Health insurer’s three-word denial brings cold shoulder from 2nd Circuit

Workplace Issues

By Mark D. DeBofsky

Mark D. DeBofsky is a name partner of DeBofsky & Associates P.C. He handles civil and appellate litigation involving employee benefits, disability insurance and other insurance claims and coverage, and Social Security law. He can be reached at mdebofsky@debofsky.com.

Posted April 27, 2016 3:13 PM

In Halo v. Yale Health Plan, 2016 WL 1426291 (2nd Cir., April 12, 2016), the 2nd U.S. Circuit Court of Appeals recently addressed whether an Employee Retirement Income Security Act-governed health insurance plan’s failure to issue a benefit determination compliant with federal claims-processing regulations should be penalized and, if so, how.The U.S. District Court had ruled that substantial compliance with the regulations was sufficient to preclude punishment. However, the federal court of appeals disagreed, holding …

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