What Constitutes Material Breach in Texas?

Determining whether a contract has been breached is fundamental to business disputes in Texas and elsewhere. Oftentimes, breach of contract is not intended by either party. In fact, the contract itself may be interpreted by the “breaching” party in such a way that the purportedly breaching conduct is not linked to the essential purpose of […]

Why Government Plans Are Exempt From ERISA

If you have been denied benefits provided through an employer-sponsored plan, your claim will generally fall under the Employee Retirement Income Security Act (ERISA). ERISA is a federal law that governs most employee benefit plans. While ERISA was originally enacted to safeguard employees’ retirement and pension benefits, its reach and scope has been expanded over the years. […]

Breast Cancer Survivor Sues Blue Cross Blue Shield for Wrongful Denial of Cancer Treatment

We are proud to represent clients against Blue Cross Blue Shield of Texas when it wrongly denies proton beam radiation therapy for cancer. This is because regardless of medical necessity, BCBS has a uniform policy to deny proton therapy treatment and force insureds to seek suboptimal treatment. Our client seeks to hold BCBS responsible for […]

Proton Therapy Treatment Approved After Insurer Initially Denied Claim

There is a tension in the American health care system between innovative medical procedures designed to save or prolong patients’ lives against the financial costs of that treatment. This tension has long simmered in proton therapy treatment of cancer. Standard radiation therapy has improved over the years and effectively controls many cancers. However, X-ray beams […]

Health Insurance Claim Denials: Aetna Doesn’t Review Medical Records

Recently, in a California insurance lawsuit involving the wrongful denial of health insurance benefits to a 19-year old claimant suffering from a rare immune-system disorder, a former medical director at Aetna (the defendant health insurer) admitted under oath to having never reviewed patient medical records when determining whether to deny health insurance claims. The testimony […]