If a health insurer mistakenly advises a patient that a surgical procedure is covered by its policy – and in reliance on that advice, the patient proceeds with the surgery, can the patient recoup the expenses incurred in undergoing the procedure from the insurance company if the insurer maintains that its prior advice was mistaken?
The main lesson taught by a recent federal court ruling issued in Florida, Wilson v. Walgreen Income Protection Plan, 2013 U.S.Dist.LEXIS 62021 (M.D.Fla. April 29, 2013), is that the Employee Retirement Income Security Act (ERISA) imposes duties of good faith and fair dealing that preclude deceptive and unreasonable claim handling tactics. The plaintiff, Deborah Wilson, […]
The scope of remedies available under Employee Retirement Income Security Act due to an employer or plan administrator’s breach of fiduciary duty is undergoing a dramatic transformation in the wake of a recent Supreme Court ruling. The most recent example is Gearlds v. Entergy Services Inc., 2013 U.S.App.LEXIS 3831 (5th Cir. Feb. 19, 2013). That […]
One of the most vexing issues in employee benefits law relates to the apparent absence of remedies when harm results from misrepresentations made to employees since Employee Retirement Income Security Act (ERISA) only permits “appropriate equitable relief” (29 U.S.C. § 1132(a)(3)) and bars claims seeking legal remedies such as monetary damages. A leading example of […]
A recent ruling from Texas discussed a vexing issue that often arises in benefit claim litigation brought under the Employee Retirement Income Security Act, 29 U.S.C. § 1001 et seq. In Franklin v. AT&T Corp., 2008 U.S.Dist.LEXIS 99128 (N.D.Tex. Dec. 9), Metropolitan Life Insurance Company, which administers AT&T’s long-term disability plan, sought dismissal from a […]
In a very significant ruling, the 6th U.S. Circuit Court of Appeals extended several recent precedents to reject an insurer’s reviewing doctor’s findings and uphold a judgment reinstating payment of disability benefits. Evans v. Unum Provident Corp., 2006 U.S.App.LEXIS 1359 (Jan. 20, 2006). The plaintiff, a nursing-home administrator, became disabled due to a seizure disorder […]