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Towers Watson risk transfer program aims to offload retiree health care risks

Last week, Towers Watson & Co. unveiled a program that would enable employers to eliminate unfunded retiree health care plan liabilities for Medicare-eligible retirees by shifting those liabilities to insurers through the purchase of group annuities.

Barger & Wolen partner Michael Newman told Business Insurance in its March 30th story about the program that retiree health care plan liabilities are a big issue for some employers.

“A lot of employers want to defuse those liabilities, but many will wait and see” for results before deciding, Mr. Newman said.

Under the program, employers would first have to adopt a defined contribution approach for health care coverage offered to Medicare-eligible retirees. Under that approach, employers agree to make a fixed contribution towards the premiums of health care plans available through Towers Watson's private exchange, with retirees picking up the difference between the credit provided by their employers and the cost of the plan they select.

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Lawsuits Over Health Exchange Premium Subsidies Challenge Heart of Reform Law

Royal Oakes was quoted in a Jan. 5th, 2014, Business Insurance article, Lawsuits Over Health Exchange Premium Subsidies Challenge Heart of Reform Law, by discussing a pair of lawsuits aimed at limiting availability of premium subsidies for health care coverage purchased through certain public exchanges.

In both cases, one filed in 2011 and another in May of 2013, the plaintiffs argue that the IRS decision to include the federal exchanges in the subsidy program improperly exposes employers in states that have declined to establish their own public exchanges to penalties from which they otherwise would have been shielded.

So far, Judges in both cases have denied the government's request for summary dismissal of the suits. Legal experts have warned that a ruling against the government would hinder the government’s ability to enforce minimum coverage requirements for employers and individuals in states that refuse to establish insurance exchanges and essentially, will cut-off access to subsidized coverage for lower-income, uninsured adults in those states.

When coupled with the enormous complication caused by the cancellation of millions of insurance policies, the subsidy issue has the potential to accomplish indirectly what the law's staunchest critics have hoped to accomplish in Congress, which is a repeal,” said Royal Oakes.


Californians Will Not Allow Health Insurers to Reinstate Coverage

By Peter Felsenfeld

More than a million California residents whose health plans were cancelled under the Affordable Care Act, a.k.a. Obamacare, will not be able to keep their existing coverage, despite President Obama’s directive that insurers keep such plans available for another year. The decision about whether to implement the president’s administrative “fix” rested with Covered California, the state’s new insurance exchange. The exchange’s board announced today that it would not allow insurers to revive plans that fell short of the ACA’s coverage mandates. Instead, California’s exchange will stay the course and continue to enroll residents into Obamacare.

Covered California made the best decision for consumers by supporting the success of our new health insurance marketplace,” said Patrick Johnston, President and CEO of the California Association of Health Plans. “Today’s decision comes with a renewed effort to ease the transition process for consumers in the form of a five-step action plan focusing on extending deadlines and increasing enrollment assistance.”

The decision will undoubtedly disappoint California residents who liked their previous coverage and had hoped they could keep their nonconforming plans for another year. The announcement also drew the consternation of state Insurance Commissioner Dave Jones, who previously expressed support for President Obama’s directive.

Covered California rejected what President Obama and I asked for – that individual policyholders be allowed to keep their existing health insurance through all of 2014. Covered California’s decision denies Californians the same opportunity health insurers are giving to its small business customers who are being allowed to renew current policies throughout 2014.”

The board’s decision, however, does not come as a surprise. Allowing nonconforming policies to continue for another year poses a risk to Obamacare’s financial viability as the move could prevent young, healthy individuals from participating in the new exchanges. A risk pool disproportionately made up of previously hard-to-insure participants could cause premiums to soar. We will watch the developments and keep you informed.

