Articles Tagged with Kantor & Kantor

For Immediate Release

March 9, 2020

Class Notices are being sent to individuals who were covered under a Blue Shield of California non-ERISA health plan during the period of September 2, 2007 through December 31, 2015, and were denied authorization or reimbursement for residential treatment of anorexia nervosa or bulimia nervosa on the grounds that their plans did not provide coverage for residential treatment.

The Supreme Court handed down a victory on February 26, 2020 to employees whose pension, healthcare or other benefit plans are mismanaged.  Under ERISA, the federal law that governs such plans, those who manage or administer such plans are considered fiduciaries bound by strict standards that require them to act with great care and in the interest of plan participants and their families.  If they fail to meet these requirements or otherwise violate the statute, ERISA give employees six years to sue unless they have “actual knowledge” that the plan managers or administrators violated their duties or the statutory requirements, in which case a three-year period for filing suit applies.  In Intel Corp. v. Sulyma, a unanimous Supreme Court held that Congress meant what it said and that plan participants must actually know about the fiduciary breach or violation to trigger the shorter deadline.  In that case, a pension plan participant stated that he never read financial disclosures posted by his employer on a website.  The Supreme Court held that, in those circumstances, the employee did not automatically gain “actual knowledge” of the plan’s risky investments based on these web postings and therefore his suit was timely.  This decision will ensure that ERISA works as intended so that employees and their families are not prematurely cut off from their right to file suit simply because an employer or insurance company posts information which could have led them to discover mismanagement.  Kantor & Kantor filed a friend-of-the-court brief on behalf of the Pension Rights Center supporting the employee, Mr. Sulyma, and we are very pleased with the result.

For questions about your pension, healthcare, or long-term disability benefits, please call Kantor & Kantor for a free consultation at 800-446-7529 or use our online contact form.

Our law firm receives many inquiries from long-term disability claimants whose insurance companies claim that they overpaid them benefits and insist that the claimants pay them back.  Often, these claimants do not have the money to pay the companies back and want to know their legal rights.

First, it’s important to know the common situations in which these overpayment issues arise.  Group disability insurance companies that fund employer-provided disability benefits draft their policies to include “offsets.”  An offset is a type of other income you might receive (or are eligible to receive) which reduces what the insurance carrier is obligated to pay you.  If you receive other income which applies retroactively, the insurance company will require you to pay back the benefits it paid you during the relevant time period.  As an example, below is language from a Lincoln National Life Insurance Company group disability policy.

RIGHT OF RECOVERY.  If benefits have been overpaid on any claim; then full reimbursement to the Company is required within 60 days.  If reimbursement is not made; then the Company has the right to:

Parents, educators and clinicians are seeing an alarming increase in mental health problems among young people. An ongoing topic of discussion among educators, medical health professionals and politicians is what can be done to curb this problem.

Following similar moves in Florida, Oregon and Utah, a recently introduced bill in the California State Legislature would allow students time off to treat or attend to mental health needs. Senate Bill 849, written by California State Senator Anthony Portantino (D-La Cañada Flintridge), would allow students in elementary school through high school time out of school to treat or attend to mental health needs without risk of being considered truant, a violation that could lead to penalties for students and fines for parents.  Under California’s current education code, mental and behavioral health problems are not eligible for excused absences.

Studies show that a rising number of school-age children in California are struggling with depression, anxiety or thoughts of self-harm. According to the national Centers for Disease Control and Prevention, suicide is the second-leading cause of death among young people ages 15-24. The CDC reported in 2017 that the number of girls 15-19 committing suicide had doubled from 2007 to 2015. The statistics cited show 5.1 suicides per 100,000 in that age group — a 40-year high. The boys suicide rate in that age group climbed 30 percent, to 14.2 per 100,000, in the same time period.

Over the past 15 years, I have represented hundreds of claimants in their claims for disability benefits governed by the Employee Retirement Income Security Act of 1974, also known as ERISA.  If an ERISA disability claim is denied, a claimant must appeal that denial to the plan administrator or insurance company before he or she is able to file a lawsuit.  The appeals process is referred to as exhausting administrative remedies (though there is no administrative agency involved). The ERISA Regulations provide rules that an administrator must follow in order to give a claimant a “full and fair review.”  See ERISA § 503; 29 CFR § 2560.503-1 (Claims procedure).

Effective April 1, 2018, the ERISA Regulations were changed to require that an insurance company or administrator provide to the claimant copies of new evidence it obtains after a claimant submits an appeal so that the claimant has an opportunity to respond to the new evidence before the insurance company issues a final claim decision.  Some insurance companies, however, refuse to provide this evidence to claimants who filed their disability claims before April 1, 2018.

What if you fall into this pre-April 1, 2018 category?  Do you have any rights to know what the insurance company is relying on before it issues a final decision on your appeal?

