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Sixth Circuit: Plan Had Subrogation Right Even Though Pre-Approval of Surgery Was Not Consistent with Plan Terms

Sixth Circuit: Plan Had Subrogation Right Even Though Pre-Approval of Surgery Was Not Consistent with Plan Terms

In Zahuranec v. Cigna Healthcare, Inc., et al., No. 21-3695, 2022 WL 1619493 (6th Cir. May 23, 2022), Plaintiff-Appellant Lisa Zahuranec appealed the district court’s dismissal of her ERISA lawsuit…

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Second Circuit: HHS Rule for Embedded Individual Out-of-Pocket Limits Does Not Apply to Pre-2016 Health Insurance Plans

In Fisher v. Aetna Life Ins. Co., No. 20-3148, __F.4th__, 2022 WL 1193999 (2d Cir. Apr. 22, 2022), the Second Circuit considered three separate but related appeals concerning Plaintiff-Appellant Jacqueline…

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Fourth Circuit Affirms District Court’s Award of Coverage for Surgery Because Claim Not Handled in ‘Fair-Minded’ Manner

In Garner v. Cent. States, Se. & Sw. Areas Health & Welfare Fund Active Plan, No. 21-1602, __F.4th__, 2022 WL 1160386 (4th Cir. Apr. 20, 2022), the Fourth Circuit affirmed…

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Ninth Circuit Revives Putative Class Action Against UnitedHealth Group for Practices Related to Substance Use Disorder Treatment

In Ryan S. v. UnitedHealth Group, Inc., No. 20-56310, 2022 WL 883743 (9th Cir. Mar. 24, 2022), Plaintiff-Appellant Ryan S. brought a putative class action under ERISA and the MHPAEA…

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Ninth Circuit Reverses Class Win Against United Behavioral Health

In Wit, et al. v. United Behavioral Health, Nos. 20-17363, 21-15193, 20-17364, 21-15194 (9th Cir. Mar. 22, 2022), a stunningly brief unpublished memorandum, the Ninth Circuit reversed Magistrate Judge Joseph…

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Fourth Circuit Revives Claims for Residential Treatment Based on Plan Administrator’s Failure to Produce Documents During Claim Review Process

In Wilson v. UnitedHealthcare Ins. Co., No. 20-2044, __F.4th__, 2022 WL 552028 (4th Cir. Feb. 24, 2022), the Fourth Circuit considered whether Defendant UnitedHealthcare Insurance Company abused its discretion in…

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