Happy New Year! In the first blog of the year we are pleased to report a Kantor & Kantor victory in Wallace v. Int’l Paper Co., No. 2:20-CV-02478-SHL, __F.Supp.3d__, 2020 WL 7643134 (W.D. Tenn. Dec. 23, 2020). In a nutshell, this case is about a plan participant who was successful in defeating two
District Court Rules Against Aetna in Long-Term Disability Dispute; Objective Evidence is Not Necessary to Prove Disability
This week’s notable decision is a recent Kantor & Kantor victory in the matter of Myers v. Aetna Life Insurance Company, No. CV 19-9555 DSF (KSx), 2020 WL 7423109 (C.D. Cal. Dec. 17, 2020); a case involving a denial of long-term disability benefits. The action was heard by the Honorable Dale S. Fischer on October 27, 2020. In its ruling, the court reaffirmed that objective evidence was not required to prove a disability. Judge Fischer also found that the evidence of Plaintiff’s treaters to be more compelling than that of Aetna’s record reviewers. Notably, the court also found that Dr. Gary Nudell’s opinion (Aetna’s reviewer), which denied the notion of disabling fibromyalgia, to be contrary to established authority which recognized the disabling potential of the disease.
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Supreme Court Finds ERISA Does Not Preempt Arkansas State Law Regulating Pharmacy Benefit Managers
This week’s notable decision, Rutledge v. Pharm. Care Mgmt., Case No. 18-540, —S.Ct.—, 2020 WL 7250098 (U.S. Dec. 10, 2020), is a major win for consumers and pharmacies clearing the way for states to pass laws and implement regulations regulating pharmacy benefit managers (“PBMs”), third party companies hired by insurers to adjudicate and reimburse pharmacies (many of them small) for the cost of drugs covered by prescription-drug plans. At issue before the Court was an Arkansas state law, Act 900, which sought to regulate PBM reimbursement prices to pharmacies for the drugs that ERISA beneficiaries and participants obtained as part of their health plan coverage. The question presented to the Court was whether Act 900 was preempted by ERISA.
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