Practice Highlights

We have a proud history of partnering with our clients in the defense of life, health, disability and ERISA claims.
We were particularly honored when clients were influential in our being named a “Go To” Law Firm for Litigation in this practice area, a distinction noted in both Forbes and Corporate Counsel magazine.
Our lawyers are regularly asked to speak at industry conferences, seminars and meetings.

Practice News

The Legal Intelligencer Names Wes Payne an "Unsung Hero" for Pro Bono Work
February 22, 2012

ERISA or Not?—What Difference Does It Make?
October 4, 2011

In Wutz Judge Wettick Further Defines Discovery And Trial Procedure For Underinsured Motorist (UIM) Cases When A Bad Faith Claim Pursuant To 42 Pa. C.S.A. § 8371 Is Also Alleged
January 2010
CounterPoint

Life, Health, Disability and ERISA

As benefit protections erode with each wave of legislation, life, health and disability decisions are being scrutinized at every level. Whether the inquiry is from an insurance department, the DOL, a judge or claimant, insurers and plans are on the hot seat. Today, the challenges of life, health and disability fiduciaries are more prominent than ever. It seems as though the landscape in which insurers and plans are required to draft new policy and plan language, interpret existing policy and plan language, and adjudicate claims—both ERISA and non-ERISA—is ever-changing.

The Life, Health, Disability and ERISA Group represents insurers, employers, brokers, re-insurers, third-party administrators, self-insureds, ERISA plans and related entities in a wide array of matters that include the routine as well as the unexpected. Our lawyers have a wealth of solid experience and broad knowledge from years of handling complex and unique issues under both individual and group plans.

Whether under the Employee Retirement Income Security Act of 1974 (ERISA) or other federal, state, insurance or regulatory laws, the LHD&E Group brings an unbridled commitment to quick, efficient and aggressive resolution of life, health and disability matters. With extensive trial experience in this area, we are able to deliver results in the courtroom as well as in alternative dispute resolutions. We understand that, while results are paramount, we must also provide our clients with timely, proactive and cost-efficient advice.

Life, Health and Disability Individual Policies

In the ever-changing landscape of individual first-party insurance disputes, the LHD&E Group has been a leader in shaping life and disability case law across the nation. From pioneering the first manifest defense in New Jersey to creating the distinction between “totally disabled” v. “residually disabled” in New York, we have guided clients successfully through the bad faith thicket.

We often apply our broad experience to pre-litigation claims, providing our clients with solid advice and insight to protect their rights and resolve issues prior to litigation. Our lawyers have a broad range of experience handling a wide range of matters, including:

Rescission
First manifest
Residual disability v. total disability
Policy interpretation
Pre-existing conditions
Fraudulent claims
Legal disability
Bad faith
Consumer fraud
Policy lapse issues
Accident v. sickness
Appropriate care
Beneficiary disputes
Inter-company arbitrations
Failure to provide proof of loss
Pre-litigation claims advice

ERISA

Comprehensive experience and attention to detail set our ERISA lawyers apart. We are dedicated to helping our clients through the maze of the ERISA statute, regulations and case law and are well-versed in establishing and maximizing ERISA protections. Whether counseling clients as to fiduciary obligations or on plan administration, arguing ERISA applicability or the ERISA standard of review, defending against overbearing discovery requests or claims alleging fiduciary breach (for statutory penalties or ERISA attorneys’ fees), we defend insurers, employers, employee benefit plans, sponsors and fiduciaries in confronting the ever-expanding issues and exaggerated claims they face.

We have solid experience in dealing with a wide array of ERISA issues in a variety of contexts, including group welfare benefit plans—life, accident, health, disability, severance and long-term care, among others—as well as pension and retirement plans. We understand the implementation and enforcement of ERISA regulations and their impact on our clients. Our approach to ERISA blends years of experience with proactive and efficient resolutions. We provide legal advice and handle ERISA matters in the following areas:

Benefit entitlement
Plan interpretation and administration
Plan amendments
Breach of fiduciary duty
Conflicts of interest
Discovery outside the administrative record
Standard of review
Exhaustion of administrative remedies
Claims for restitution of plan benefits
Statutory penalties
Attorney’s fees
Preemption
Removal
Employee benefit plan design
Summary plan descriptions
ERISA exemptions: church and government plans
Compliance issues

Health

The healthcare industry is experiencing enormous upheaval. The system is under extreme pressure to change, with the ripple effect foisting untold duress upon health insurers, plan administrators, employers and providers.

Our group has the experience to navigate clients though this healthcare minefield. Recent changes in the law, as well as decisions by State and Federal courts, are shifting the nature of liability and eroding existing protections. New theories are being invented and old ones expanded. We have extensive experience representing and counseling in various areas of healthcare law. Our representations include:

Benefit entitlement
Compliance Issues under ERISA, PPACA, fraud and abuse laws and pertinent regulations
Healthcare antitrust claims
Fraud
Medicare and Medicaid fraud and abuse
RICO
HIPAA analysis and implementation
Coverage issues
Counseling third-party administrators
Bad faith
Breach of fiduciary duty
Plan interpretation

Representative Matters