Can ERISA Plan Administrators Recover Overpaid LTD or Health Insurance Benefits?
Plan administrators for health and disability insurance governed by the Employee Retirement Income Security Act (ERISA) often seek reimbursement when a beneficiary receives a third-party settlement or is otherwise overpaid. But the ability to recover those overpaid long-term disability (LTD) or health insurance benefits isn’t absolute. The U.S. Supreme Court has clarified — and restricted […]
Understanding the LTD Claims Process Under ERISA: Navigating 29 C.F.R. § 2560.503-1
If you’re pursuing a Long-Term Disability (LTD) claim, understanding the legal framework governing the claims process is crucial. For employees and claimants dealing with LTD benefits, the Employee Retirement Income Security Act (ERISA) provides important protections and clear procedures that insurers must follow. One key regulation is 29 CFR § 2560.503-1, which outlines the mandatory […]
Heartsill v Ascension
In a routine long-term disability case involving a nurse with fibromyalgia, two unique elements stand out: Ascension’s headquarters in St. Louis County mandated lawsuits be filed in the Eastern District of Missouri, despite most employees working elsewhere, and the discovery order exposed biased medical reviewers. The client’s benefits were reinstated with the application of complex […]
M.M v OPM
A client’s child required treatment for severe mental illness was denied, with the insurance company claiming a less costly level of care was sufficient. However, the court ruled in our favor, citing that the denial contradicted the medical evidence. It was demonstrated that the insurance company’s chosen medical reviewer had disregarded pertinent evidence, and the […]
Ray v Unum
A Missouri neurosurgeon experiencing macular degeneration had purchased an individual disability plan while still a resident in California. The case was filed in California to benefit from more favorable “bad faith” laws. In collaboration with a local Californian law, we settled the case for more than the benefit amount.