The typical scenario in a benefits claim works something like this: An employee becomes ill or injured. An employee takes a medical leave of absence. If the employer has sponsored a disability program, a claim for benefits is filed. If there is a short-term disability plan, that benefit program may or may not be ERISA-qualified. […]
The United States District Court for the District of Idaho has ruled that a medical provider, acting pursuant to a pretreatment authorization and assignment of rights, may appeal an adverse benefit determination on the patient’s behalf for purposes of exhaustion under ERISA. In Abdilnour v. Blue Cross of Idaho Health Service Inc., Case No. 17-00412 […]
J.J. Conway has been named a 2018 SuperLawyer by Thomson Reuters. J.J. has been listed as SuperLawyer or SuperLawyer Rising Star on eleven occasions. SuperLawyers is a “rating service of outstanding lawyers from more than 70 practice areas who have attained a high degree of peer-recognition and professional achievement.” The selection process “includes independent research, peer […]
The U.S. Department of Labor has decided to implement ERISA disability benefits claims regulations. The regulations were proposed at the end of 2016, with a scheduled January 1, 2018 effective date. The regulations were designed to ensure various due process protections of ERISA disability claimants under 29 U.S.C. § 1133 and 29 C.F.R. § 2560.503-1, […]
The Tort Trial & Insurance Practice Section of the American Bar Association has published an article authored by J.J. Conway, Esq. discussing the history and usage of Social Security Disability Insurance awards in long-term disability insurance cases. The article, published in the Health and Disability Law Committee Newsletter, discusses the interplay between Social Security Disability Insurance Benefits […]
The standard of review in ERISA cases can have a considerable impact on the outcome of a long-term disability claim. As the Supreme Court observed in Firestone Tire & Rubber Co. v. Bruch, 489 U.S. 101, 115 (1989), “the validity of a claim to benefits under an ERISA plan is likely to turn on the interpretation of terms in […]
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Everything we do is centered on effectively and promptly resolving our clients’ benefits disputes whether in the courtroom or at the bargaining table. We focus on successfully litigating and resolving employee benefit and contractual disputes involving private contracts of insurance and claims brought under the Employee Retirement Income Security Act of 1974 (“ERISA.”)
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