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Defendants in State Case Alleging ERISA Denials File Notice to Remove to Federal Court


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4 days ago
A case originally brought in Orange County Superior Court by five substance use disorder treatment providers against Anthem Blue Cross Life and Health Insurance Company and affiliates will proceed in federal court, per a notice of removal filed Tuesday in the Central District of California.
The Discovery House LLC, Discovery Transitions Outpatient Inc., DHP Heights LLC, MT Golden Corporation, and MT Process LLC, all out-of-network providers of services, including residential treatment, inpatient and outpatient care, therapy, and medication management, filed a complaint Jan. 19, alleging denial of Employee Retirement and Income Security Act (ERISA) benefits; breach of implied, oral, and written contract; breach of covenant of good faith and fair dealing; promissory estoppel; and unfair competition against the defendants. ....

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beritajatim.com - get the latest breaking news, showbiz & celebrity photos, sport news & rumours, viral videos and top stories from beritajatim.com Daily Mail and Mail on Sunday newspapers.

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Second Circuit: Madoff Ponzi Scheme Customers Did Not Receive Fictitious Profit Payments "For Value" | Jones Day


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In the latest chapter of more than a decade of litigation involving efforts to recover fictitious profits paid to certain customers of Bernard Madoff s defunct brokerage firm as part of the largest Ponzi scheme in history, the U.S. Court of Appeals for the Second Circuit held in
In re Bernard L. Madoff Investment Securities LLC, 976 F.3d 184 (2d Cir. 2020) (
Madoff ), that the customers did not have a defense to avoidance and recovery because they received the payments for value. The Second Circuit also ruled that the trustee overseeing the brokerage firm s liquidation properly determined the amount subject to recovery despite calculating the defendants liability by netting the amounts they received against what they invested since the firm s inception. ....

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Judge Rules ERISA Does Not Govern Plan Insuring Sole Employee


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February 10, 2021
Judge Charles Eskridge of the Southern District of Texas ruled Tuesday that the employee health plan of an individual who unintentionally shot themselves while at work is not governed by the Employee Retirement and Income Security Act (ERISA), effectually remanding the matter to state court.
The plaintiff, who is the sole owner and employee of an automobile repair shop, said in the original complaint that they kept a gun at the business for protection. After the accidental self-inflicted injury resulting from “attempting to remove a stuck bullet,” the judge explained, the plaintiff filed a claim with the defendant, Life Insurance Company of North America, for medical and disability benefits. Defendant Matt Reiter, an employee of third-party work-related injury claims administrator Salus Claims Management, denied the plaintiff’s claim, “asserting that using or cleaning a gun wasn’t within the covered scope of employme ....

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Judge Denies UBH's Motion to Dismiss Allegation of Parity Act Violation


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February 1, 2021
On Friday in the District of Utah, Judge Ted Stewart denied United Behavioral Health (UBH) and Motion Picture Industry Health Plan for Active Participants’ motion to dismiss a claim by individual plaintiffs that alleged that the defendants violated the Mental Health Parity and Addiction Equity Act of 2008 (Parity Act) through coverage denial.
The plaintiffs, a parent and a dependent, stated that UBH denied coverage of the dependent’s residential therapy treatment at Evoke Wilderness Program. The company claimed such programs are “experimental and unproven” and that the dependent was “not at risk,” of self-harm or harm to others, “was medically stable, was not experiencing withdrawal symptoms, was not under the care of a psychiatrist, and did not require 24-hour medical or psychiatric care,” the court explained. After the wilderness program, the dependent was admitted to Catalyst Residential Treatment, which the ....

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