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Tag Archives: Insurance

Record supports denial of long-term disability benefits

Aetna did not abuse its discretion in denying an employee’s request for long-term disability benefits following a car accident. Although the employee initially received short-term benefits, subsequent examinations by both treating and independent medical professionals concluded she was capable of ...

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Medical group can sue insurer for unpaid bill

A healthcare provider has a private right of action under a statute that requires medical insurers to pay for emergency care without prior authorization regardless of whether the provided emergency services are in-network or out-of-network. The insurer’s demurrer to the ...

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Doctors can use statute to sue over insurance payment

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Doctors who billed nearly $250,000 but were paid less than $15,000 can sue their patient’s health plan under a Virginia statute setting pay rates for out-of-network emergency care, a circuit judge has ruled. A statute establishing what’s known as the ...

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‘True excess’ and ‘coincidental excess’ policies distinguished

In a case stemming from a wrongful death settlement, one carrier argued the “other insurance” language in two policies rendered both true excess policies, thereby requiring pro rata sharing of the burden. But one policy was found to be a ...

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