You already know that denials of ERISA-governed disability benefits are reviewed under a de novo standard unless the benefit plan gives the administrator discretionary authority to determine eligibility for benefits or to construe the terms of the plan.

But courts…

You know that many states ban discretionary language in ERISA plans.  This issue tees up litigation over what state law will apply –the choice of law issue.

This new case is a good read because it provides helpful analysis when…

ERISA preemption of state law claims is today’s topic…

This issue comes up more frequently now with managed care organizations creating networks of doctors or preferred providers, and the issue that arises is: at what rate should the insurer pay…

You already know about the contractual limitations provision in disability policies. The provision works to bar untimely lawsuits. 

So, it is no surprise that the interpretation/application of these provisions has been the subject of significant litigation.

Here’s a short new…

This just in….

On May 4, 2020, The Department of Labor (DOL), the Department of the Treasury, and the Internal Revenue Service issued the final ruling, linked here final ruling that “extend[s] certain timeframes otherwise applicable to group health plans,…

As you know, many states have imposed statutes which affect which standard of review governs ERISA claim decisions.

Many policies include a “choice of law” provision, setting forth which state law will govern the standard of review. 

But what happens …

You know that ERISA requires that the claimant receive “adequate notice in writing…setting forth the specific reasons for such denial, written in a manner to be understood by the participant.”

But what is “adequate notice,” and what is the remedy …