Sunday, December 20, 2015

Two More Ninth Circuit Cases On The Horizon

Creitz & Serebin LLP is counsel for plaintiff-appellants in two appeals pending before the Ninth Circuit, both of which will have oral arguments heard in March 2016.

In one, Anderson v. Sun Life, the Ninth Circuit will be deciding whether, in the face of ambiguous language in a long term disability policy, the plan's insurer can deny benefits to a career operating room nurse on the basis that she ceased to be a nurse when the hospital where she worked gave her a temporary light duty job as an accommodation to her injury.

The second, Upadhyay v. Aetna, asks the court to decide two issues:
First, does the Ninth Circuit's holding in Harlick v. BCBS (that plan insurers waive all defenses to the payment of benefits not raised during the administrative process) apply to a settlement agreement between the participant and her employer, when the insurer always knew of the existence of the settlement, but failed to raise it until after litigation had commenced; and

Second, in light of the Supreme Court's decisions in Heimeshoff v. Hartford and UNUM v. Ward, can an ERISA fiduciary insurer enforce a contractual limitations period contained in its insurance policy that
(1) violates the California Insurance Code;
(2) was not disclosed at any point during the administrative process; and
(3) would nullify the California notice-prejudice rule (something that the Supreme Court in UNUM v. Ward said it would make "scant sense" to permit insurers to do).

If you find yourself struggling with your ERISA plan's administrator or insurer over your benefits (pension, disability, health, or otherwise), let us see if we can help.

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