MGU Liability in Stop Loss Litigation

 According to industry experts, roughly 25% of the $4-$6 billion annual stop loss market is sold through independent Managing General Underwriters. Another unknown, but certainly hefty, share is sold through “captive MGUs”—MGUs wholly owned or controlled by carriers. Again
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Claims Administrator Required To Enforce Plan Exclusionary Language

The U.S. District Court for the Central District of California recently held in Dubaich v. Connecticut General Life Insurance Co., C.D. Cal., No. 2L11-cv-10670-DMG-AJW (April 25, 2013), that a health plan participant could not obtain coverage for treatment of her degenerative disc dis
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Scheduled to be voted on the floor of the House THIS WEEK — Saturday, May 4

 This is the “Anti-Subrogation” bill, and it would legislatively limit a Plan’s contractual right to be reimbursed for medical care if the member/patient received less than a full recovery from a third party who might have liability. Based upon the outcome of persona
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Will New Litigation Risks Proliferate Because of Health Reform?

With thousands of pages of new laws and rules, there must be thousands of new reasons for employees to sue for health benefits not delivered properly in the wake of near-complete enactment of health reform starting in 2014, one could be forgiven for thinking. Health reform certainly d
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ERISA can apply to Individual Policies: Offering a group discount constitutes a “contribution” sufficient to create an ERISA plan

Can ERISA apply to the claims made on individual policies purchased with discounted premiums? YES. Here is a great new case that highlights the analysis to establish that ERISA applies when employees purchase individual policies, with group discounted premiums. McCann v. UNUM Providen
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Ninth Circuit Breathes New Life Into Retirees’ Claim for Lifetime Healthcare Benefits

Employers may unwittingly create implied vested contractual rights to retirement and healthcare benefits for their employees in perpetuity. In Sonoma County Ass’n of Retired Employees v. Sonoma County, No. 10-17873 (February 26, 2013), the Ninth Circuit vacated a district court’s dism
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