Originally posted to Barger & Wolen's Employment Law Observer

Health Insurance Premium Regulation Bid Draws Criticism

Barger & Wolen partners Richard De La Mora and Richard Hopkins were both quoted in a Nov. 14, 2013, Daily Journal article, Hospital insurance premium regulations bid draws criticism, about a proposed ballot initiative intended to regulate insurance premiums and how it could actually end up leading to narrower networks and fewer choices for consumers.

The ballot initiative proposes to give California's Insurance Commissioner Dave Jones the ability to regulate health insurers' premiums by expanding Proposition 103 to include health insurers. Passed in 1988, Proposition 103 currently applies to property and casualty insurers.

Some attorneys are concerned that in an effort to create more affordable healthcare, the initiative could lead to insurers having to leave the market and hospitals having to drop out of networks.

“Hospitals are constantly pushing for higher and higher [compensation],” De La Mora said.

De La Mora told the paper he was also concerned that the proposition would lead to a complicated process for determining how to best regulate the industry.

“When Prop. 103 [went] into effect, it took years to figure out what it meant, and the result was a formula” for rate regulation, he said.

Hopkins told the paper that plans on California's health exchange, which was developed in response to the passage of the federal Affordable Care Act, indicate that insurers have developed more tightly brokered relationships between themselves and providers.

“If everyone can buy insurance regardless of preexisting conditions [which Obamacare requires], you have to find a way of managing the cost of health care being provided,” including closer payer/provider arrangements, he said.


Court favors plain and ordinary meaning of policy terms when insured claims policy language is ambiguous

Two of Barger & Wolen's lawyers -- Martin Rosen and Ophir Johna -- received a victory from the Ninth Circuit Court of Appeal earlier this week in Glassman v. Crown Life Ins. Co., 2013 U.S. App. LEXIS 21312 (9th Cir. 2013). 

In Glassman, the plaintiff insured sued his disability insurer, Crown Life, claiming that while Crown Life had been paying his disability claim for well over two decades, it had failed to increase his benefits each year due to a cost of living adjustment rider that he had purchased with the policy. With well over 20 years of purported policy benefit increases at issue, the amount at stake exceeded $1.5 million.

Crown Life brought a motion to dismiss the action based on both policy interpretation and statute of limitation grounds. 

Although the United States District Court for the Central District of California (Judge Steven V. Wilson) permitted the insured to conduct discovery, the court eventually granted Crown Life's motion to dismiss. 

It ruled (as Crown Life had argued) that the language of the rider served to increase a potential residual disability benefit, but did not increase the amount of total disability benefits payable in any month. The insured appealed the district court's ruling. 

On appeal, the Ninth Circuit sided with Crown Life and affirmed the district court's ruling, finding that "The language of the Rider unambiguously applies only to partial or 'residual' disability benefits, rather than total disability benefits." Id. at *1-2.

The opinion, while unpublished, is a reminder to insureds and their lawyers that simply contending that policy language is ambiguous does not make it so, and that courts will construe policy language in its plain and ordinary meaning.

To listen to the Ninth Circuit arguments, click here.

Upcoming SCOTUS case could have wide implications for ERISA plans

Barger & Wolen partner Royal Oakes was interviewed by PLAN SPONSOR magazine on October 8, 2013, in regards to Heimeshoff v. Hartford Life & Accidental Insurance Co. High Court to Rule on Litigation Limitations Period.

The U.S. Supreme Court agreed to hear the case that could have far-reaching implications for litigation against Employee Retirement Income Security Act (ERISA)-covered plans.

In the case, Heimeshoff, a Walmart employee who submitted a claim for long-term disability benefits under her employer, argues that ERISA plans should not be allowed to impose a limitations period that begins before the claimant exhausts administrative remedies and is able to file suit, because doing so could allow the limitations period to waste away while the claimant is going through the plan's administrative review process.

Oakes told PLAN SPONSOR that the Supreme court will examine the extent to which any ERISA plan, including retirement plans, may specify a deadline to sue, and if it is subject to being protected by legal remedies or subject to being rewritten by courts. If the Supreme Court rules for Heimeshoff and upholds the idea of essentially rewriting plan terms simply because a claimant thinks they are unfair, it could open the door for much additional litigation against plans, he said.

