benefits-denial

9 cases — ← All topics

Case Title Lower Court Docketed Status Flags Tags Question Presented
23-586 United Behavioral Health, et al. v. D. K., et al. Tenth Circuit 2023-12-01 Denied Amici (1)Response Waived administrative-record benefits-denial erisa health-benefits judicial-review substantial-evidence treating-provider Is an ERISA-governed plan that denies health benefits required to discuss contrary opinions from the member's treating providers in the decision lette…
23A365 United Behavioral Health, et al. v. D.K., et al. Tenth Circuit 2023-10-24 Presumed Complete administrative-record benefits-denial erisa medical-providers substantial-evidence tenth-circuit Whether the Tenth Circuit improperly imposed a heightened explanation requirement on ERISA plan administrators when denying health benefits claims, co…
22-1213 Roslyn Gonzalez v. Blue Cross Blue Shield Association, et al. Fifth Circuit 2023-06-15 Denied Response Waived administrative-remedies administrative-review benefits benefits-denial coverage-denials federal-employee-health-benefits-act fehba opm-review plan-participant Does the denial of 'benefits' under FEHBA include denial of the plan participant's access to services, or access to the OPM administrative review of c…
21-6982 Robert Stanley Gordon v. Metropolitan Life Insurance Company Ninth Circuit 2022-01-27 Denied IFP benefits-denial conflict-of-interest custody erisa evidence evidence-retention long-term-disability plan-concealment Whether ERISA long-term disability benefits can be denied after years of plan concealment
20-378 North Cypress Medical Center Operating Company, Ltd., et al. v. Cigna Healthcare, et al. Fifth Circuit 2020-09-24 Denied administrative-discretion benefits-denial circuit-split conflicts-of-interest employee-retirement-income-security-act erisa firestone-analysis judicial-review standard-of-review totality-of-factors Whether, in reviewing an ERISA administrator's benefits denial, it is automatically dispositive that 'two other courts' upheld the administrator's int…
20-242 Norine Sylvia Cave v. Delta Dental of California, et al. Ninth Circuit 2020-08-28 Denied Relisted (2) beneficiaries-rights benefits-denial breach-of-fiduciary-duties claim-adjudication erisa erisa-fiduciary-duty fiduciary-duties fiduciary-responsibility medical-records medical-records-withholding plan-administration unauthorized-benefits Whether a covered entity violates ERISA, by improperly denying beneficiaries' rights and further compounds such violations by approving unauthorized b…
19-146 Thomas P. Kelly, Jr. v. Reliance Standard Life Insurance Company, et al. Third Circuit 2019-07-31 Denied Response Waived administrative-review benefits-denial circuit-split disability-benefits disability-standard erisa futility futility-doctrine own-occupation remand retroactive-benefits Should this Court resolve the conflict among the Circuits about whether it would be futile to require an ERISA plan participant upon remand to retroac…
18-9480 Gregory Stanley Roberts v. Inservco Insurance Services Third Circuit 2019-05-30 Denied Response WaivedRelisted (2)IFP act-534 administrative-determination administrative-law agency-determination benefits-denial disability-benefits due-process employment-law injury-claim light-duty workers-compensation workplace-injury youth-development-center Whether the Insurance Service's denial of Act 534 benefits and light duty work for the petitioner's second injury was proper under the relevant worker…
18-134 Jennifer Perkins v. US Airways, Inc., et al. Fourth Circuit 2018-07-31 Denied Response Waived 12(b)(6) benefits-denial current-employment-status erisa health-benefits medicare-as-secondary-payer medicare-secondary-payer plan-documents summary-judgment unreasonable-denial-of-benefits Whether the court erred in dismissing petitioner's claims under the Medicare as Secondary Payer Act and ERISA for unreasonable denial of benefits, and…