“BCBSTX moves to dismiss Count IV of the Complaint as it applies to it. BCBSTX contends that Count IV must be dismissed because the civil penalties available under ERISA for alleged failure to provide plan …
“As an independent, non-fiduciary, third-party administrator, Everest might still be liable . . . if the Geddesses had made claims against Everest individually, distinct from its role as United’s agent. But they did not. Nor …
The district court’s reliance on the Sixth Circuit’s decision in Wenner was misplaced, both because it is contrary to the law of this circuit and because that decision’s rationale is flawed. In Wenner, a claimant’s …
The make-whole rule provides that an insurer cannot enforce its subrogation rights unless and until the insured [i. e., Farie] has been made whole by any recovery, including any payments from the insurer.” Copeland Oaks …
Tenet alleges that it provided approximately $ 241,000 worth of medical services to Sylvester based on UniCare’s representation that Sylvester was covered under the Plan. . . . Pursuant to the Managed Care Agreement, UniCare …
What is data mining? Data mining has been described as process of extracting data from large databases of information in a manner that is meaningful to the extractor. What kind of information? Many different kinds.
Derived from these components, the Sixth Circuit has held that an ERISA fiduciary has a duty to “give complete and accurate information in response to participants’ questions.” Drennan v. Gen. Motors Corp., 977 F.2d 246, …
I have been reporting the highlights of the Ingenix database controversy which has been at the center of investigation by the New York Attorney General and several significant lawsuits. According to the allegations, the use …