Oakes argued the provisions of the plan in the case were unambiguous and agreed to by all parties. “If a claimant feels something is unfair because of administrative remedies and the duty to file suit, she has a right to use other legal doctrine,” he noted.

As an example, Oakes pointed to a doctrine called “equitable tolling,” which permits a policyholder to go to court and say the plan sponsor or insurance company is trying to enforce a statute of limitations in an unfair manner by being vague or compelling noncompliance. “There are other ways to protect claimants; it is not necessary to rewrite plan terms,” Oakes said, adding that use of other legal doctrines is a far less onerous remedy.

Oakes said the case is not about the ERISA statute of limitations. “If a law says you have this time to file, that is a statute of limitations; but if an insurance company has a deadline for filing litigation written in the plan terms, that is a contractual obligation,” he said.

“It’s a matter of common sense and fundamental fairness. When parties agree on plan terms and they are unambiguous, both sides are entitled to rely on those plain, straightforward terms being upheld,” Oakes contended. The law has safeguards against rewriting contracts, and claimants have other recourses when someone is under duress or the plan is wildly ambiguous, he concluded.

The Court is scheduled to hear the case on October 15, 2013. Barger & Wolen will continue to follow and update our readers as to the latest news.

More about the case and a link to DRI’s amicus brief is at

New Insurance Laws and Pending Legislation in California

By Samuel Sorich

The California Legislature ended its 2013 session on September 13, 2013. The Legislature passed a number of insurance-related bills during this year’s session. Some of the bills passed this year have already been signed into law; other passed bills are waiting action by Governor Jerry Brown.

Here are summaries of noteworthy new laws and bills being considered by Governor Brown.

New Laws

AB 584 requires admitted and nonadmitted insurance companies to regularly conduct an Own Risk and Solvency Assessment (ORSA) consistent with the NAIC’s ORSA Guidance Manual. Upon the request of the Insurance Commissioner, an insurer must submit an ORSA Summary Report to the Insurance Commissioner. AB 584 provides that the Report is not subject to public disclosure. An insurer that has an annual direct written premium of less than $500 million is exempt from the bill’s requirements however the Insurance Commissioner has the authority to require an exempt insurer to conduct an ORSA based on specified criteria. AB 584 becomes operative on January 1, 2015.

AB 1236 authorizes a licensed contractor organized as a limited liability company to obtain statutorily required liability insurance coverage from an eligible surplus line insurer. AB 1236 goes into effect on January 1, 2014. 

SB 146 has three elements. First, the bill provides that a copy of a prescription for workers’ compensation pharmaceutical services is not necessary unless the provider of services has entered into a written agreement that requires a copy of the prescription for a pharmacy service. Second, an employer, pharmacy benefit manager, insurer, or third-party claims administrator may request a copy of the prescription during a review of any records of prescription drugs dispensed by a pharmacy. Third, any entity that submits a pharmacy bill for payment, on or after January 1, 2013, and is denied payment for not including a copy of the prescription from the treating physician, has until March 31, 2014 to resubmit the bill for payment. SB 146 went into effect on August 19, 2013. 

Bills Being Considered by the Governor

Governor Brown has until October 13, 2013 to act on these bills.

AB 32 would increase the annual aggregate amount of qualified investments eligible for the existing Community Development Financial Institution tax credit from $10 million to $50 million. AB 32 would authorize the Insurance Commissioner to adopt emergency regulations to implement this credit against the insurance gross premium tax. AB 32 would require the Legislative Analyst’s Office, on or before June 30, 2016, to submit a report to the Legislature on the effectiveness of the tax credits allowed.  

