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This month’s Friday Five explores decisions from around the country discussing the concept of reasonableness in various forms. One court rejected the parties’ proffered definitions of the term “working” and instead determined that a dictionary definition was reasonable. Two cases reflect courts...
The use of artificial intelligence (AI) by insurance companies is one of the most important regulatory issues currently facing the U.S. insurance industry. Recommendations and decisions concerning insurance policy underwriting, pricing and claims adjudications can now be performed faster and more...
Saul Ewing LLP is pleased to announce that Amy Kline and Caitlin Strauss have been honored in the 2025 JD Supra Readers' Choice Awards for their exemplary authorship of The Friday Five. This prestigious award recognizes the top authors and firms for exceptional thought leadership over the past year...
On March 6, 2025, the U.S. Department of Health and Human Services (“HHS”) Office for Civil Rights (“OCR”) announced a civil money penalty (“CMP”) of $200,000 against Oregon Health & Science University (“OHSU”) for failing to provide a patient’s personal representative with timely access to medical...
Amy Kline, Partner at Saul Ewing LLP and Insurance Practice Co-Chair, will be presenting at the upcoming ILTCI (Intercompany Long-Term Care Insurance Conference Association, Inc.) conference on March 10 beginning at 10:45 a.m. The program will be held at the Philadelphia Marriott Downtown. Amy's...
This month’s Friday Five addresses cases covering ERISA preemption, the viability of a claim for benefits where the claimant alleges to have not received notice of a prior claim denial, an affirmance by the Circuit Court of a denial of benefits, and District Court reviews of decisions denying...
On February 20, 2025, the U.S. Department of Health and Human Services (HHS), Office for Civil Rights (OCR) announced a $1.5 million civil money penalty (CMP) against Warby Parker, Inc. (WP). WP is a manufacturer and online retailer of prescription and non-prescription eyewear. The CMP was finalized...
Marshall Dworkin, Counsel at Saul Ewing LLP, will be speaking at the upcoming Arias 2025 Legal Update Webinar on February 20, 2025. This webinar provides an update and discussion on some of the most significant insurance and reinsurance cases decided by the courts in 2024. Fielding Huseth of Moore &...
During this 60-minute CLE program, insurance industry experts analyzed the use of AI at several points in the insurance policy lifecycle, including underwriting, pricing and claims adjudication, with the goal of helping the insurance industry navigate these unchartered legal waters. Experts from the...
This month’s Friday Five covers an appellate ruling on a complicated case raising both state and federal claims, an instance of procedural improprieties in the administrative review process informing the court’s substantive benefits decision, an equitable ERISA claim for an administrator’s payment...
This month’s Friday Five explores recent decisions including the standard of review for ERISA benefit denials, whether structural conflict entitles a claimant to conflict-of-interest discovery, whether a “relative value units” analysis warrants equitable tolling, whether the administrative record...
This month’s Friday Five explores recent decisions including the impact of a COVID furlough on eligibility for LTD benefits, what constitutes a breach of an employer’s fiduciary duty, what defines total proof of disability or is viewed as a severe procedural violation, and the appropriate weight...
Philadelphia (December 4, 2024) - Saul Ewing LLP announced today that James S. Gkonos, Counsel in the firm’s Insurance Practice, has been appointed Chairman and President of the Federation of Regulatory Counsel (FORC), the premier organization for attorneys who practice insurance regulatory law in...
On November 1, 2024, the U.S. Department of Health and Human Services (“HHS”), Office for Civil Rights (“OCR”) announced a $90,000 settlement with Bryan County Ambulance Authority (“BCAA”), a provider of emergency medical services in Oklahoma, concerning potential violations of the Health Insurance...
On October 31, 2024, the U.S. Department of Health and Human Services (“HHS”), Office of Civil Rights (“OCR”) announced a $500,000 settlement with Plastic Surgery Associates of South Dakota (“PSA”) concerning potential violations of the Health Insurance Portability and Accountability Act of 1996 (...
This month’s Friday Five discusses cases involving ERISA preemption, the methodology for calculating qualified joint and survivor annuity benefits, a dispute over an attempt to supplement the record before the Court, a factual dispute precluding summary judgment on a bad faith claim, and the payroll...
On October 21, 2024, the U.S. Department of Health and Human Services (“HHS”) Office for Civil Rights (“OCR”) announced a civil monetary penalty (“CMP”) of $70,000 against a solo dental practice that provides family dental care, Gums Dental Care, LLC (“GDC”), based on a complaint that GDC failed to...
Insurers’ use of artificial intelligence is under increasing scrutiny from regulators and consumers. California, Colorado, and New York (and several other states) have already issued guidance on the use of artificial intelligence by insurers. Additionally, some states have adopted their own versions...
In October 2024, the U.S. Department of Health and Human Services (“HHS”), Office for Civil Rights (“OCR”) announced the imposition of a civil monetary payment against Providence Medical Institute (“PMI”), a large medical practice based in Southern California with 275 providers who work in 35...