Upcoming insurance week: October 25, 2021


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(Reuters) – Here are some events of interest to the insurance law community this week. All times are local, unless otherwise noted.

Monday, October 25

4:00 p.m. – The U.S. Department of Justice’s consolidated complaint against Kaiser Permanente is due to be filed in federal court in San Francisco, following its July decision to intervene in six long-running whistleblower trials accusing the giant of health for overcharging the government for services to Medicare-enrolled patients. Benefit of managed care plans. U.S. District Judge Edward Chen will hold a first case management conference on the consolidated complaint on Tuesday, October 26 at 1:30 p.m. Kaiser Permanente denies the allegations.

The main case is US ex rel Osinek v. Kaiser Permanente, US District Court for the Northern District of California, No. 13-cv-03891. For the United States: Assistant Deputy Attorney General Sarah Harrington of the United States Department of Justice; Assistant U.S. Attorney Benjamin Wolinsky of the Northern District of California. For the rapporteur applicants: Eric Gibbs, Gibbs Law Group; Mark Hardiman, Nelson Hardiman; William Hanagami, Hanagami Law Firm; Roger Lewis, Goldberg Kohn; J. Bernard Alexander by Alexander Morrison + Fehr; R. Scott Oswald, Labor Law Group; Daniel Twetten, Loevy & Loevy; Mike Ronickher, Constantine Cannon For Kaiser Permanente: David Deaton, O’Melveny & Myers.

Tuesday October 26

9:00 a.m. – 6th U.S. Circuit Court of Appeals to Hear Arginaw Chippewa Indian Tribe’s Argument That Michigan’s Blue Cross Blue Shield Breached Their Fiduciary Duty, as Benefits Plan Administrator social ERISA of the tribe, not taking advantage of federal regulations. that allow Indian tribes to pay Medicare-like rates (MLR) for services provided by hospitals participating in Medicare. This will be the 6th Circuit’s second review of the case: in 2018, it rejected the tribe’s other arguments to increase its $ 8.4 million judgment against BCBS, but found that the MLR-based claims had been rejected prematurely. While in pre-trial detention, the district court ruled the MLR regulations inapplicable. On appeal, the tribe said the judge adopted an “unduly restrictive interpretation of the MLR settlement,” contrary to the settlement’s stated goal of increasing health services available to the tribes. The case is Saginaw Chippewa Tribe v. Blue Cross Blue Shield of Michigan, 6th United States Court of Appeals No. 21-1226. For the tribe: Perrin Rynders de Varnum. For BCBS of Michigan: Tacy Fletcher Flint of Sidley Austin.

Wednesday October 27

2:00 p.m. – U.S. 4th Circuit Court of Appeals to Hear Philadelphia Indemnity Insurance’s challenge to lower court rulings that its policy covered the collapse of a walkway on the second floor of a compound housing for students at Elon University, and that she had engaged in unjust and deceptive acts. practices under North Carolina law, known as Chapter 75, in handling the claim. The district court awarded DENC LLC, owner of Elon’s Crest, $ 400,000 in damages and $ 221,000 in attorney fees under Chapter 75. Philadelphia argues that the collapse endorsement of DENC’s commercial property policy did not cover the 2018 collapse as it was caused by long-term water damage to the wooden beams supporting the concrete structure, rather than any sudden and unexpected events. Philadelphia also defends its claims-handling process and says the lower court erred in concluding that any error in its communications with the DENC, such as a denial letter citing irrelevant policy provisions, was a deliberate act.

The case is DENC v. Philadelphia Indemnity Insurance, 4th United States Court of Appeals No. 20-1644. For DENC: Gregg McDougal, McDougal Law Firm; John Branch III, Nelson Mullins Riley & Scarborough. For Philadelphia Indemnity: David Brown of Goldberg Segalla.

Friday October 29

10:00 am – The United States Supreme Court will meet to consider certiorari claims, including one challenging an appeal decision that adopted a disparate impact standard on discrimination by ERISA plan sponsors and trustees under the Medicare Secondary Payment Act. In October 2020, a 2-1 panel of the 6th U.S. Court of Appeals relaunched DaVita Inc.’s lawsuit against the Marietta Memorial Hospital Employee Health Benefit Plan and its third-party administrator, Medical Benefits. Mutual Life Insurance (MedBen). Circuit 6 discovered that DaVita plausibly alleged that Marietta and MedBen “indirectly” discriminated against people with end-stage kidney disease by having no network dialysis provider and limiting reimbursement from non-network providers. The 9th Circuit expressly rejected the detention of the 6th Circuit a month later in a similar lawsuit by DaVita, creating a circuit split. The Supreme Court asked DaVita to respond to Marietta’s petition, signaling interest in it.

The case is Marietta Memorial Hospital Employee Health Benefit Plan v. DaVita, United States Supreme Court No. 20-1641. For Marietta Memorial and MedBen: John Kulewicz de Vorys, Sater, Seymour & Pease. For DaVita: Jeffrey Bucholtz of King & Spalding.

2:00 p.m. – The U.S. 4th Circuit Court of Appeals will hear an appeal by K&R Contractors against the 2020 award of black lung benefits to Virginia coal miner Michael Keene. K & R’s only ground of appeal is that the administrative law justices of the United States Department of Labor’s Office of Workers’ Compensation Programs were appointed through a process similar to that which the United States Supreme Court did. ruled unconstitutional in Lucia v. SEC in June 2018; and, despite the ratification of their appointments by the Secretary of Labor, continue to enjoy protections against dismissal that violate the doctrine of the separation of powers. The Ministry of Labor says the two ALJs who reviewed Keene’s eligibility in 2018 and 2019 were duly appointed before acting on K & R’s administrative appeal, and that K&R interprets the revocation protections too broadly. The case is K&R Contractors v. Director, Office Of Workers’ Compensation Programs, 4th US Circuit Court of Appeals No. 20-2021. For K&R entrepreneurs: Charity Ann Barger of the Street Law Firm. For the Director, OWCP: Amanda Mundell, US Justice Department; Cynthia Liao, US Department of Labor.

Do you know of an event that could be included in Week Ahead in Insurance Law? Contact Alexia Garamfalvi at [email protected]

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