AB 1113 would make changes to the provisional driver’s license program which applies to individuals between 16 and 18 years old. AB 1113 would require a person to hold an instructional driver’s permit for a minimum of nine months prior to applying for a provisional driver’s license (current law sets a minimum of six months), would prohibit a provisional licensee from driving between the hours of 10 p.m. and 5 a.m., with exceptions (current law sets the hours at 11 p.m. and 5 a.m.), and would prohibit a provisional licensee from transporting passengers who are under 21 years of age, with exceptions (current law applies the prohibition to passengers under 20 years of age).       

AB 1309 would limit access to the occupational disease and cumulative injury provisions of California’s workers’ compensation laws for professional athletes who are employed by out-of-state teams. 

AB 1371 would require the driver of a vehicle to provide a three-feet distance between the vehicle and a bicycle when passing.   

AB 1391 is the Department of Insurance’s omnibus bill which addresses a number of issues. Among other things, AB 1391 would repeal Insurance Code provisions which exempt risk retention groups from the Business Transacted with Producer Controlled Insurer Act, would modify statutory provisions relating to insurer risk-based capital reports to conform to NAIC model language, would amend statutory provisions relating to the exam waiver for licensees moving to California to conform to the NAIC Producer Licensing Model Act, and would specify in statute a three-hour ethics component for inclusion in the 24 hours of continuing education which agents and brokers must complete every two years. 

SB 36 would require the Department of Insurance to include on its website a dedicated web page that includes workers’ compensation data, statistics, and reports relating to insurers, including, but not limited to, claims loss data, expenses and financial reports. The Department would only use data already collected by both the Department and the Department of Industrial Relations.

SB 161 would establish required attachment points and exclusion prohibitions for stop-loss health insurance for small employers.

SB 251 would allow an insurer to offer its automobile, homeowners, earthquake, commercial and workers’ compensation insurance policyholders the option to receive renewal notices electronically. 

SB 353 would require health care service plans and insurers that advertise or market health insurance products in the individual or small group markets in a non-English language that is not a threshold language described in the Health and Safety Code or the Insurance Code to provide specified documents and communications in that non-English language. 

SB 476 would eliminate the sunset dates for the Auto Consumer Assessment, the Organized Automobile Fraud Activity Interdiction Assessment, and the Life and Annuity Consumer Protection Fund. The bill also would lower the maximum assessment for the Auto Consumer Assessment from $0.30 per vehicle to $0.25 per vehicle and would expand the application of Life and Annuity Consumer Protection Fund to include life insurance and annuity products valued at less than $15,000.  

SB 639 would codify certain provisions of the federal Affordable Care Act (ACA) and would allow a carrier, no more frequently than each calendar quarter, to establish an index rate for the small employer health insurance market based on the total combined claims cost for providing essential health benefits within the single risk pool required by the ACA.

Originally posted to Barger & Wolen's Insurance Litigation & Regulatory Law Blog.

Could Medpay Be The Latest Target In California Bad Faith Claims?

Marina Karvelas was quoted in a July 18, 2013, article published by Claims Journal, Could Medpay Be The Latest Target In California Bad Faith Claims, about a recent appeals court decision in California dealing with bad faith claims related to medical payments coverage.

The case, Justin Barnes v. Western Heritage Insurance Company, involved a plaintiff who was injured at 11 years old when a table fell on his back during a recreational program. A superior court found that the plaintiff could not sue the recreational program provider's insurance for bad faith for denying him coverage in part because the plaintiff had already settled a suit against the program provider. The appeals court reversed the trial court's decision.

Karvelas told the Claims Journal that she thought the decision could increase bad faith claims relating to medical payments coverage if the decision survives scrutiny by the California Supreme Court.

The Barnes decision muddies the waters on the collateral source rule which up until this decision was fairly clear in California,” she said. “An insurance policy taken out and maintained by the alleged wrongdoer, including its medpay provisions, is not wholly independent of him/her and thus cannot be considered to be a collateral source.

