California Insurance Litigation Blog

California Insurance Litigation Blog

Category Archives: ERISA

Subscribe to ERISA RSS Feed

Third-Party ERISA Administrator Abused Discretion by Denying Medical Coverage: A Tale of What Not to Do

Posted in Abuse of Discretion, Administrative Record, Conflict of Interest, ERISA, Fiduciary Duty, Health Insurance, Standard of Review
Sometimes an administrator so unashamedly abuses its discretion in handling an insurance claim that its actions constitute a textbook example of “what not to do” for other administrators and the ensuing decision provides a clear illustration of how courts apply an abuse of discretion standard of review under the Employee Retirement Income Security Act (“ERISA”).  … Continue Reading

Recent Federal Court Decisions Give Teeth to California’s Ban on Discretionary Clauses in ERISA Plans

Posted in Case Updates, Disability Insurance, ERISA
A virtually insurmountable concrete wall was once an apt analogy for the effect of discretionary clauses in ERISA Plans on claimants attempting to challenge a plan administrator’s unreasonable interpretation of policy terms.  A valid discretionary clause gave insurance companies power to construe the terms of ERISA- governed group insurance policies based on their own interpretation, … Continue Reading

Echague v. Met Life: Equitable Surcharge is an Available Remedy Against Unresponsive Plan Administrators Under ERISA

Posted in Case Updates, Equitable Relief, ERISA, Life Insurance
The Employee Retirement Income Security Act of 1974 (“ERISA”) seeks to protect participants in employer-sponsored plans, but lack of adequate communication and transparency is an often an unfortunate byproduct of the insurance industry.  The California district court shed light on this issue in Echague v. Metro. Life Ins. Co., 2014 U.S. Dist. LEXIS 68642 (N.D. … Continue Reading

A Pro-Insurer Decision Provides Guidance for Insureds on the Application of Estoppel and Waiver to Statute of Limitations Defenses in Disability Insurance ERISA Cases

Posted in Case Updates, Disability Insurance, ERISA, Statute of Limitations
At times, decisions that appear favorable to insurers can also have unexpectedly positive take-aways for policy holders.  Gordon v. Deloitte & Touche, __ F.3d ___, 2014 U.S. App. LEXIS 6688 (9th Cir. April 11, 2014) is just such a case.  Although, the Ninth Circuit in Gordon ruled in favor of the insurer in finding that … Continue Reading

ERISA Administrator Must Show That a Theoretical Job Actually Exists in Order to Serve as Justification for Claim Denial

Posted in Case Updates, Disability Insurance, ERISA
A common justification for denying a claim for long-term disability insurance benefits or short-term disability insurance benefits is that the claimant is capable of returning to work in another job.  However, insurers / ERISA administrators are not allowed to deny a claim just because an insured might be capable of returning to any job, rather … Continue Reading

Helpful Tips to Policyholders: Pay Close Attention to Plan’s Limitations Provisions

Posted in Case Updates, Disability Insurance, ERISA, Insurance Questions and Concepts, Policy Interpretation, Statute of Limitations
Do you have a disability insurance policy, health insurance policy or life insurance policy through your work?  If you do, you should read this article as you may miss some important deadlines if you do not. The Supreme Court’s recent  holding that the limitations periods in employer-sponsored plans are enforceable, even where such limitations periods … Continue Reading

California District Court Rules That a Treating Physician’s Observations are “More Persuasive” Than a Paper Reviewer’s Contrary Opinions

Posted in Case Updates, Disability Insurance, ERISA, Standard of Review
When reviewing a claim for disability insurance, insurers and other claim administrators often rely on the opinions of paid physicians to support their improper denial decisions.  For example, a disability insurance company will hire a doctor to conduct a “paper review” – that is, reviewing an insured’s medical records, without actually examining the insured – … Continue Reading

Policyholder Wins Handed Down in Insurance Decisions. Daily Journal Publishes McKennon Law Group PC Article.

