Justia Insurance Law Opinion Summaries

Blue Mountain Energy appealed a Benefits Review Board decision affirming an award of black lung benefits to Terry Gunderson. An administrative law judge (ALJ) originally denied benefits under the Black Lung Benefits Act (BLBA), and Gunderson appealed to the Board and then to the Tenth Circuit Court of Appeals. The Tenth Circuit remanded for further proceedings because the ALJ did not sufficiently explain the basis for the denial. The ALJ again denied benefits, and the Board vacated and remanded the ALJ’s decision because it did not comply with the Tenth Circuit’s remand. On the second remand, the ALJ awarded benefits, and the Board affirmed. Blue Mountain petitions for review, arguing that the ALJ violated the Administrative Procedure Act (APA). Specifically, Blue Mountain contended the ALJ gave the preamble to the regulations redefining compensable pneumoconiosis in 20 C.F.R. 718.201 the force and effect of law, even though the preamble had not been subject to APA notice and comment. Blue Mountain also contended its rights under the APA were violated when the ALJ refused to reopen the proceedings to allow it to submit evidence challenging the medical literature cited in the preamble. After review, the Tenth Circuit found no reversible error as Blue Mountain argued, and affirmed. View "Blue Mountain Energy v. Director OWCP" on Justia Law

Lee Ann Helfrich received benefits through her federal-employee health-insurance plan, the Blue Cross and Blue Shield Service Benefit Plan, for the treatment of injuries she sustained in a car accident. After Helfrich reached a settlement with the other driver’s insurance company, Blue Cross and Blue Shield Association (BCBSA) and Blue Cross and Blue Shield of Kansas City (BCBSKC) sought reimbursement for the benefits paid, as provided in the terms of the Plan. Helfrich appealed the district court’s judgment requiring her to reimburse BCBSA and BCBSKC (together Blue Cross) because the Federal Employees Health Benefits Act of 1959 (FEHBA) preempted a Kansas insurance regulation prohibiting subrogation and reimbursement clauses in insurance contracts. Finding no reversible error in the district court’s judgment, the Tenth Circuit affirmed. View "Helfrich v. Blue Cross & Blue Shield Assoc" on Justia Law