“Stated simply, the injured plaintiff cannot recover against the tortfeasor under the liability provisions of the tortfeasor’s insurance policy and then sue the insurance company under the medpay provision of that same policy. The Barnes court concluded differently. The medpay provision in a tortfeasor’s liability policy can be construed as a collateral source. As a third party beneficiary of the medpay provisions, all the injured plaintiff has to do is allege the insurance company committed a wrongful act against him/her when handling the medpay claim. In Barnes, Western Heritage allegedly failed to notify the injured plaintiff of the one-year time limit to present medpay claims. The alleged failure violated California’s regulations governing the fair settlement of claims,” Karvelas said. “The Barnes decision is problematic for insurers not only with respect to the collateral source rule but reflects an ever increasing effort by California’s plaintiff’s bar to create private rights of action for violation of the fair claims settlement regulations.”

Karvelas also told the publication that policy changes to medical payments coverage may be looming.

“It may behoove insurers to add provisions to their liability policies that the Barnes court found were missing in the policy at issue. These would include provisions that reflect an intent that payment under the liability provisions of the policy extinguishes the insurer’s obligation under the medpay provisions of that same policy,” Karvelas said.


Recent decision limits the protections from liability for ERISA pension plan fiduciaries

James Hazlehurst wrote an article published in The Daily Journal on June 12, 2013, that discussed the Ninth Circuit Court of Appeals ruling in Harris v. Amgen that limited the protections from liability for ERISA pension plan fiduciaries afforded by the “presumption of prudence” for investments in employer stock.

As Hazlehurst points out, the “presumption of prudence” developed out of the tension between the competing goals of protecting employee pension plan investments and providing loyalty incentives to employees. The prudent investor standard requires plan fiduciaries to diversify investments held by the plan. To allow for employee loyalty incentives through employer stock, Congress created an exception to the diversification requirement for investments in the stock of an employer. 

In Amgen, the Ninth Circuit expanded on a previous ruling, Quan v. Computer Sciences Corp., identifying circumstances under which the “presumption of prudence” does not apply. Hazlehurst notes that Amgen is important in defining the limits of the protections afforded by the “presumption of prudence.”

The case clarifies that a company is not protected from liability as a plan fiduciary unless the company exclusively delegates its investment authority under the plan and expressly disclaims that authority.

Without that delegation and disclaimer, Hazlehurst continues, the company may be liable for plan losses as a fiduciary.

Thus Amgen illustrates why companies should not only be concerned with running afoul of securities law for material misrepresentations and omissions in connection with the sale of their stock. Those same activities may expose the company to liability for pension plan losses where the company has not adequately delegated and disclaimed its investment authority under the plan and is not otherwise protected by the “presumption of prudence.”


Cigna Agrees to Re-evaluate and to Compensate Disability Insureds in the Amount of $77 million

In a wide ranging re-evaluation of disability claims covering its insureds in California, Connecticut, Maine, Massachusetts and Pennsylvania, Cigna Corporation may pay up to $77 million in past disability income insurance claims.  According to a statement by Cigna yesterday, "We are voluntarily agreeing to review an isolated subset of past long-term disability claims files from 2009 and 2010 (also from 2008 in California only) under updated standards,"(Law360, subs. req.).

In 2009, a market conduct action was initiated alleging certain Cigna companies may have violated federal and state insurance trade practices laws.  Cigna came up with a plan to resolve any disputes, and the parties -- which included the insurance departments of all five states listed above -- agreed to settle the market conduct action.  As part of its statement yesterday, Cigna clarified that the "regulatory settlement agreement grew out of a normal cycle of review by state regulators." 

As part of the remediation plan, Cigna agreed to:

  1. Establish an internal disability claim quality assessment team;
  2. Report on the reassessed claims involved in the remediation plan to all five insurance departments for a period of two years;
  3. Compensate the five states for costs incurred in the monitoring process;      
  4. Revise its policies to ensure compliance with Social Security Disability Income benefits laws, the selection of evaluation personnel, and the gathering of medical information; and
  5. Pay certain fines and administrative fees to the departments.

