Hendricks v. Aetna Life Ins. Co., No. CV 19-06840-CJC(MRWx), 2021 WL 2497950 (C.D. Cal. June 11, 2021) (Judge Cormac J. Carney).

As modern medicine advances, so do health care costs. Health insurers have an incentive to keep those costs down, and one way to do that is to deny claims for benefits by classifying expensive new treatments as “experimental and investigational.”

This case involves plaintiffs’ benefit claims for lumbar artificial disc replacement (“ADR”), a new alternative to traditional spinal fusion. Lumbar ADR has shown promise because it has the potential to provide improved flexibility and mobility to patients with spinal problems. The FDA has approved at least two lumbar disc replacement products, in 2004 and 2006. Continue Reading Court Certifies Class Action Challenging Aetna’s Benefit Denials for Lumbar Artificial Disc Replacement

Last week, the Ninth Circuit’s decision in Wong v. Flynn-Kerper, No. 19-56289, __F.3d__, 2021 WL 2307485 (9th Cir. June 7, 2021) (before Circuit Judges Friedland and Bennett, and District Judge Frederick Block), is a meandering tale of deceit, greed, and incompetence with respect to Employee Stock Ownership Plan (ESOP) administration. But the moral of the story is clear, as the Ninth Circuit joined the Fourth Circuit in barring the defensive use of equitable estoppel when estopping the plaintiff would contradict an ERISA plan’s express terms. Continue Reading Ninth Circuit Holds That a Party, Whether a Plaintiff or a Defendant, Cannot use Equitable Estoppel to Contradict the Express Terms of an ERISA Plan in Litigation with the Plan

Miller v. Reliance Standard Life Ins. Co., No. 20-30240, __ F.3d __, 2021 WL 2221347 (5th Cir. June 2, 2021) (Before Circuit Judges Haynes, Duncan, and Engelhardt).

Continuity of coverage provisions in benefit plans seem fairly straightforward – if you have coverage under your employer’s plan, when your employer switches insurance companies you should still maintain your coverage. However, employees, through no fault of their own, often get tripped up in these transitions and sometimes lose their coverage despite years of service to their employers. In this case, the Fifth Circuit prevented that from happening. Continue Reading Fifth Circuit Construes Continuity of Coverage Provision in Favor of Disabled Participant