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Peter Sessions

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Peter S. Sessions is a partner at Kantor & Kantor who has been with the firm since 2004. Peter represents individual clients seeking health, life, and disability benefits, typically under employee health plans.

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The Ninth Circuit Giveth, the Ninth Circuit Taketh Away in Two Health Cases Against United

Ryan S. v. UnitedHealth Group, Inc., No. 20-56310, __ F. App’x __, 2022 WL 883743 (9th Cir. Mar. 24, 2022) (Before Circuit Judges Collins and Lee, and District Judge Jill A. Otake)

Wit v. United Behavioral Health, No. 20-17363, __ F. App’x __, 2022 WL 850647 (9th Cir. Mar. 22, 2022) (Before Circuit Judges Christen and Forrest, and District Judge Michael M. Anello)

We have two notable decisions this week; both are unpublished memorandum dispositions from the Ninth Circuit involving class actions against UnitedHealthcare and its affiliates.
Continue Reading The Ninth Circuit Giveth, the Ninth Circuit Taketh Away in Two Health Cases Against United

Wilson v. UnitedHealthcare Ins. Co., No. 20-2044, 2022 WL 552028 (4th Cir. Feb. 24, 2022) (Before Circuit Judges Agee, Thacker, and Quattlebaum).

This week’s notable case once again demonstrates how health insurance claims are confusing and littered with procedural and substantive land mines. This case involves one person who received treatment at one facility during one continuous period of time, yet the Fourth Circuit’s analysis of the related insurance claims submitted for that treatment has resulted in three different holdings: one regarding medical necessity, one regarding the administrator’s breach of fiduciary duty, and one regarding the claimant’s failure to properly follow procedural rules.
Continue Reading Fourth Circuit Rules That Administrator’s Failure to Respond to Claimant’s Request for Information Demonstrated Futility of Appealing

Newsom v. Reliance Standard Life Ins. Co., No. 20-10994, __ F.4th __, 2022 WL 500403 (5th Cir. Feb. 18, 2022) (Before Circuit Judges Higginbotham, Stewart, and Wilson).

When an ERISA administrator denies a benefit claim because the claimant is not an eligible plan participant, what happens when a court later rules that this decision was wrong? Does the court order that benefits be approved? Or does the court give the administrator a second chance to deny the claim by allowing it to determine whether the now-covered participant met the plan benefit criteria? The title gives this one away, but read on to find out how the Fifth Circuit decided the issue.
Continue Reading Fifth Circuit Rules That Insurer Gets a “Second Bite at the Apple” After Making Faulty Coverage Determination