: : 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 …

: : 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, …

: : Primer Provider Reimbursement Pleading To Avoid Motion To Dismiss

“Before the Court is Defendants Cigna Healthcare Inc., Cigna Health and Life Insurance Co., Connecticut General Life Insurance Co., and Cigna Healthcare of Arizona’s (collectively, “Cigna”) Motion to Dismiss. In October 2018, PSCC received a …

: : Plaintiff May Proceed On ERISA Claims Challenging Repricing of Provider Claims

Through this matter, Plaintiffs are attempting to stop Defendants allegedly improper practice of underbilling for chiropractic services that Plaintiffs provided to their patients. Presently before the Court are motions to dismiss the First Amended Complaint …

: : Duke Energy Benefits Committee Sues Law Firm & Plan Member in ERISA Reimbursement Case

Defendants have refused, despite numerous requests, to reimburse the Plan forbenefits the Plan paid on Heafner’s behalf out of Settlement Funds he received in connection withthe Accident. Defendants’ actions violate the terms of the Plan. …

: : Employer Sues Stop Loss Carrier and Express Scripts Alleging Fiduciary and Contractual Breach

“Express Scripts moves for summary judgment on Henkel’s claim for breach of fiduciary duty. Henkel alleges that Express Scripts breached its fiduciary duty not only by failing to adhere to the coverage criteria in the …

: : Court Remands Insurer’s Recoupment Claims Against Provider to State Court Applying Davila Test

Here, plaintiff seeks damages in the amount of $226,562.62, which it contends make up the unpaid balance of overpayments to Dr. Gupta. BCBSLA’s complaint does not seek a constructive trust or an equitable lien on …

: : Disability Insurer Policy Language Does Not Support ERISA Claim for Reimbursement of Overpayments

Provident offers a second theory of liability: equitable lien by agreement. Annual supplemental claims forms, signed and submitted by Messing between 2010 and 2017, contain the following language: “should my claim be overpaid for any …

: : Discovery Permitted on Breach of Fiduciary Duty Claim Despite Overlap with Claim for Benefits

It is true that the claims overlap. But where they do, they operate as alternate theories of liability. Pleading multiple causes of action and alternative theories of liability is a standard practice of civil litigation. …