California Insurance Litigation Blog

California Insurance Litigation Blog

Category Archives: Legislation

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Recent Federal Cases Applying the State and Federal Mental Health Parity Acts: What Do They All Mean?

Posted in Case Updates, Class Actions, Health Insurance, Legislation
The Federal Mental Health Parity and Addiction Equity Act (“MH Parity Act”) requires, at a minimum, that the financial requirements and treatment limitations for mental health benefits set by group health plans and health insurance carriers be no more restrictive than those provided for non-mental health medical benefits.  The MH Parity Act was originally signed … Continue Reading

New California Law Requires that Short-Term Disability Policies Provide Coverage for Severe Mental Illness

Posted in Disability Insurance, Legislation, News
In a victory for insurance consumers and mental health advocates, a recent change to the California Insurance Code mandates that short-term disability insurance policies provide coverage for “severe mental illnesses” as that term is defined in the Insurance Code. Passed in 2013, and signed in to law by Governor Jerry Brown on October 4, 2013, … Continue Reading

California Bans the Inclusion of Policy Provisions Giving Insurance Companies Discretionary Authority to Decide Claims

Posted in ERISA, Insurance Commissioner, Legislation, News, Standard of Review
In a major victory for consumers, Governor Jerry Brown signed a bill that makes discretionary clauses – typically contained in ERISA-governed life, health and disability insurance policies/ERISA plans void and unenforceable in new or renewed policies.  SB 621 was authored by Senate Insurance Committee Chair Ron Calderon (D-Montebello) and sponsored by Insurance Commissioner Dave Jones, … Continue Reading

New California Law Requires That Insurers and Agents Verify that an Annuity is Suitable for the Consumer

Posted in Agent/Broker, Annuities, Insurance Commissioner, Legislation
California Governor Jerry Brown recently signed a new law that will provide increased protection to seniors and other consumers who are interested in purchasing an annuity.  AB 689, which was sponsored by the California Department of Insurance and authored by Assembly Budget Committee Chair Bob Blumenfield (D-San Fernando Valley), requires that insurers verify that an … Continue Reading

California Insurance Commissioner Jones Announces New Regulations On Annuities For Seniors

Posted in Annuities, Legislation, News
In recent years there have been many cases of insurance agents selling unsuitable annuities to members of the public, especially seniors.  These annuities typically involve large premiums and very large cash surrender charges.  The large cash surrender charges are often in place for at least the first five years of the annuity and usually exist … Continue Reading

Dave Jones Reveals the Priorities for His Tenure as California’s Insurance Commissioner

Posted in Legislation, News
California’s new Insurance Commissioner, Dave Jones, identified his priorities at his inauguration on January 3.  He plans to accomplish his objectives by making the California Department of Insurance “the strongest consumer protection agency in the nation”, and he plans to “set the standard for other consumer protection agencies.”   His priorities are: Implementation of federal health … Continue Reading

California’s Office of Administrative Law Approves Homeowners Underinsurance Regulations

Posted in Homeowners Insurance, Legislation, News
Because of fairly recent California wild fires and California’s history of rising property values (at least this was the case a few years ago), many California homeowners have found themselves underinsured for fire losses.  The California Department of Insurance has been considering new regulations governing standards and training for estimating replacement value on homeowners’ insurance … Continue Reading

California’s Largest Health Insurers are Fined by California Department of Managed Health Care for Inadequate Claims Practices

Posted in Health Insurance, Legislation, News
In today’s Los Angeles Times Business Section, Duke Helfand writes about an 18-month investigation by the California Department of Managed Health Care into the payment practices of Aetna Inc., Anthem Blue Cross of California, Blue Shield of California, Cigna Corp., Health Net Inc., Kaiser Foundation Health Plan and United Healthcare/PacifiCare. … Continue Reading

Governor Schwarzenegger Vetoes AB 1868 That Would Have Banned Discretionary Clauses in Group Insurance Policies

Posted in ERISA, Legislation, News, Standard of Review
Today Governor Schwarzenegger vetoed AB 1868 that would have banned discretionary clauses in group insurance policies.  This is a disappointment to consumer groups but not to insurers who rely on them.  Currently, the Department of Insurance bans them in group policies anyway.  Here are the Governor’s comments on why it was vetoed: To the Members … Continue Reading

Certain Health Insurance Reforms Go Into Effect as of September 23

Posted in Health Insurance, Insurance Commissioner, Legislation
On September 23, 2010, the Patient Protection and Affordable Care Act, part of the recently enacted health care reform law, went into effect for insurance plans that begin on or after this date.  Health care reforms beginning Sept. 23, 2010 include: No pre-existing condition exclusions for children under age 19: requires insurers to cover children … Continue Reading

Disability Policy Discretionary Clauses Come Under Congressional Attack

Posted in ERISA, Legislation, News, Standard of Review
Policyholder/Employee groups who have group disability insurance coverage through their employers and who find themselves operating in the byzantine world of ERISA have long criticized discretionary clauses contained in such ERISA policies.  These often have the effect of giving insurance companies firmer ground to support claim denials because the “abuse of discretion” standard of review … Continue Reading