Kantor & Kantor, LLP, one of the most experienced law firms in the nation dealing with litigating insurance claims against insurance companies, is proud that once again five Partners have been selected to the 2020 Southern California Super Lawyers list.  Co-Founders Lisa Kantor and Glenn Kantor are joined by Senior Partners Alan Kassan and Corinne Chandler, and Partner Brent Dorian Brehm makes his fourth consecutive appearance.

No more than five percent of the lawyers in Southern California are selected by Super Lawyers. Super Lawyers, part of Thomson Reuters, is a rating service of outstanding lawyers from more than 70 practice areas who have attained a high degree of peer recognition and professional achievement. The annual selections are made using a patented multiphase process that includes a statewide survey of lawyers, an independent research evaluation of candidates and peer reviews by practice area. The result is a credible, comprehensive and diverse listing of exceptional attorneys.

The Super Lawyers lists are published nationwide in Super Lawyers Magazines and in leading city and regional magazines and newspapers across the country. Super Lawyers Magazines also feature editorial profiles of attorneys who embody excellence in their practice of law. For more information about Super Lawyers, go to SuperLawyers.com.

There comes a time in your life when you will need to consult with a lawyer – whether it be good news or bad news. A good lawyer works with you, helps you understand the situation, and guides you to the best possible result. At Kantor & Kantor we routinely speak with individuals who have had life, health, and disability claims denied by their insurance companies.

As lawyers we are well-versed in the practice of law, but we rely on the information from our clients to steer us in the right direction and guide each case. It takes TEAMWORK to get the best possible result for our clients.

Here are a few tips for talking to your lawyer and telling them what they need to know.

We represent many clients who have been denied long-term disability benefits in lawsuits against the insurance companies who have denied their claims. Many of our clients ask, “What is the value of my disability claim?”

This question usually presents itself in the context of mediation, which is a form of voluntary alternative dispute resolution, because our clients must decide whether to take the insurance company’s lump sum settlement offer. There are many factors to consider. To aid our clients’ decision-making process, we will prepare a “present value calculation” designed to capture the total value of all benefits in dispute.  In most circumstances, the value of your benefit can be broken up into two parts:  the past-due benefits and the future benefits.  Benefits, both past and future, are calculated by taking your net monthly benefit (total gross monthly benefit minus offsets” for other income you receive) and multiplying by the number of months benefits are due. However, past and future benefits have to be calculated differently in order to account for inflation.

Past-due benefits are calculated by multiplying the net monthly benefit by the number of months of past-due benefits you are owed. Then, we add interest to compensate you for the fact that, had you been properly paid your past-due benefits, those benefits would have been worth more in the past than they are in the present, because inflation has made the value of each dollar decrease over time.  Notably, the insurance carriers seldom factor in interest on the past-due benefits in the context of mediation. However, if your case does not settle and the court makes a decision in your favor, it has the discretion to award prejudgment interest on the past-due benefit. The percentages that courts award vary and range from the nominal interest amount rate dictated by 28 U.S.C. § 1961 (1-year constant maturity Treasury yield) to 10% interest. See, e.g., Blankenship v. Liberty Life Assur. Co. of Bos., 486 F.3d 620, 628 (9th Cir. 2007) (affirming award of prejudgment interest at a rate of 10.01 percent, compounded monthly); Oster v. Standard Ins. Co., 768 F. Supp. 2d 1026 (N.D. Cal. 2011) (finding current U.S. Treasury Rate at .3% too low and awarding prejudgment interest at the rate of 5% ).

In addition to dealing with short term disability benefits, long term disability benefits, and health insurance denials, many of our clients are also tasked with keeping track of changes to their Social Security benefits. Here are some of the changes that will take effect on January 1, 2020 for Social Security recipients –

  • Social Security recipients will get a 1.6 percent cost-of-living adjustment (COLA) in their monthly benefits starting in January. The average individual retired Social Security beneficiary is expected to see a monthly benefit jump from $1,479 to $1,503, an increase of roughly $24 per month or $288 for the year.
  • As a result of the COLA, the maximum monthly benefit a single recipient can get also will grow. That benefit will increase from $2,861 per month in 2019 to $3,011 per month in 2020.

Kantor & Kantor Partner Elizabeth Hopkins filed an Amicus Brief in the Supreme Court on October 28, 2019 for The Pension Rights Center in support of the Ninth Circuit in Intel Corp. Investment Policy Committee et al. v. Christopher M. Sulyma  The case is about whether workers get six years or three years to sue over ERISA violations.

Please see the brief here:  18-1116bsacPensionRightsCenter

For questions on the handling of your Pension benefits, please do not hesitate to contact Kantor & Kantor for a no-cost consultation at (800) 446-7529 or use our online contact form.

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