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Tag Archives: Health Insurance

Insurance Company Bias in ERISA Cases: Hartford’s History of Bias and Discovery of an Insurer’s Biased Claims Administration Process

Posted in: Abuse of Discretion, Conflict of Interest, Disability Insurance, Discovery, ERISA, Health Insurance, Insurance Litigation Blog, Life Insurance September 26, 2018

The Employee Retirement Income Security Act (“ERISA”), a 1974 federal law, sets minimum standards for many employee benefit plans and serves to provide protection for individuals in these plans.  Discovery in ERISA cases is often limited because the statute’s primary goal is to provide inexpensive and expeditious resolution to employee benefit claims.  District courts are generally limited to the administrative record unless a so-called structural conflict of interest exists.  Considering that insurers make benefit determinations on life, health and disability insurance claims and profit when an adverse decision is made, this scenario creates an inherent conflict of interest whenever an insurer administers a claim.

Courts find that a conflict of interest exists where the “entity that administers the plan, such …

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When Guarding the Henhouse, Some Foxes Go Rogue: When an Insurer’s Conflict of Interest Factors into Administrating Group Long-Term Disability ERISA Plans

Posted in: Abuse of Discretion, Accidental Death or Dismemberment, Conflict of Interest, Disability Insurance, Disability Insurance News, ERISA, Health Insurance, Insurance Litigation Blog, Life Insurance, News July 25, 2018

Few Americans can retire on their savings alone.  Many workers participate in an employee benefits plans, which serve to provide financial security in case of disability or retirement.  In the case of insurers that decide who qualifies for life, health and disability insurance benefits, there exists a major concern about the significant conflict of interest that exists when these insurers make these decisions and also pay for these benefits.  Will these insurers exalt their own interests of bottom line profitability over the interests of ERISA plan participants and beneficiaries who file claims for life, health and disability benefits? It is not a leap of logic that this conflict of interest results in insurance companies wrongfully denying ERISA benefit claims.

In

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Orange County Lawyer Publishes Article in July 2018 edition by Robert J. McKennon Entitled “Insurers’ Intermediaries: The Implications of Actions Taken by Agents, Employers, and Third-Party Administrators”

Posted in: Accidental Death or Dismemberment, Agent/Broker, Bad Faith, Disability Insurance, ERISA, Health Insurance, Legal Articles, Life Insurance July 13, 2018

In July 2018, The Orange County Bar Association published an article written by Robert J. McKennon and Stephanie L. Talavera of the McKennon Law Group PC in the Orange County Lawyer.  The article addresses the liability implications of the relationship between insurers and various types of intermediaries.  As the article explains, depending on the nature of the relationship between the insurer and others involved in the process, the insurer may be held liable for the actions of those who act as its intermediaries.  The article gives tips on how to make an insurer vicariously liable for the acts of those functioning as intermediaries in the insurance process.

Insurers’ Intermediaries: The Implications of Actions Taken by Agents, Employers and Third-Party Administrators

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Opportunistic Rescission: When Do Insurers Waive their Right to Rescind an Insurance Policy?

Posted in: Accidental Death or Dismemberment, Agent/Broker, Disability Insurance, Disability Insurance News, Health Insurance, Insurance Litigation Blog, Life Insurance, News, Waiver & Estoppel July 12, 2018

All too often, we see insurance companies deny insurance claims by attempting to opportunistically rescind insurance policies. This practice has become more prevalent in recent years as insurers look for ways to deny insurance claims.

Anyone who has purchased a disability, life or health insurance policy is likely familiar with the significant paperwork involved in the insurance application process. The paperwork includes policy notices, policy applications, supplemental policy applications, personal history questionnaires, policy warnings, medical examination documents, etc. These will include numerous and detailed questions relevant (and often not so relevant) to the risk being insured. An insurance agent or broker will ask questions on the policy application and often additional questions not on the application. Only after the applicant …

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Ninth Circuit Interprets the Health Parity Act in Favor of Insureds Seeking Health Insurance Benefits

Posted in: ERISA, Health Insurance, Insurance Litigation Blog, Legal Articles, News June 14, 2018

Insurance companies often attempt to provide different levels of benefits for the treatment of physical injuries and mental health issues in the same policy.  Mental health parity describes the equal treatment of mental health conditions and non-mental health conditions in insurance plans. When a plan or policy has parity, it means that if a covered person is provided unlimited doctor visits for a chronic condition like diabetes then that person must offer unlimited visits for a mental health condition, such as depression or schizophrenia.  Under federal law, health insurance plans must have parity in benefits.

The Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008, 29 U.S.C. § 1185a, requires that if a plan provides …

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Bad Faith Claims Handling: California Department of Insurance Investigates Aetna’s Health Claim Denials

Posted in: Bad Faith, Breach of Contract, Disability Insurance, Disability Insurance News, ERISA, Health Insurance, Insurance Bad Faith, Legal Articles February 21, 2018

On our blog, we frequently discuss the improper tactics insurers use to deny legitimate claims for life, health, disability and other forms of insurance. For our latest article on the pervasive problem in health insurance claims denials, see https://mslawllp.com/la-times-report-pervasive-problem-of-improper-health-insurance-denials/. Mckennon Law Group PC has had much experience litigating against health insurers who deny legitimate medical claims. We know this is a rampant problem. So, it was not shocking to us that at least one very large health insurer, Aetna, took highly improper actions to deny medical insurance claims.

On February 12, 2018, the California Department of Insurance (“CDI”) issued a press release confirming its investigation of Aetna, one of the largest health insurance providers in the U.S. California Insurance …

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LA Times Report: Pervasive Problem of Improper Health Insurance Denials

Posted in: Disability Insurance News, Health Insurance, Legal Articles February 03, 2018

After using a diabetes insulin pump for nine years, David Lazarus suddenly received a denial letter from his insurer, Blue Cross Blue Shield of Illinois. The denial letter notified Lazarus that his employer’s health plan would no longer cover the cost of his diabetes insulin pump. He was now responsible for the cost of the pump: $8,703. The reason cited for his insurer’s sudden change of heart? Lack of medical necessity. His medical insurance claim was denied.

An insurer may deny a medical insurance claim before or after the medical service sought to be covered, either through the denial of preauthorization requests or denial of claims for payment after the medical service is provided. Some insurers require preauthorization requests before …

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U.S. Supreme Court Upholds Church Plan ERISA Exemption

Posted in: Bad Faith, Benefits, Breach of Contract, Church Plans, Disability Insurance, ERISA, Government Plans, Insurance Litigation Blog, Insurance Questions and Concepts June 09, 2017

The Employment Retirement Income Security Act of 1974, otherwise known as ERISA, protects employees from unanticipated losses in retirement or pension plans.  As we have discussed in several articles on the topic, ERISA safeguards such plans by establishing strict protections and requirements on the administration of most employer-sponsored health, disability, life, retirement and other employee benefits plans.  However, ERISA does not govern all employer-sponsored benefit plans.  In general, ERISA carves out exemptions for those plans established or maintained by a government or church entity.

Just a few days ago, in Advocate Health Care Network v. Stapleton, the United States Supreme Court determined a significant question affecting pension plans run by church-affiliated hospitals.  As we predicted months ago, the …

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Plaintiff Recovers $750,000 Based on Plan Administrator’s Breach of Fiduciary Duty

Posted in: Bad Faith, Benefits, Church Plans, Disability Insurance News, ERISA, Government Plans, Insurance Litigation Blog, Insurance Questions and Concepts May 23, 2017

The McKennon Law Group PC periodically publishes articles on its Insurance Litigation and Disability Insurance News blogs that deal with frequently asked questions in insurance bad faith, life insurance, long-term disability insurance, annuities, accidental death insurance, ERISA and other areas of law.   To speak with a highly skilled Los Angeles long-term disability insurance lawyer at the McKennon Law Group PC, call (949)387-9595 for a free consultation or go to our website at www.mckennonlawgroup.com and complete our free consultation form today. 

In some instances, ERISA plan participants may be able to “continue” or “convert” their employer-sponsored long-term disability, life, medical or other insurance policy even after they no longer work for their employer.  This ability to convert to an individual policy …

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When the Price is Right: Types of Attorneys’ Fee Arrangements For Handling Long-Term Disability ERISA Claims

Posted in: Bad Faith, Benefits, Church Plans, Disability Insurance, Disability Insurance News, ERISA, Government Plans, Insurance Bad Faith, Insurance Litigation Blog, Insurance Questions and Concepts May 04, 2017

The McKennon Law Group PC periodically publishes articles on its Insurance Litigation and Disability Insurance News blogs that deal with frequently asked questions in insurance bad faith, life insurance, long term disability insurance, annuities, accidental death insurance, ERISA and other areas of law.  To speak with a highly skilled Los Angeles long-term disability insurance lawyer at the McKennon Law Group PC, call (949)387-9595 for a free consultation or go to our website at www.mckennonlawgroup.com and complete our free consultation form today.

Long-term disability insurance may be the most important type of insurance policy one can buy.  In the unfortunate event that an unexpected disability prevents you from working, long-term disability insurance provides a substitute income in your time of need.  …

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