A commentary on insurance coverage issues in Hawaii and beyond
The Sixth Circuit affirmed the district court in finding that the insurer who reserved rights was entitled to reimbursement for uncovered claims. Great Am. Fid. Ins. Co. v. Stout Rises Ross, Inc., 2024 U.S App, LEXIS 8576 (6th Cir. April 8, 2024).
Stout Rises Ross, Inc. was sued in two…
The estate's claims against the life insurance company failed, but the Ninth Circuit remanded for further review claims against the decedent's employer. Estate of Foster v. Am .Marine Sys. Group Ben. Plan, 2021 U.S. App. LEXIS 3555 (9th Cir. Feb. 9, 2021).
The estate filed suit under the civil enforcement provision…
What steps should a reviewing court take when the administrator of an employee benefits plan governed by ERISA denies benefits, but has a conflict of interest? In Montour v. Hartford Life & Accident Ins. Co., No. 08-55803, 2009 U.S. App. LEXIS 20378 (9th Cir. Sept. 14, 2009)(authored by Hawai`i's Judge Clifton), the Ninth Circuit…
Whether payment claims were preempted by ERISA was the issue in Lone Star OB/GYN Associates v. Aetna Health Inc., No. 08-50646, 2009 U.S. App. LEXIS 18572 (5th Cir. Aug. 18, 2009).
Aetna was the administrator of "employee welfare benefit plans" regulated by ERISA. Lone Star entered a provider agreement with Aetna and became a…
I was recently asked to look into investment and disclosure requirements for health insurance companies authorized to issue policies in Hawaii. A summary follows:
Hawaii Law
Investment requirements for all insurance companies are addressed in the Article VI of the Hawaii Insurance Code, Haw. Rev. Stat. §431:6-101-6-602. Generally, any security or other investment purchased by an insurer…
Must an ERISA plan reimburse its beneficiaries for the cost of photocopying medical records? Faced with this issue, the Ninth Circuit decided against the beneficiary in Sgro v. Danone Waters of N. Am., Inc., No. 06-55916 (9th Cir. July 2, 2008). The result would presumably be controlling in an ERISA case originating…
