We recognize that “[P]lan administrators are not obliged to accord special deference to the opinions of treating physicians because there is also a potential conflict of interest on the part of a treating physician who, …
he appeal requires us to consider, among other things, the circumstances in which extrinsic evidence can be used to demonstrate the existence of a “latent” ambiguity in a contract that is clear on its face …
he district court concluded that the WDCA reverse preempts RICO under the McCarran-Ferguson Act because RICO does not “relate to the business of insurance,” the WDCA was enacted to regulate the business of insurance, and …
Based on our review of the record, these conclusions do not reflect a rational connection between the known facts and the decision to deny benefits. . . Unlike the cases the Plan relied upon in …
In the case at bar, Plaintiff is no longer a participant in Defendant’s ERISA plan and he does not allege a wrongful withholding of benefits. . . . Plaintiff does not claim that Defendant promised …
. . . plaintiff relies on Great-West & Annuity Insurance Company v. Knudson, 534 U.S. 204, 122 S. Ct. 708, 151 L. Ed. 2d 635 (2002), to attempt to circumvent the well-established rule that a …
he preemption language in section 514(a) of the Employee Retirement Income Security Act of 1974 (ERISA) is exceedingly broad. The preemption language in the law ERISA replaced – the Welfare and Pension Plans Disclosure Act …
A Georgia U.S. district court has awarded summary judgment to an ERISA plan on its claims to reimbursement from funds acquired in a personal injury settlement. In the Eleventh Circuit, plan language must conform to …
Edward A. Zelinsky, Benjamin N. Cardozo School of Law, comments on the Ninth Circuit’s recent decision sustaining the San Francisco health ordinance under an ERISA preemption challenge. The paper is entitled “Employer Mandates and ERISA …
Similar to the federal False Claims Act, many states have enacted analogous statutes. As enacted by section 6031 of the Deficit Reduction Act of 2005, section 1909 of the Social Security Act (Act) provides a …