Law Professor Says Supreme Court Decision May Lead To More Approved Employee Health Benefit Claims

Lexington, VA Wednesday, September 03, 2008

In a new article published by Health Affairs, the leading journal of health policy, Washington and Lee School of Law Professor Tim Jost concludes that a recent Supreme Court decision will likely lead to more approvals of health insurance claims submitted by employees and more litigation over those claims that are denied.

The Supreme Court's June 2008 decision, Metropolitan Life Insurance (MetLife) v. Glenn, interpreted the Employee Retirement Income Security Act (ERISA), the federal statute that governs the health, disability, and pension benefit plans of employers. The Court recognized the conflict of interest that often faces ERISA plan administrators: Under ERISA, the plan administrator -- either the employer itself or a third-party insurer -- often both evaluates the claims made by employees and pays the claims it decides to approve. In MetLife, the Supreme Court made it easier for this conflict to be invoked in court by employees who sue the plan administrator to reverse denied claims.

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Timothy S. Jost holds the Robert L. Willett Family Professorship of Law at the Washington and Lee University School of Law. He is a co-author of the casebook Health Law, used widely throughout the United States in teaching health law, and of a treatise and hornbook by the same name. He is also the author of Health Care Coverage Determinations: An International Comparative Study; Disentitlement? The Threats Facing our Public Health Care Programs and a Rights-Based Response; and Readings in Comparative Health Law and Bioethics. His most recent book is Health Care at Risk: A Critique of the Consumer-Driven Movement from Duke University Press.

Health Affairs is the leading journal of health policy thought and research and is consulted by 55% of staff members on U.S. congressional committees of jurisdiction in health. Published since 1981, Health Affairs is nonpartisan and presents a wide range of research and commentary on health issues of current concern in both domestic and international spheres. The Health Affairs website receives over 1 million page views each month.

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