Barger & Wolen works with clients along all insurance lines on market-conduct exams and reviews before the California Department of Insurance.  For more information click here

Older Entries

April 1, 2013 — Supreme Court Directs Trial Courts To Look At The Merits In Determining Whether To Certify A Class

March 20, 2013 — Supreme Court Closes CAFA Loophole

February 15, 2013 — Representations Of Future Tax Treatment To Induce Creation Of Pension Plan Are Not Actionable As A Matter Of Law

January 23, 2013 — Trial Court Abuses Its Discretion by Forcing Insurer to Bear the Cost of Giving Notice to Putative Class Members

January 18, 2013 — Program for Definitive Disability Conference Set!

January 11, 2013 — Early Bird Registration for Definitive Disability Conference Expire on 1/31/2013

October 23, 2012 — Barger & Wolen Launches Disability Insurance Industry Conference

October 2, 2012 — More than 20 new insurance-related bills signed into law by Governor Brown

September 19, 2012 — Podcast: Impact of Recent California Legislation

September 12, 2012 — Administrative Law Judge Invalidates Fair Claims Settlement Practices Regulations by California Department of Insurance

August 24, 2012 — Update: California Health Insurance Initiative Will Be on the Ballot in November 2014

August 20, 2012 — Supreme Court Upholds Affordable Care Act, But Just Barely

August 16, 2012 — Abandoned Property: Complying with California's Unclaimed Property Laws

May 31, 2012 — Signatures Filed for California Health Insurance Initiative

May 7, 2012 — California Assembly Passes Bill Requiring Health Insurance Filing and Disclosures

April 4, 2012 — California Workers' Compensation Looms as a Major 2012 Legislative Issue

March 19, 2012 — Significant Insurance Bills Being Considered by California Legislature

February 27, 2012 — "Dismemberment by Severance" v. Loss of Use: A Smorgasbord of Interesting Disability Cases

February 6, 2012 — Life Insurer "Death Master" Investigation Leads to Multi-State Regulatory Settlement

January 9, 2012 — Signatures May Be Collected for California Health Insurance Initiative

January 5, 2012 — Burden of Proof: The "What Changed?" Argument from "A Smorgasbord of Interesting Disability Cases"

December 19, 2011 — Bad Faith: A Smorgasbord of Interesting Disability Cases

December 12, 2011 — Appropriate Care: A Smorgasbord of Interesting Disablity Cases

December 9, 2011 — A Smorgasbord of Interesting Disablity Cases: Accidental Bodily Injury

November 30, 2011 — A Smorgasbord of Interesting Disablity Cases: Accident v. Sickness

November 30, 2011 — A Smorgasbord of Interesting Disablity Cases: Abuse of Discretion / Objective Evidence of Disability

November 14, 2011 — Barger & Wolen's Life, Health, Disability Insurance Law Blog Named to The Insurance Law Community's Top Blogs for 2011

November 1, 2011 — U.S. News & World Report & Best Lawyers Names Barger & Wolen to Their Best Law Firms List

August 18, 2011 — Collateral Source Rule Inapplicable When Injured Person's Medical Expenses are Discounted by Health Insurer

June 15, 2011 — Former President of Association of California Insurance Companies Joins Barger & Wolen

February 25, 2011 — Commissioner Jones Responds to Federal Government Announcement of New State Grants for Health Insurance Rate Review

February 7, 2011 — Guidelines for Health Insurers Requesting Rate Increase Issued by California Insurance Commissioner (SB 1163)

October 6, 2010 — Liability Insurer Does Not Waive Right to Raise Misrepresentations in Application for Failing to Follow Internal Underwriting Guidelines

October 4, 2010 — 14th Annual Insurance Forum in Chicago Sponsored by Barger & Wolen

