. The United States Life Ins. Co., 175 Cal. App. 4th 1208 (2009) is an important California Court of Appeal decision that addressed whether a two-year benefits limitation on…
Second Circuit Holds Delayed Discovery Rule Applies to Unfair Competition Claims
Recently, in Broberg v. The Guardian Life Insurance Company of America, 171 Cal. App. 4th 912 (2009), the Court of Appeal held that the “delayed discovery” rule, which applies to…
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? …
Council for Disability Awareness Follows Approvals of Disability Claims by the SSA and Private Disability Insurers
Allison Bell of the National Underwriter reported on September 11, 2009 that approved disability claims rose more quickly in 2008 at the Social Security Disability Insurance program than at private…
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…
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…
