Archives for Health Insurance

New Jersey Federal Court Declines to Dismiss ERISA Action Against Health Insurance Claims Administrators

In HUMC Opco, LLC v. United Benefit Fund, the United States District Court for the District of New Jersey addressed motions to dismiss an ERISA action brought against a health insurer and insurance claims administrators. The action concerned medical bills in excess of $7 million, for medical care provided by a hospital over the course of nearly a year. According to the Complaint, the patient’s health insurer was obligated to pay over $789,000.00 for the medical care based upon the so-called “Medicare rate,” but instead paid less than $12,900.00. Following the patient’s death, his spouse assigned his right to benefits
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Pennsylvania Superior Court Holds That Fraudulent Acts Exclusion Precludes Liability Coverage for ERISA Class Action

​The Pennsylvania Superior Court has held that pursuant to a fraudulent acts policy exclusion, a policyholder was not entitled to liability coverage for a class action verdict arising from the policyholder’s misleading description of an ERISA benefits plan. In Cigna Corp. v. Executive Risk Indem., Inc.,the policyholder sought coverage for a class action challenging the policyholder’s 1998 conversion of its defined benefit pension plan to a cash balance plan. This conversion had the effect of freezing or reducing the benefits of some participants. While a trial court determined that the conversion did not violate ERISA, the court also found that
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