Archive: 2018

Proton Therapy Treatment Approved After Insurer Initially Denied Claim

By Amar Raval December 31, 2018 Posted in Blog, News & Events

At Berg Plummer Johnson & Raval, we have represented clients whose claims for proton therapy treatment have been denied. Whether you have been denied coverage for proton therapy treatment or...

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Fifth Circuit Explains Breach of Fiduciary Remedies and Need for Complete Plan Documents

By Amar Raval October 5, 2018 Posted in Blog

An important case out of the Fifth Circuit issued earlier this week outlines several issues related to ERISA. However, we want to highlight its explanation of the scope of ERISA’s equitable...

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Mississippi Judge Finds “Decades-Long” Pattern of Misconduct by Reliance Standard in Disability Cases

By Amar Raval July 19, 2018 Posted in Blog

A judge in the Southern District of Mississippi found a “decades-long pattern of arbitrary claim denials and other misdeeds” by Reliance Standard in long term disability cases[1]. The facts of the...

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Fifth Circuit Court Reverses the Denial of Accidental Death Insurance Benefits in a West Nile Virus Case

April 30, 2018 Posted in Blog

On March 22, 2018, the Fifth Circuit Court of Appeals — in Wells v. Minnesota Life Insurance Co., where the defendant-insurer denied accidental death coverage to the plaintiff under her husband’s...

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Fifth Circuit Court Overrules the Abuse of Discretion Standard in ERISA Denial of Benefits Cases

March 23, 2018 Posted in Blog

On March 1, 2018, the en banc Fifth Circuit Court of Appeals — in Ariana M. v. Humana, an ERISA health benefits case where the plan administrator denied benefits — ruled in favor of our plan...

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What Constitutes Material Breach in Texas?

February 28, 2018 Posted in Blog

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...

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The Enforceability of Texas Non-Compete Agreements

February 21, 2018 Posted in Blog

In most states, covenants not to compete are legal, but are limited in effect so as to prevent unreasonable abuse of such restrictions.  Similarly, in the state of Texas, the legislature enacted the...

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Insurers Use Social Media to Investigate Disabled Claimants

January 26, 2018 Posted in Blog

Disability insurers — both long-term and short-term — now regularly investigate the social media profiles (i.e., Facebook, Instagram, Twitter, etc.) of their policyholder-claimants to determine...

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

January 12, 2018 Posted in Blog

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...

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