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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Archives for Health Insurance
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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