Category: Claims for Benefits

Claims for Benefits / ERISA Litigation / Health and Welfare Plans

25 Mar, 2022

Wit Is Flipped: The Ninth Circuit Reverses Major ERISA Decision

The Ninth Circuit just reversed decisions from the U.S. District Court for the Northern District of California in Wit v. United Behavioral Health, which had ordered United Behavioral Health (“UBH”) to reprocess thousands of claims for behavioral and mental health treatment. Wit is an ERISA...

Claims for Benefits / ERISA Litigation / Health and Welfare Plans

17 Jan, 2022

Ninth Circuit Opens Door to Claims by Out of Network Providers

Lawsuits by out-of-network medical providers against ERISA plans and their third party administrators rank as one of the most common ERISA-type cases being raised these days. In these cases, out-of-network medical providers purport to provide services to patients—often substance use or mental health treatments—and then...

Claims for Benefits / ERISA Litigation

4 Dec, 2021

Eighth Circuit Defines How Summary Judgment Procedures Apply to ERISA Benefit Claim Reviews

Vanilla ERISA claims seeking plan benefits may well be the most common lawsuit encountered by federal judges. Even so, the Federal Rules of Civil Procedure do not expressly contemplate how these ERISA claims for benefits—with their unique limits on discovery and discretionary standard of review...

401(k) Plans / Claims for Benefits / ERISA Litigation

15 Jan, 2021

A Recent Decision Highlights the Potentially Broad Application of the Failure-to-Exhaust Defense

A recent decision by the U.S. District Court for the Northern District of Georgia in Fleming v. Rollins, Inc., 2020 U.S. Dist. LEXIS 227697 (N.D. Ga. Nov. 23, 2020) highlights the disagreement among courts about the scope of ERISA’s requirement that participants exhaust their ERISA...