Posted in Breach of Contract, Case Updates, Disability Insurance, Duty to Defend, Duty to Settle, ERISA, Insurance Bad Faith, News, Unfair Business Practices/Unfair Competition
The February 10, 2014 edition of the Los Angeles Daily Journal featured Robert McKennon’s article entitled:  “Policyholder Wins Handed Down in Insurance Decisions.”  In it, Mr. McKennon discusses six insurance decisions handed down in California and federal courts in 2013 that were favorable to policyholders.  … Continue Reading

Supreme Court Looks at ERISA Plan Terms to Govern Limitation Periods to File Lawsuits

Posted in Case Updates, Disability Insurance, ERISA, Policy Interpretation, Statute of Limitations
In a highly anticipated decision, a unanimous United States Supreme Court held that insureds with employer-sponsored plans are contractually bound by the limitations periods set forth in their plan documents.  These limitations periods, which specify when insureds must file any legal actions under the Employee Retirement Income Security Act of 1974 (“ERISA”), are enforceable so … Continue Reading

Rochow v. LINA: A Game-Changer in ERISA Disability Benefits Litigation

Posted in Case Updates, Equitable Relief, ERISA, Fiduciary Duty
While this blog often discusses disability, life and health insurance/employee benefit decisions under the Employee Retirement Income Security Act of 1974 (“ERISA “), we rarely discuss federal circuit court of appeal decisions from outside the Ninth Circuit Court of Appeals (which governs California).  We are making an exception here, as a recent case from the … Continue Reading

How to Read Your ERISA Disability Denial Letter: A Gritty Exploration of the Common Language in Actual Denial Letters and How to Respond to Them

Posted in Disability Insurance, ERISA, Insurance Questions and Concepts
If your ERISA short-term disability or long-term disability claim was denied, you likely received a dry, lengthy rejection letter explaining the basis for the denial.  This letter may appear persuasive, but insurers/claims administrators often offer improper justifications to support their denial decisions to increase their profits.  Calling an experienced ERISA attorney should be your next … Continue Reading

Equitable remedies gain favor in ERISA cases

Posted in ERISA, News
The November 21, 2013 edition of the Los Angeles Daily Journal featured Robert McKennon’s article entitled:  “Equitable remedies gain favor in ERISA cases.”  In it, Mr. McKennon discusses a significant development in the Employee Retirement Income Security Act of 1974 (ERISA) in the last couple of years.  This significant development is due to the 2011 … Continue Reading

FAQs: Should You Hire an Attorney to Help You With Your ERISA Appeal?

Posted in Disability Insurance, ERISA, Insurance Questions and Concepts, Life Insurance
The McKennon Law Group PC periodically publishes articles on its California Insurance Litigation Blog that deal with frequently asked questions in the insurance bad faith, life insurance, long term disability insurance, annuities, accidental death insurance and ERISA areas of the law.  This article in that series focuses on appealing a denial of your long term … Continue Reading

Ten Things to Know Before You File a Claim for Long-Term Disability Insurance Benefits

Posted in Disability Insurance, ERISA, Insurance Questions and Concepts
1.  Make Sure You Have a Complete Copy of Your Plan/Policy – The first step when making a claim for long-term disability insurance benefits is to secure a copy of your policy.  If your employer provided your insurance coverage, request a full and complete copy of your policy from Human Resources.  Make sure you get … Continue Reading

California Court Limits the Enforceability of Contractual Limitation Periods Because the Insurer Failed to Properly Provide ERISA Plan Documents

Posted in Case Updates, Disability Insurance, ERISA, Fiduciary Duty
In an interesting opinion concerning a dispute over long-term disability (“LTD”) insurance benefits due under an ERISA plan, a District Court held that an ERISA administrator cannot rely on a contractual limitation period to defeat an insured’s claim where it failed to provide the insured with sufficient documentation and/or notice of the existence of the … Continue Reading

Recovery of Overpayments Under ERISA

Posted in Equitable Relief, ERISA
Keith Parker, an excellent mediator who specializes in mediating ERISA matters, authored the following article on “Recovery of Overpayments Under ERISA”   We at the McKennon Law Group PC are happy to recommend this outstanding article for your reading.  We include the entire article below with permission from Mr. Parker. Section 1132(a)(3)(B) of ERISA authorizes participants, … Continue Reading

United States Supreme Court to Decide When the Statute of Limitations Period Begins in an ERISA Disability Case

Posted in Case Updates, Disability Insurance, ERISA, Statute of Limitations
By granting certiorari in Heimeshoff v. Hartford Life and Accident Insurance Co., 496 Fed. Appx. 129, 2012 U.S. App. LEXIS 19269, 2012 WL 4017133 (2d Cir. September 13, 2012), the United States Supreme Court is poised to address an issue that has left countless ERISA claimants without a remedy to challenge a wrongful denial of … Continue Reading

FAQs: Can an Insured Sue for Future Policy Benefits and Attorneys’ Fees in a Lawsuit Against an Insurer for Disability Insurance Benefits?