New Appeal Regulations For Health Plans Require Final Claims Decision To Be Made By External Reviewer

Posted in ERISA, Health Insurance, Legislation, News
The Department of Health and Human Services issued new appeal regulations under the recently enacted Patient Protection and Affordable Care Act (“Affordable Care Act”).  These regulations give claimants the right to appeal decisions made by their health plan to an outside, independent decision maker, regardless of what state they live in or what type of … Continue Reading

Cell Phone Users Catch a Break

Posted in Legislation, News
The Thursday August 5, 2010 edition of the Los Angeles Daily Journal featured my article entitled “Cell Phone Users Catch a Break,” in the Perspective column. It discusses the U.S. Copyright Office’s recent announcement regarding its decision to exempt wireless telephone handsets from the anti-circumvention provision under the Digital Millennium Copyright Act. The article is posted below with permission … Continue Reading

Federal Insurance Office Is Now A Reality

Posted in Legislation
On July 21, 2010, President Obama signed into law the Dodd-Frank Wall Street Reform and Consumer Protection Act (H.R. 4173).  The Act directs the U.S. Treasury Department to create a Federal Insurance Office (“FIO”)  The FIO has the authority to monitor all aspects of the insurance industry, establish Federal policy on international insurance matters, serve … Continue Reading

District Court Provides Additional Guidance on Scope of Discovery Under Glenn

Posted in Case Updates, ERISA, Legislation
In the last several years, the scope of discovery in ERISA cases has been a point of contention between plaintiff and defense counsel.  Plaintiffs typically want free range to conduct discovery on any potentially relevant information addressing the conflict of interest issue while defense counsel would like discovery requests to be as narrow as possible.  Generally, … Continue Reading

Submission of the Claim File: Seal or Redact?

Posted in Administrative Record, Discovery, ERISA, Legislation, News
For most insurance litigation, the majority of the evidence used by both sides comes from the claim file, also known as the administrative record in ERISA cases.  The claim file represents the insurance carrier’s written record of its handling and processing of an insurance claim.  Obviously, this information is highly relevant whenever coverage or a … Continue Reading

Ninth Circuit Court of Appeals Applies Montour to the Conflict of Interest Analysis in ERISA Case

Posted in Disability Insurance, Legislation, News
In the aftermath of the United States Supreme Court holding in Metropolitan Life Ins. Co. v. Glenn, 554 U.S. 105, 128 S.Ct. 2343, 2348 (2008), the courts have struggled to apply this holding. The Ninth Circuit did so in Montour v. Hartford Life & Accid. Ins. Co., 582 F.3d 933 (9th Cir. 2009). In turn, … Continue Reading

Documents Reviewed by Independent Medical Examiner Sufficient to Satisfy Plan Obligation to Consider All Relevant Documents

Posted in Legislation, News
The United States Court of Appeals for the Ninth Circuit, in an unpublished decision, addressed the question of whether documents reviewed by an independent medical examiner, but not by the plan administrator, was sufficient to satisfy the Plan’s obligation to consider all relevant documents. Sun Sun Lin v. Mellon Long Term Disability Plan, 2010 WL … Continue Reading

New California Health Insurance Legislation Moves Forward

Posted in Legislation, News
The debate over national health care reform has moved to the California Legislature, which will begin taking the initial steps to implement the complex series of health insurance overhauls prescribed by the federal government. The Legislature seeks to enact reforms signed into law by President Obama this year. Among other things, certain Bills would prohibit … Continue Reading

The Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act Summary and Implementation Timelines

Posted in Health Insurance, Legal Articles, Legislation, News
Eric M. Peterson from the law firm of Dorsey & Whitney LLP has done a nice job summarizing the recently enacted Patient Protection and Affordable Care Act.  Peterson’s article, ‘Health Care Reform is Here’ is set forth verbatim immediately below, followed by the Democratic Policy Committee‘s implementation timeline for both Acts. Health Reform and Reconciliation … Continue Reading

The NAIC Announces Hearings on Stranger-Owned Annuities

Posted in Legislation, Life Insurance, News
Stranger-Owned Annuities allow investors to purchase an interest in the life of an elderly or terminally ill person, inducing the insured to purchase the policy largely for the benefit of unrelated and sometimes unknown beneficiaries. The NAIC will examine whether greater regulation of the Stranger-Owned Annuity market is warranted and whether consumers are adequately protected. … Continue Reading

California Insurance Commissioner Says Anthem Blue Cross Violated California Law More Than 700 Times

Posted in Health Insurance, Legislation, News
Just when you thought the bad news for Anthem Blue Cross (“Anthem”) could not get any worse, it does.  According to an article by Duke Helfand appearing in today’s Los Angeles Times, California Insurance Commissioner Steve Poizner reported that Anthem, California’s largest for-profit health insurer, violated California law more than 700 times over a three-year period by … Continue Reading