Summary Judgment Motions Partially Granted, Denied In Health Care Payment Dispute

PORTLAND, Ore. - An Oregon federal magistrate judge on Aug. 5 partially granted and partially denied summary judgment motions made by both parties in a health care payment dispute between a health care provider and a health insurer and plan administrator (Robert Metcalf v. Blue Cross Blue Shield of Michigan...

6th Circuit: Administrator Properly Applied Coordination-Of-Benefits Provision

CINCINNATI - A health plan administrator did not violate the Employee Retirement Income Security Act by interpreting the coordination of benefits (COB) provision of the plan to deny payment of benefits for medical expenses that were paid by an individual automobile insurance policy, the Sixth Circuit...

3rd Circuit Reverses Dismissal Of Dispute Against Health Insurer; Analysis Wrong

PHILADELPHIA - A Third Circuit U.S. Court of Appeals panel on Aug. 16 reversed a putative class action reimbursement dispute against a health insurer, saying the lower court improperly relied on the defendant's competing account of events when dismissing the claim (TRi3 Enterprises v. Aetna Inc....

Health Plan Administrator Granted Summary Judgment In Payment Dispute

NEWARK, N.J. - In an unpublished decision, a New Jersey federal judge on Aug. 21 granted summary judgment in favor of a health plan administrator in a reimbursement suit, saying the claims at issue were properly processed (Montvale Surgical Center v. Horizon Blue Cross Blue Shield of New Jersey, et al...

11th Circuit Affirms Reversal Of Denial Of Health Care Benefits

ATLANTA - In an unpublished, per curiam opinion, a panel of the 11th Circuit U.S. Court of Appeals on Aug. 22 affirmed judgment in favor of a plaintiff in a wrongful denial of benefits suit, agreeing that the plan excluded coverage for injuries received committing felonies and not misdemeanors (Cornelius...

Mississippi Federal Judge Declines To Remand Denial Of Benefits Suit

JACKSON, Miss. - A Mississippi federal judge on Aug. 26 denied a motion to remand a wrongful denial of health care benefits suit, saying a later-added defendant timely and properly removed the case to federal court (Silas Anderson v. Blue Cross and Blue Shield, et al., No. 13-402, S.D. Miss.; 2013 U...

Michigan Federal Judge Denies Remand In Denial Of Benefits Suit; ERISA Applies

KALAMAZOO, Mich. - A Michigan federal judge on Aug. 28 denied a motion to remand a wrongful denial of health care benefits suit to state court and granted the defendant's motion to dismiss, while allowing the plaintiff to amend the complaint (Anne Florence Andrea-Pearson v. Grand Valley Health Plan...

Judge Declines To Dismiss Health Care Suit; Issues On Alter-Ego Liability Exist

CHICAGO - An Illinois federal judge on Sept. 10 denied a motion to dismiss a health care insurance suit alleging breach of contract and violation of the Consolidated Omnibus Budget Reconciliation Act (COBRA) but granted the plaintiff's motion to strike an affidavit the defendants filed in support...

Louisiana Federal Judge Remands Reimbursement Suit, Says Jurisdiction Lacking

NEW ORLEANS - A Louisiana federal judge on Sept. 16 remanded a health care reimbursement suit to state court, finding that the court lacked subject matter jurisdiction (Omega Hospital v. Louisiana Health Service & Indemnity Co., et al., No. 13-21, E.D. La.; 2013 U.S. Dist. LEXIS 131988).

California Federal Judge Remands Health Care Payment Dispute; No ERISA Preemption

LOS ANGELES - A California federal judge on Sept. 18 remanded a breach of health care contract suit to state court, saying that the Employee Retirement Income Security Act did not preempt the claims (Port Medical Wellness Inc. v. Connecticut General Life Insurance Co., et al., No. 13-3604, C. D. Calif...

Federal Judge Declines To Dismiss Fraudulent Health Care Billing Claims

NEWARK, N.J. - A New Jersey federal judge on Sept. 24 declined to dismiss a fraudulent health care billing suit, finding that the plaintiff health insurer properly supported its claims against the health care provider (Connecticut General Life Insurance Co. v. Roseland Ambulatory, No. 12-5941, D. N.J...

La. Federal Judge Dismisses Denial Of Benefits Case, Allows Amendment

LAFAYETTE, La. - A Louisiana federal judge on Sept. 23 adopted the findings of a magistrate judge in dismissing a wrongful denial of health benefits case, but allowed the plaintiff time to amend her complaint to assert violations of the Employee Retirement Income Security Act (Amelia Simon v. Express...

