Requesting that a Plan Administrator Reconsider a Denial of Benefits May Preserve the Right to Sue

Posted in: Disability Insurance News, Insurance Blog January 20, 2016

Exchanging correspondence with a plan administrator requesting reconsideration of a denial may preserve the right to sue by extending contractual time limitations and demonstrating that the pursuit of administrative remedies would be futile.  The United States District Court Southern District of California determined that the date of an initial claim denial did not trigger a pension plan’s two-year time limitations clause, since the language within the clause indicated that resolution of the claim, rather than awareness of the claim, is the triggering event.  Watkins v. Citigroup Retirement Systems, No. 15-CV-731 DMS (NLS), 2015 WL 9581838 (S.D. Cal. Dec. 30, 2015). The Court also declined to dismiss the plaintiff’s complaint for failing to exhaust administrative remedies due to the defendant’s persistent restatement of its position in response to Plaintiff’s repeated requests for reconsideration. Id.

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Hanging on the Past: What to Remember About the Abuse of Discretion Standard of Review as it Applies to ERISA Cases

Posted in: Disability Insurance News, Insurance Blog January 08, 2016

Although we recently explained that policies offered, issued, delivered, or renewed on or after January 1, 2012 are afforded de novo review as a result of California Insurance Code section 10110.6 (see The Death of the Abuse of Discretion Standard of Review in ERISA Disability Insurance Cases in California), a recent ERISA case helps to remind us that older ERISA plans, which vest discretion in plan administrators and claim administrators, remain subject to the more lenient abuse of discretion standard of review.  Accordingly, it remains critical to understand how courts review a plan administrator’s decision to deny benefits under this standard of review.

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Department of Labor Proposes New, Claimant-Friendly ERISA Regulations for Disability Insurance Claims

Posted in: Disability Insurance News, ERISA, Health Insurance, News, News Blog December 10, 2015

From time to time, the U.S. Department of Labor promulgates new regulations governing disability insurance benefit claims and health insurance benefit claims that are governed by the Employee Retirement Income Security Act of 1974, commonly referred to as ERISA.  The regulations must be followed by plan administrators and claim administrators when reviewing disability insurance and health insurance benefit claims submitted by claimants.  Recently, the Department of Labor proposed changes to the regulations governing long-term disability insurance benefit claims and short-term disability insurance benefit claims.

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Robert McKennon and Joe McMillen Publish Article: “When is Insurer’s Delay a Breach?”

Posted in: Insurance Blog December 02, 2015

The November 27, 2015 edition of the Los Angeles Daily Journal features an article written by Robert McKennon and Joseph McMillen of the McKennon Law Group entitled: “When is Insurer’s Delay a Breach?.”  In the article, Mr. McKennon and Mr. McMillen discuss an important decision from the U.S. District Court for the Northern District of California, Travelers Indem. Co. of Connecticut v. Centex Homes, 11-CV-03638-SC (N.D. Cal., filed Oct. 8, 2015) in which the court wrestled with the issue of how much delay is too much before an insurer crosses the line and breaches its defense duty.  In other words:  What is the point at which an insurer’s delay in defending amounts to a breach of its duty to defend?

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Mistreated by Your Insurer? Insurers May Not Be Able to Hide Behind ERISA Preemption to Defeat Claims for Intentional Infliction of Emotional Distress

Posted in: Breach of Contract, Disability Insurance, Disability Insurance News, ERISA, Health Insurance, Insurance Blog, Life Insurance, News, Preemption November 30, 2015

Insureds obligingly pay premiums on their life, health and disability insurance policies and dutifully provide updated information upon request by their insurers, but often do not enjoy the same courtesy when they file an insurance claim.  In extreme cases, antagonistic insurers engage in a host of tactics, including appointing claims examiners who refuse to return phone calls, conducting intrusive surveillance, accusing insureds of filing false claims or inundating the insured’s employer and treating doctors with document demands—only to deny the insured’s claim.  Astonished by this treatment, many insureds wonder if they can sue them for emotional distress damages.  The short answer is yes—but there are hurdles.

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Robert McKennon and Joe McMillen Publish Article: “Supreme Court Ramps Up Interest in ERISA”

Posted in: Insurance Blog November 10, 2015

The November 6, 2015 edition of the Los Angeles Daily Journal features an article written by Robert McKennon and Joseph McMillen of the McKennon Law Group entitled: “Supreme Court Ramps UpInterest in ERISA.” In the article, Mr. McKennon and Mr. McMillen discuss five important United States Supreme Court cases involving litigation over employee life, health and disability benefit claims governed by the Employee Retirement Income Security Act of 1974. It discusses these cases and explains that the High Court has: (1) relaxed the standard for an employee to recover his attorney fees; (2) allowed discovery previously not permitted; (3) significantly expanded employee remedies; (4) determined plan language controls benefit reimbursement claims; and (5) confirmed an employer’s right to choose plan terms limiting the time to file a lawsuit.

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AB 387 Grants California Department of Insurance New Powers to Protect Disability Insurance Consumers

Posted in: Disability Insurance News, Insurance Blog, Insurance Commissioner, Long Term Care Insurance, News October 14, 2015

Short-term disability insurance and long-term disability insurance policies provide insurance benefits to consumers who are unable to continue working due to injury or sickness.  Such coverage can be offered as a benefit of employment by an employer (in which case, the policy is usually governed by a federal law called the Employee Retirement Income Security Act of 1974 or ERISA) or can be purchased by the individual insured.

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With Discretionary Language Even Barred in Self-Funded ERISA Plans, is This the Death of The Abuse of Discretion Standard of Review In California?

Posted in: Abuse of Discretion, De Novo Review, Disability Insurance News, ERISA, Standard of Review October 12, 2015

Recently, we explained that District Courts within the state of California, applying California Insurance Code section 10110.6, ruled that, even if an insurance Plan contains language giving discretion to a claim administrator, that language is unenforceable, and de novo is the proper standard of review.  See The Death of the Abuse of Discretion Standard of Review in ERISA Disability Insurance Cases in CaliforniaA recent ruling expanded the application of California’s anti-discretionary language statute to self-funded plans, further signaling the end of the abuse of discretion standard of review in California Federal Courts.

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