September 28, 2010 — Patient Protection and Affordable Care Act of 2009 Now in Effect

September 23, 2010 — Blue Shield Wins Summary Judgment in Rescission Case

September 17, 2010 — Barger & Wolen Receives First-Tier Ranking in the Inaugural "Best Law Firms" Survey by U.S.News and Best Lawyers®

August 19, 2010 — Barger & Wolen's Insurance Law Blogs Named to Top 50 Blogs by LexisNexis Insurance Law Community

August 9, 2010 — California Supreme Court Holds Treble Damages Not Permitted under the Unfair Competition Law - Restitution is the Sole Monetary Remedy

July 7, 2010 — Supreme Court Upholds San Francisco Health Care Plan Requiring Employer Contributions

July 6, 2010 — The Federal Insurance Office is on the Way

June 22, 2010 — Don't Miss the Barger & Wolen Presentations at the 2010 Western Claim Conference

May 26, 2010 — "Prevailing Party" Status Not Necessary for an ERISA Attorneys' Fees Award

May 18, 2010 — Barger & Wolen Updates the Book of Insurance Law

May 13, 2010 — Legislation to Cap Punitive Damages in California Defeated; Plaintiff's Lawyers Rejoice

April 29, 2010 — Court Refuses Requests to Depublish Decision Affirming Rescission of Health Insurance Policy

April 7, 2010 — Assembly's Insurance Committee to Hold Hearing Today on Legislation Voiding Discretionary Clauses in Disability and Life Insurance Policies

April 6, 2010 — Court Finds Triable Issue of Fact as to Rescission of Health Insurance, but Upholds Dismissal of Bad Faith and Punitive Damage Claims

March 25, 2010 — AB 2578: Proposition 103 Coming to Managed Health Care?

January 21, 2010 — California Court of Appeal Upholds Rescission of Health Insurance Policy

November 12, 2009 — United States' Amicus Brief Argues Medicare Act Preempts Statutory Consumer Protection and State Common Law Claims

October 26, 2009 — The U.S Supreme Court's Iqbal Opinion to Get Congressional Airing

October 21, 2009 — No More Gender Rating in California

October 21, 2009 — House Committee Votes to Strip Health Insurance Industry of Exemption from Federal Antitrust Laws

October 20, 2009 — Will Healthcare Reform Affect the Rate of Claim Denials?

September 28, 2009 — Council for Disability Awareness Follows Approvals of Disability Claims by the SSA and Private Disability Insurers

September 28, 2009 — Proposed Amendments to Health Care Reform Criticized By Insurance Industry

September 23, 2009 — An Insurance Agent Who Portrays Herself As Expert Owes a Heightened Duty of Care to the Insured

September 23, 2009 — Ninth Circuit Upholds Dismissal of Action Filed Twenty Days After Expiration of ERISA Plan's One-Year Contractual Limitations Period

September 16, 2009 — Ninth Circuit Clarifies Application of Abuse of Discretion Review When Insurer Has a Conflict of Interest

August 31, 2009 — Denial of Class Certification in Annuity Case Overruled Under a De Novo Standard of Review

August 26, 2009 — New Regulations Require Disclosure of Data Breaches

August 7, 2009 — ERISA-Governed Health Plan Excluding Coverage for Non-Contracted Providers Held to be Unambiguous

July 20, 2009 — No Special Treatment For "Top Hat" ERISA Plans In The Ninth Circuit

July 17, 2009 — Plan Participant Who Withdrew All Assets from Retirement Plan Still has Standing to Sue for Breach of Fiduciary Duty

July 2, 2009 — California Supreme Court Holds That Section 17200 Claims Must Comply With Class Action Requirements

June 24, 2009 — Golden Gate Restaurant Association Files Petition for Writ of Certiorari

June 18, 2009 — President Proposes National Insurance Office

June 3, 2009 — California Insurance Commissioner Unveils Proposed Rescission Regulations