N.J. Federal Judge Remands Health Care Reimbursement Suit To State Court

NEWARK, N.J. - A New Jersey federal judge on Oct.7 remanded a health care reimbursement suit to state court, finding that the defendant failed to show that federal preemption existed under the Employee Retirement Income Security Act (Medwell v. CIGNA Healthcare of New Jersey Inc., No. 13-3998, D. N.J...

High Court Hears Arguments On Limitations Period In ERISA Benefits Denial Case

WASHINGTON, D.C. - A beneficiary's claim for wrongful denial of disability benefits under the Employee Retirement Income Security Act does not accrue for limitations purposes until the plan's internal benefits resolution process has been exhausted, notwithstanding a plan provision providing that...

Providers Fail To Allege Assignments; Federal Judge Dismisses Claims For Benefits

NEWARK, N.J. - Health care providers seeking payment for services provided to plan participants failed to allege with specificity the assignments on which they asserted derivative standing under the Employee Retirement Income Security Act, a federal judge in New Jersey ruled Oct. 24 (NJSR Surgical Center...

Divided En Banc 7th Circuit: Breach Of Fiduciary Duty Claim Continues

CHICAGO - A divided en banc Seventh Circuit U.S. Court of Appeals on Nov. 7 ruled that the husband of a health plan participant may proceed with his claims that the plan sponsor and insurer breached their fiduciary duties under the Employee Retirement Income Security Act by failing to inform him during...

Illinois Federal Judge Denies Summary Judgment Motions In Reimbursement Suit

CHICAGO - An Illinois federal judge on Nov. 7 declined to grant summary judgment motions brought by both sides in a reimbursement dispute between chiropractors and a group of insurance companies (Pennsylvania Chiropractic Association, et al. v. Blue Cross Blue Shield Association, et al., No. 09-5619...

Calif. Federal Judge Denies Temporary Restraining Order In Denial Of Benefits Suit

OAKLAND, Calif. - A California federal judge on Nov. 8 denied a plaintiff's motion for a temporary restraining order to keep her health insurance company from allegedly wrongfully denying benefits for her continued residential treatment for eating disorders (Alison O. v. Anthem Blue Cross Life and...

New York Federal Judge Partially Dismisses Health Care Reimbursement Suit

WHITE PLAINS, N.Y. - A New York federal judge on Nov. 14 partially granted the defendants' motion to dismiss a health care reimbursement dispute (Bridget M. Curran v. Aetna Life Insurance Co., et al., No. 13-289, S.D. N.Y.; 2013 U.S. Dist. LEXIS 163162).

New Jersey High Court Won't Review Ruling That ERISA Preempts Hospital's Claims

TRENTON - The New Jersey Supreme Court on Dec. 6 denied a petition for certification of a Superior Court ruling that Employee Retirement Income Security Act Section 514(a) expressly preempts a medical provider's claims against the ERISA plan for payment of the provider's customary fees for the...

Supreme Court Rules On Limitations Period In ERISA Denial Case

WASHINGTON, D.C. - The U.S. Supreme Court ruled Dec. 16 that the contractual limitations provision of a disability benefits plan that requires participants to bring suit within three years after "proof of loss" is due is enforceable under the Employee Retirement Income Security Act, even if...

California Federal Judge Remands Reimbursement Suit, Finds No Preemption Exists

SAN JOSE, Calif. - A California federal judge on Dec. 16 remanded a reimbursement dispute to state court, holding that the Employee Retirement Income Security Act did not preempt the state law claims (Bay Area Surgical Management v. United Healthcare Insurance Co., et al., No. 13-2512, N.D. Calif.; 2013...

Supreme Court Justice Halts Birth Control Mandate For Catholic Group

WASHINGTON, D.C. - U.S. Supreme Court Justice Sonia Sotomayor on Dec. 31 temporarily blocked the federal government from enforcing the birth control mandate contained in the Patient Protection and Affordable Care Act (PPACA) against an order of Catholic nuns at the request of the group after a lower...

Government Opposes Supreme Court's Halt Of Birth Control Mandate

WASHINGTON, D.C. - The federal government on Jan. 3 filed a brief with the U.S. Supreme Court opposing an emergency injunction pending appellate review or, in the alternative, a petition for a writ of certiorari before judgment and injunction pending resolution following a Dec. 31 order by Justice Sonia...

N.J. Federal Judge Remands Reimbursement Dispute; No Federal Jurisdiction Exists

NEWARK, N.J. - In an unpublished opinion, a New Jersey federal judge on Jan. 21 granted a plaintiffs' motion to remand its health care reimbursement suit, saying neither complete preemption nor an embedded federal question of jurisdiction existed (MHA d/b/a Meadowlands Hospital Medical Center v....