: : Power of Attorney May Supply Standing for Health Care Providers Despite Anti-Assignment Clause

“Although the Court recognizes the POA was not executed under circumstances discussed by the Circuit, the Circuit did not limit the use of a POA solely to those circumstances. To the contrary, the Third Circuit …

: : DOL & NY AG Investigation Leads To $15.6M Settlement of Alleged Improper Claims Denials

The EBSA annouced a settlement of alleged Mental Health Parity and Addiction Equity Act violations in the following news release: NEW YORK – United Behavioral Health and United Healthcare Insurance Co. will pay $13.6 million to …

: : Attorney’s Letter Insufficient To Serve As Request for Administrative Review

“Plaintiff’s attorney’s letter to Lincoln makes no mention of a breach of fiduciary duty claim against Defendant nor does it request administrative review of that claim. Rather, the letter accuses Lincoln of wrongfully denying coverage …

: : Does A Grant of Power of Attorney To A Health Care Provider Confer Standing?

“In 2018, the Third Circuit held in American Orthopedic & Sports Medicine v. Independence Blue Cross Blue Shield, that “anti-assignment clauses in ERISA-governed health insurance plans as a general matter are enforceable.” 890 F.3d 445, …

: : Plan Prevails On Participant’s Challenge to Recoupment By Administrative Offset Of Benefit Payments

The Court is obliged to dismiss this action because Plaintiff has ultimately pleaded himself out of court. . . . Notably, Defendant has not pleaded that Plaintiff, in seeking to recoup and recouping the overpayments, …

: : GAO Report Offers Insights Into EBSA Investigations & Enforcement Activities

“EBSA regional offices conduct investigations of retirement and health plans to detect and correct violations of Title I of ERISA and related criminal laws. EBSA investigators identified 4,273 violations in the 1,411 investigations closed in …

: : Seventh Circuit Uses “Dual Hat” Versus “Single Hat” Analysis To Decide State Law Preemption Issues

“The exclusive benefit rule is a cornerstone of ERISA that state law cannot dilute. While ERISA narrowly contemplates parallel liability against the dual-hat director and officer defendants, it preempts further aiding and abetting liability that …

: : District Court Grants Over $200,000 In Attorneys’ Fees And Costs Against UNUM In Disability Case

In any action brought by a plan participant, beneficiary, or fiduciary under ERISA, “the court in its discretion may allow a reasonable attorney’s fee and costs of action to either party.”  29 U.S.C. § 1132(g) …