The Mental Health Parity Act Explained And Why It Matters

Mental illness affects a significant number of Americans, and many of them are not able to get the treatment they need. Even when health plans cover mental health benefits, they can be harder to access and less comprehensive than other types of health benefits. The Mental Health Parity Act (MHPA) of 1996 was the original […]

What To Do If a Life Insurance Policy Claim Is Denied

Life insurance is usually purchased to make sure a beneficiary has some financial means if the policyholder should die. Life insurance contracts promise to pay a beneficiary in a timely manner upon proof of death and compliance with policy terms and conditions. However, because insurance companies would rather not pay out any more than is […]

Insurance Denials for Proton Therapy Treatment for Cancer Patients

Many patients who are receiving treatment for cancer may pursue proton therapy. This recent development in radiation therapy uses protons instead of X-rays. Since X-rays are known to put patients at risk of additional illnesses, proton therapy is extremely promising with fewer side effects. However, the availability of this treatment is limited to only a […]

Health Insurance Litigation Client Review

Mr. Raval was the first attorney I found in a web search. Three other attorneys I spoke with as well recommended him. So, we first encountered his excellence among his peers. We hired him to represent my wife against an LTD (long term disability) claim denial. He convinced the insurance company to reverse its decision […]

Update on Federal Efforts to Ban Discretionary Clauses in all ERISA Cases

Mental Health Matters Act Advances to Senate In May, the Employee and Retiree Access to Justice Act (H.R. 7740) was introduced in the U.S. House of Representatives. The bill seeks to ban discretionary clauses in all employer-sponsored benefit plans governed by ERISA. If passed, this federal ban on discretionary clauses would return ERISA cases to […]

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 While ERISA was originally enacted to safeguard employees’ retirement and pension benefits, its reach and scope has been expanded over the years. […]

Congress Considers Total Ban on Discretionary Clauses in ERISA Plans

Earlier this month, the Employee and Retiree Access to Justice Act (H.R. 7740) was introduced in the U.S. House of Representatives. A companion bill was also introduced in the Senate as S. 4219. The bill seeks to ban discretionary clauses in all employer-sponsored benefit plans governed by ERISA. If passed, this federal ban on discretionary […]

Prudential’s Long Term Disability Denial Overturned by Texas Federal Judge

At Berg Plummer & Johnson, LLP we often deal with long term disability claim denials. We are pleased to report the good news for our client, Kristy Midkiff, where we served as local counsel alongside Terry Coleman. The case of Midkiff v. Prudential is a study in some of the twists and turns a long term disability […]

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 […]