Supreme Court Upholds Affordable Care Act, But Just Barely

Barger & Wolen partner John LeBlanc and summer associate Natalie Ferrall wrote an article published in the Westlaw Journal – Insurance Coverage on Aug. 10, 2012, about the Supreme Court's closely watched ruling on healthcare reform and how the court found its controversial individual mandate to be constitutional.

In their article, LeBlanc and Ferrall note that the court focused on two key provisions of the Patient Protection and Affordable Care Act: the individual mandate, requiring most Americans to have insurance coverage; and the Medicaid expansion requirement which, had the court not struck it down, would have required states to meet certain federal requirements to receive funding. The article provided legal context and background on the Affordable Care Act and discussed how the court came to the conclusion that the law was “mostly constitutional.”

“In doing so, the court emphasized that its role was not to address the soundness of federal policy, but rather to interpret the law and enforce limits on federal power,” LeBlanc and Ferrall wrote.

Please click on the link to download the PDF: Supreme Court Upholds Affordable Care Act, But Just Barely.

The Conundrum of Self-Reported Symptoms

The Defense Research Institute’s For the Defense has published an article by Jerel C. Dawson entitled “The Conundrum of Self-Reported Symptoms.”  This article addresses some of the issues surrounding self-reported symptoms in ERISA disability cases.  Mr. Dawson’s expert discussion talks about objective medical evidence of fibromyalgia, chronic fatigue syndrome and judicial acceptance of subjective complaints.  “The Conundrum of Self-Reported Symptoms” provides an excellent overview of the relevant issues for ERISA attorneys facing claims of self-reported symptoms.  

Republished with Permission Here

About the Author:

Jerel C. Dawson is a Partner at Shutts & Bowen LLP
1500 Miami Center, 201 South Biscayne Boulevard | Miami, FL 33131
Phone: 305-358-6300

 

 

The Top Life, Health, Disability and ERISA Decisions of 2008

The annual meeting of the Defense Research Institute took place on October 22, 2008 in New Orleans, Louisiana. Presented at the meeting was this article titled, “The Top Life, Health, Disability and ERISA Decisions of 2008.”   Written by three prominent defense attorneys, this article highlights some of the most influential decisions from 2008.

The article, available here, was authored by:

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No Abuse of Discretion Where Insurer Requires Objective Evidence

Salomaa v. Honda Long Term Disability Plan, 542 F. Supp. 2d 1068 (C.D. Cal. 2008).

An insurer denied the ERISA plan participant’s disability claim, in part, because he failed to support his claimed disability from CFS with “objective test results.”  During the participant’s initial appeal of his LTD benefits, his attorney asked the insurer if there were any tests the participant should undergo in order to help establish his disability.  The participant’s attorney did not receive a response and yet the insurer, citing a lack of medical documentation that Plaintiff was afflicted by CFS or that he was unable to perform the duties of his occupation, denied his claim. 

After explaining that a factor tending to show a potential conflict of interest is the failure to engage in meaningful dialogue during the review process, the court found that decision to deny benefits due to the absence of objective test data while opting not the request a SPECT scan was an indication of “evasiveness during the review process, and a conflict of interest.”  Nevertheless, noting the distinction between a medical condition and the effect of that condition on an employee's ability to perform occupational duties is well established, the court “affirm[ed] a plan administrator's right to require objective evidence that employees are totally disabled by the medical condition which afflicts them, regardless the condition at issue.”

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