The LHD / ERISA advisor – June 2021 | Hinshaw & Culbertson – The LHD / ERISA advisor

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Hinshaws LHD / ERISA advisor remains committed to bringing you the latest legal developments that can guide your life, health, and disability litigation strategy and claims decisions.

In this issue, we cover court rulings related to the Mental Health Parity Act and Addiction Equity Act, the “material factor” causality analysis of an accidental death benefit, the defense of statute of limitations in an ERISA Second Circuit health benefit case, and the limits a bad faith lawsuit based on the attorney’s litigation strategies

  • The appeal to plan ambiguities, tenth district rules that are hindered after receipt of the notice of termination, did not exclude the employee from LTD perks
    • in the Carlile v. Reliance Standard Life Ins. Co., the Tenth Circle finds the term “active” full-time employee ambiguous and grants an employee who has suffered a disability after receiving his notice, but before his effective notice date.
  • Second Circuit issues statute of limitations in favor of health plan administrators
    • in the Connecticut General Life Ins. Co. v Biohealth Labs, Inc., the Second Circuit decided that the statute of limitations applied to unjust enrichment and not to fraud on ERISA 503 (a) (3) claims.
  • The sixth court upheld the refusal of accidental death benefits under the Substant Factor test
    • in the Duncan v. Minnesota Life Ins. Co., The Sixth Circuit ruled that an insurer refused accidental death benefits on the grounds that a patient’s leukemia caused the fall that led to his death.
  • Health plan may not exclude certain autism treatments
    • in the Doe versus United Behavioral Health, a California federal court ruled that an insurer that chooses to cover autism cannot rule out certain treatments for the condition.
  • Court blocks the plaintiff’s attempt to investigate the medical examiner’s claim review history
    • in the Adkins v. Life Insurance Company of North America, a Washington district court blocked a plaintiff’s attempt to uncover the claims review history of an insurance company’s medical examiner.
  • The insurer’s likelihood of denying the claim does not excuse the claimant’s obligation to seek administrative remedies prior to filing a lawsuit
    • in the Ruderman versus Liberty Courage. Grp., Inc., a New York district court ruled that just because an insurer could have denied a claim does not excuse the claimant’s obligation to seek administrative remedies prior to filing a lawsuit.
  • Little-pleaded Parity Act suit survives dismissal motion
    • in the Nathan W. v. Anthem BlueCross BlueShield of Wisconsin, a federal court ruled that conclusive allegations of discriminatory medical necessity criteria are sufficient to deny a motion to dismiss a lawsuit under the Mental Health Parity Act.

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