“ . . . [I]n order for Principal to reasonably deny S.W.’s hospital charges, substantial evidence had to support its determination that the primary focus of her hospitalization was mental health treatment, i.e., treatment designed …
The federal courts have been in some disagreement as to whether, under Rule 56, a court is obliged to consider the materials “on file” in deciding whether a “genuine issue as to any material fact” is …
Rotech has argued that it could, within its discretion, rely upon Huff’s sworn answers to interrogatories and the opinion of Dr. Wilson in concluding that it is entitled to be reimbursed out of any recovery Huff receives …
It is well-established that ERISA plan participants and beneficiaries may assign their rights to their health care provider. Misic v. Bldg. Serv. Employees Health & Welfare Trust, 789 F.2d 1374, 1378-79 (9th Cir. 1986). As …
Defendant argues that it met its obligation to provide notice under COBRA because [it] . . . placed in the mail to Brooks a letter explaining that he was eligible to continue his health and …
Section 2719 of the Public Health Services Act sets forth standards for plans and issuers that are not grandfathered health plans regarding internal claims and appeals and external review. These rules are aimed at bolstering …
Professor Roger Baron has a new website on which he addresses ERISA subrogation issues. The website is available here. Professor Roger Baron teaches at the University of South Dakota School of Law. A 1976 graduate …
People make mistakes. Even administrators of ERISA plans Conkright v. Frommert, 130 S. Ct. 1640 (U.S. 2010) The pithy statement quoted above, coupled with the comment that a “single honest mistake” does not alter the …
The Patient Protection and Affordable Care Act (the “Affordable Care Act”) (P. L. 111-148, as amended) requires the Secretary of Labor to provide Congress with an annualreport containing general information on self-insured employee health benefit …
. . . our decision does not prevent Henderson from bringing a subsequent action pursuant to ERISA Section 502(a)(1)(B) to recover benefits associated with any unjustly withheld compensation that she receives if she is successful …