Posted in Disability Insurance, ERISA, Insurance Questions and Concepts
The McKennon Law Group PC periodically publishes articles on its California Insurance Litigation Blog that deal with frequently asked questions in the insurance bad faith and ERISA area of the law.  This is another such article in that series. If an insurance company has unfairly denied an insured’s disability benefits or has otherwise committed bad … Continue Reading

Ninth Circuit Emphasizes Need for an Insurer to Have a Meaningful Dialogue With the Claimant When Denying Benefits

Posted in Abuse of Discretion, ERISA, Health Insurance
A recent Ninth Circuit Court of Appeals decision reaffirmed the need for plan administrators to state the reasoning behind their denial of coverage.  In Lukas v. United Behavioral Health,  __ F.3d __, 2013 U.S. App. LEXIS 1230 (9th Cir. Jan. 17, 2013) the Ninth Circuit was faced with evaluating whether the district court properly weighed … Continue Reading

Can an ERISA Claims Administrator Engage in Post-Trial Discovery Regarding Benefit Issues? No, Says District Court

Posted in Abuse of Discretion, Attorneys Fees, Case Updates, Disability Insurance, Discovery, ERISA
In what may be a matter of first impression, Judge Cormac J. Carney of the United States Federal District Court for the Central District of California denied Sun Life and Health Insurance Company’s Objections to Proposed Judgment in an ERISA long-term disability insurance claim case handled by McKennon Law Group PC.  As detailed here, Robert … Continue Reading

McKennon Law Group Wins Disability Insurance Lawsuit Against Sun Life And Health Insurance Company Following Trial

Posted in Abuse of Discretion, Conflict of Interest, Disability Insurance, ERISA, News, Standard of Review
On November 27, 2012, following a trial before Judge Cormac J. Carney of the United States Federal District Court for the Central District of California, Robert J. McKennon and Scott E. Calvert of the McKennon Law Group secured a victory for their client in a lawsuit against Sun Life and Health Insurance Company.  Representing the … Continue Reading

Under ERISA, Communications with In-House Counsel Before a Final Claims Decision are Not Privileged and are Subject to Discovery to Show a Conflict of Interest

Posted in Conflict of Interest, Disability Insurance, ERISA
Are insureds entitled to communications between an insurance company’s in-house counsel and the claims handlers that might otherwise be protected by the attorney-client privilege?  Following a new ruling by the Ninth Circuit Court of Appeals, if the claimant is insured under an ERISA plan, the answer might be “yes.” For decades, courts, including the Ninth … Continue Reading

Equitable Relief in the Ninth Circuit Just Got Better for Consumers

Posted in Case Updates, Equitable Relief, ERISA
The Wednesday July 11, 2012 edition of the Los Angeles Daily Journal featured Robert McKennon’s and Scott Calvert’s article entitled: “Equitable Relief in the Ninth Circuit Just Got Better for Consumers.”  In it, Mr. McKennon and Mr. Calvert discuss two important Ninth Circuit rulings allowing certain equitable relief to ERISA plan participants that have definite … Continue Reading

California Court of Appeal Upholds Insurance Coverage for Health Net Finding The “Dishonest Acts” Exclusion Did Not Preclude Coverage

Posted in Case Updates, Duty to Defend, ERISA, General Liablity
In Health Net, Inc. v. RLI Insurance Company, et al., the California Court of Appeal, Second District, reversed a trial court’s entry of judgment on a Motion for Summary Judgment finding some coverage for Health Net, Inc. (“Health Net”) in connection with numerous lawsuits filed against it arising under the Employee Retirement Income Security Act of … Continue Reading