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Expert Analysis

• The Important Role Of Contra Proferentem In ERISA Cases

  

  A Pennsylvania federal court's recent decision in Stein v. Paul Revere Life Insurance illustrates what happens when ERISA plan terms are unclear, and why the contra proferentem principle should be applied uniformly in all ERISA cases, says Mark DeBofsky at DeBofsky Law.

• No Surprises Act Gives Plan Sponsors Savings Opportunities

  

  Under the No Surprises Act, the potential savings for an ERISA group health plan and its participants are significant, and sponsors should focus on the negotiation of third-party administrator service agreements to avoid exposure to breach of fiduciary claims for payment of excessive fees, say attorneys at Hall Benefits.

• HHS Advisory Opinion Serves As Free Drug Program Guide

  

  A careful review of the U.S. Department of Health and Human Services' recent advisory opinion and track record on free drug programs provides a rubric for manufacturers to ensure that similar programs are viewed favorably under the Anti-Kickback Statute, say Dominick DiSabatino and Cortney Inman at Sheppard Mullin.

• ACA Anti-Discrimination Rules May Apply To 3rd-Party Admin

  

  A Washington federal court's recent ruling in C.P. v. Blue Cross Blue Shield, where a third-party administrator applied plan rules that excluded gender-affirming care, potentially expands the scope of covered entities under the Affordable Care Act's anti-discrimination rule, say Kara Backus and Allison Jacobsen at Lane Powell.

• Courts Should Follow 8th Circ. On ERISA Procedure Rules

  

  Other courts should take note of the Eighth Circuit's refusal to view Yates v. Symetra Life Insurance as an administrative law claim and join the growing effort to restore regular civil procedure to Employee Retirement Income Security Act cases, says Mark DeBofsky at DeBofsky Law.

• High Court Ax Of Atty-Client Privilege Case Deepens Split

  

  The U.S. Supreme Court's recent dismissal of In re: Grand Jury as improvidently granted maintains a three-way circuit split on the application of attorney-client privilege to multipurpose communications, although the justices have at least shown a desire to address it, say Trey Bourn and Thomas DiStanislao at Butler Snow.

• Biden Admin.'s Anti-Merger Stance Is Leading To Bad Policies

  

  A U.S. Department of Justice Antitrust Division speech reflects the Biden administration's goal to move enforcement in a markedly anti-merger direction, an approach that is leading to bad policies and enforcement decisions, says Cleary attorney David Gelfand, a former DOJ Antitrust Division official.

• 9th Circ. Should Rethink Inadequate UBH Ruling

  

  The Ninth Circuit should seriously consider rehearing Wit v. United Behavioral Health en banc because its recent claims reprocessing decision in the case raises troubling questions about the future of Employee Retirement Income Security Act's class actions, says Mark DeBofsky at DeBofsky Law.

• Hertz Ruling Could Help Debtors Avoid Make-Whole Premiums

  

  A Delaware bankruptcy court’s recent ruling in Hertz, disallowing claims for make-whole premiums and post-petition interest at the contract rate, could be relied upon by debtors to sidestep those provisions, and potentially provide higher recoveries for equity holders, say Theresa Foudy and Alexander Severance at MoFo.

• Atty-Client Privilege Arguments Give Justices A Moving Target

  

  Recent oral arguments before the U.S. Supreme Court in a case regarding the scope of the attorney-client privilege appeared to raise more questions about multipurpose counsel communications than they answered, as the parties presented shifting iterations of a predictable, easily applied test for evaluating the communications' purpose, say Trey Bourn and Thomas DiStanislao at Butler Snow.

• Predictions For The 2023 Drug Pricing Landscape

  

  2022 was the year of legislative action around drug pricing, while 2023 is likely to serve up precedential judicial action — including active legal challenges with respect to the government's programs covering outpatient prescription drugs, accumulators and third-party funders, says Margaux Hall at Ropes & Gray.

• NY Adult Survivors Act Look-Back: What Orgs Must Know

  

  With the look-back window for New York's Adult Survivors Act now open, survivors of past sexual abuse have a new opportunity to file civil claims — so organizations that could face litigation should take specific steps to ensure best practices both before and after lawsuits arise, say Michael Appelbaum and Christina Holdsworth at Goldberg Segalla.

• Legal Standing For Nature: The Road Not Taken

  

  Fifty years have passed since former U.S. Supreme Court Justice William O. Douglas asked whether natural objects like trees and rivers should have standing — and while the high court has since narrowed access to the courtroom for potential environmental plaintiffs, Douglas' vision is worth revisiting, says Ninth Circuit Judge Margaret McKeown.