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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...

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...

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...

Medical practices, dental practices and other health care entities must again comply with the federal Corporate Transparency Act (“CTA”). The deadline for compliance is March 21, 2025. What You Need to Know: The Corporate Transparency Act filing deadline is now March 21, 2025. Medical practices and...

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...

December 2024 was an active month for the U.S. Department of Health and Human Services ("HHS"), Office for Civil Rights ("OCR"). OCR announced (i) a $1.19 million civil monetary penalty ("CMP") against Gulf Coast Pain Consultants, LLC d/b/a Clearway Pain Solutions Institute ("GCPC"); (ii) $548,265...

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...

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...

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...

In late September 2024, the U.S. Department of Health and Human Services (“HHS”), Office for Civil Rights (“OCR”) announced a settlement with Cascade Eye and Skin Centers, P.C., a health care provider in the state of Washington (“CESC”), concerning potential violations of the Health Insurance...

This month’s Friday Five covers cases relating to Long-COVID, a class action RICO suit, the physical illness exclusion to accidental death and dismemberment claims, consideration due to an Administrative Law Judge’s disability determination, and self-reported claims of fatigue. The Saul Ewing ERISA...

This month’s Friday Five discusses cases addressing the effect of continuing to receive benefits during the period of alleged disability, reliance on an employer’s records in making a disability determination, the admissibility of expert and lay testimony from a physician in a trial over LTD...