June 2, 2009 — Dispute Between Securities' Brokers Not Subject to FINRA Arbitration

May 29, 2009 — Victory in Health Care Rescission Case

May 11, 2009 — Health Care Service Plan Not Liable for Provider's Failure to Diagnose Illness

April 26, 2009 — Welcome to Our Blog

April 23, 2009 — The Conundrum of Self-Reported Symptoms

April 16, 2009 — California Court Disallows Non-Party Spouse to Health Insurance Policy the Ability to Sue for Fraud

April 15, 2009 — Ninth Circuit Denies En Banc Review of Golden Gate Restaurant Association

April 3, 2009 — The Top Life, Health, Disability and ERISA Decisions of 2008

April 2, 2009 — U.S. Supreme Court Ends Long-Running Standoff With Oregon Supreme Court Over Punitive Damages

March 27, 2009 — Insurer Abused Discretion by not Considering Medical Report Created After Date of Disability

March 6, 2009 — No Abuse of Discretion Where Insurer Requires Objective Evidence

March 4, 2009 — California Supreme Court Hears Arguments Regarding Standing for UCL Class Actions

March 2, 2009 — The End of Discretionary Authority in Montana?

February 27, 2009 — Social Security Disability Backlog Delays Payments

February 20, 2009 — About Jenny H. Wang

February 19, 2009 — Geithner Says Federal Insurance Charter Is Important Part of Economic Plan

February 17, 2009 — California Insurance Commissioner Seeks Disability Insurance Changes

February 9, 2009 — Congress to Consider Optional Federal Charter for Life Insurers

February 7, 2009 — Commentator Takes Aim at Insurers Acting as Claims Administrators Under ERISA

February 1, 2009 — City of San Francisco Files Lawsuit Contending State Regulators Allow Discrimination Against Women

January 19, 2009 — NAIC Looks at Disability Insurance Best Practices

January 9, 2009 — When Compensatory Damages Are "Substantial," Third Circuit Adopts a 1:1 Punitive Damages Ratio

January 7, 2009 — Has The Age Of Billion-Dollar Verdicts Passed?

December 31, 2008 — ERISA Authorizes a Participant to Sue for Misconduct when it Impairs Plan Assets in Participant's Individual Account

December 28, 2008 — Claim Remanded To Claims Administrator Initially Terminated Before Providing Participant With Requested Plan Documents

December 28, 2008 — Exhaustion Of Administrative Remedies Not Required When Claimant Reasonably Relied On Administrator's Statement That He Was Not Required To Exhaust His Remedies Before Filing A Lawsuit

December 27, 2008 — No Abuse of Discretion Where Plan Fails to Consider Plaintiff's Salary in "Any Occ" Benefits Determination

December 26, 2008 — ERISA Preempts State Law Requiring That Insurer Reimburse Claimant for Copying Costs

December 24, 2008 — The Failure to Disclose Information to the Participant Justified an Increased Level of Scrutiny and the Court's Review of "New" Evidence Not Offered During The Claim

December 21, 2008 — Claimant Was Not Required to Exhaust Issues on Appeal

November 30, 2008 — Under Abatie, Discovery of Profitability Reports is Not Allowed

November 30, 2008 — Hearsay Exception Required for Certain Documents Outside the Administrative Record

November 29, 2008 — Structural Conflict Exists Even When Benefits Paid Out of a Trust

November 27, 2008 — It is an Abuse of Discretion to Ignore Contrary Evidence

November 26, 2008 — Abuse of Discretion to Rely on Employer's Accommodation that Materially Altered Participant's Job Duties

November 25, 2008 — City Ordinance Requiring Minimum Health Care Expenditures for Employees is Not Preempted by ERISA

November 22, 2008 — Structural Conflict of Interest Warrants Discovery of Statistical Information on Claims

November 21, 2008 — Participant Cannot Sue on Behalf of the Plan Without an Attorney