Bain v. Oxford Health Insurance: Judge Finds Insurer Liable for Breach of Fiduciary Duty Under ERISA As Medical Necessity Guidelines Were Inconsistent With Medical Standards of Care

On Behalf of | Mar 4, 2020 | Disability Insurance, ERISA, ERISA - Abuse of Discretion, ERISA - Conflict of Interest, ERISA - Fiduciary Duty, ERISA - Standard of Review, Insurance Litigation Blog

In a recent decision by the U.S. District Court for the Northern District of California, Bain v. Oxford Health Insurance, 2020 WL 808236, the Court held that it is an abuse of discretion for an insurance company to rely on unreasonable medical necessity guidelines, to...

Insurance Company Bias in ERISA Cases: Hartford’s History of Bias and Discovery of an Insurer’s Biased Claims Administration Process

On Behalf of | Sep 26, 2018 | Disability Insurance, Discovery, ERISA, ERISA - Abuse of Discretion, ERISA - Conflict of Interest, Firm News, Health/Medical Insurance, Insurance Litigation Blog, Life Insurance

The Employee Retirement Income Security Act (“ERISA”), a 1974 federal law, sets minimum standards for many employee benefit plans and serves to provide protection for individuals in these plans. Discovery in ERISA cases is often limited because the statute’s primary...

When Guarding the Henhouse, Some Foxes Go Rogue: When an Insurer’s Conflict of Interest Factors into Administrating Group Long-Term Disability ERISA Plans

On Behalf of | Jul 25, 2018 | Accidental Death or Dismemberment, Disability Insurance, Disability Insurance News, ERISA, ERISA - Abuse of Discretion, ERISA - Conflict of Interest, Firm News, Health/Medical Insurance, Insurance Litigation Blog, Life Insurance, News

Few Americans can retire on their savings alone.  Many workers participate in an employee benefits plans, which serve to provide financial security in case of disability or retirement.  In the case of insurers that decide who qualifies for life, health and disability...

Ninth Circuit Grants a Small Reprieve to the Abuse of Discretion Standard of Review, Ruling That Discretionary Language Provisions in Self-Funded ERISA Will Apply

On Behalf of | Aug 24, 2017 | Disability Insurance News, ERISA, ERISA - Abuse of Discretion, ERISA - De Novo Review, ERISA - Standard of Review, Firm News, Insurance Litigation Blog

When litigating ERISA-governed short-term disability, long-term disability, life and medical insurance claims, a major consideration is which “standard of review” will apply to the Court’s review of the insurer’s decision – abuse of discretion or de novo.  The de novo...

9th Circuit puts final nail in coffin for discretionary clauses in insurer-funded ERISA plans

On Behalf of | May 24, 2017 | Case Updates, Disability Insurance, Disability Insurance News, ERISA, ERISA - Abuse of Discretion, ERISA - De Novo Review, ERISA - Preemption, ERISA - Standard of Review, Firm News, Health/Medical Insurance, Insurance Litigation Blog, Life Insurance, Policy Interpretation

Disability and life insurers frequently include clauses in their insurance policies affording them complete discretion to decide whether a claim has merit.  The clauses usually state the insurer has total discretion to decide whether the claimant is eligible for the...

How Do Insurers Deny Valid Disability Insurance Claims?

On Behalf of | Feb 8, 2017 | Bad Faith, Disability Insurance News, ERISA, ERISA - Abuse of Discretion, Firm News, Insurance Bad Faith, Insurance Litigation Blog

The McKennon Law Group PC periodically publishes articles on its California Insurance Litigation Blog that deal with related issues in a series of articles dealing with insurance bad faith, life insurance, long-term disability and short-term disability insurance,...

The Prevalence of Life, Health and Disability Benefit Claim Denials is Astounding: It’s Worse Than You Thought

On Behalf of | Feb 2, 2017 | Bad Faith, Disability Insurance, Disability Insurance News, ERISA, ERISA - Abuse of Discretion, Firm News, Health/Medical Insurance, Insurance Bad Faith, Insurance Litigation Blog, Life Insurance

The U.S. Department of Labor estimates that a whopping 75 percent of long-term disability claims are denied.  With over six decades of collective experience representing both insurers and their policyholders, the lawyers at McKennon Law Group PC have seen insurers...

Robert McKennon Publishes Article: Ninth Circuit: ‘Independent’ Physicians may Favor Insurers

On Behalf of | Sep 8, 2016 | ERISA, ERISA - Abuse of Discretion, ERISA - Standard of Review, Firm News, Insurance Litigation Blog, Legal Articles, News Blog

In the September 8, 2016 edition of the Los Angeles Daily Journal, Robert McKennon of the McKennon Law Group published an article regarding the use of so-called “independent” physicians used by insurance companies as a pretense to deny valid claims. In the article...

With Discretionary Language Even Barred in Self-Funded ERISA Plans, is This the Death of The Abuse of Discretion Standard of Review In California?

On Behalf of | Oct 12, 2015 | Disability Insurance News, ERISA, ERISA - Abuse of Discretion, ERISA - De Novo Review, ERISA - Standard of Review, Firm News

Recently, we explained that District Courts within the state of California, applying California Insurance Code section 10110.6, ruled that, even if an insurance Plan contains language giving discretion to a claim administrator, that language is unenforceable, and de...

ERISA Disability Insurance Claimants Take Note – Discovery Is Allowed In De Novo Review Cases

On Behalf of | Sep 14, 2015 | Disability Insurance News, ERISA, ERISA - Abuse of Discretion, ERISA - De Novo Review, ERISA - Standard of Review

Well-intentioned policymakers enacted the Employee Retirement Income Security Act of 1974 (“ERISA”) over forty years ago to provide for the protection of participants’ employee benefits in part by establishing a uniform set of rules to ensure efficient proceedings. ...