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As Pilot Life challenged a disability insurance claim denial, the equitable remedies that are provided by ERISA might still have been available to Mr. Dedeaux despite this ruling, as ERISA provides several equitable Injunctive remedies to challenge denials of benefit claims, such mandating that the wrongfully denied benefit be provided.
Perhaps you thought the medical treatment you recently received was covered by your health insurance and didn't give it a second thought. A few weeks later, however, you receive a letter from your
A question most Americans have when visiting the doctor: Will my insurance cover it? Healthcare can be extremely expensive, and an unexpected bill can throw off your entire budget, especially if ...
Denied claims can usually be appealed externally to an independent medical review by an independent review organizations (IROs). A de facto denial, rather than denying a prior authorization request (PAR) outright, may allow an insurer to delay responding or to indicate to a covered person they have been approved a treatment, procedure, or claim ...
Claim-denial rates have been increasing for more than a decade. The health policy and research firm KFF reported that 17% of in-network claims by HealthCare.gov insurers were denied in 2021. The ...
Employee benefits in the United States include relocation assistance; medical, prescription, vision and dental plans; health and dependent care flexible spending accounts; retirement benefit plans (pension, 401(k), 403(b)); group term life insurance and accidental death and dismemberment insurance plans; income protection plans (also known as ...
An insurance company has many duties to its policyholders. The kinds of applicable duties vary depending upon whether the claim is considered to be "first party" or "third party." Bad faith can occur in either situation—by improperly refusing to defend a lawsuit or by improperly refusing to pay a judgment or settlement of a covered lawsuit.
Health insurers denied nearly 43 million claims in 2017 in part of the individual insurance market, and patients appealed well under 1% of those decisions, according to the nonprofit Kaiser Family ...