ERISA Benefits Litigation

Overview

Employee Retirement Income Security Act (ERISA) benefits litigation is a complex, ever-evolving area of the law. In this dynamic environment, the U.S. Supreme Court regularly hears and rules on ERISA cases that affect fundamental aspects of ERISA litigation. Members of Robinson+Cole’s ERISA Benefits Litigation Team are at the forefront of ERISA law. We understand the federal and state ERISA regulations and how they evolve. Additionally, we frequently track the ERISA activity of all the U.S. Courts of Appeals.

Our Services

Robinson+Cole is one of the few firms in the Northeast and Florida with a specific team of lawyers and nonlawyer professionals who focus on advising and defending employers, plans, and insurers in connection with claims for employee welfare benefits, including the following:

  • federal appeals shaping ERISA procedures governing insured benefit claims
  • complex health care issues involving ERISA
  • claim procedures to ensure that claim fiduciaries comply with ERISA regulations
  • payor/provider disputes
  • provider de-listing disputes
  • pharmacy benefit manager (PBM) antitrust claims
  • nonparticipating provider reimbursement claims
  • pharmacy benefit plan/provider disputes
  • behavioral health claim disputes, including claims alleging violations of federal and state mental health parity and addiction equity laws

Our wide spectrum of clients includes the following:

  • insurance companies
  • life, health, disability, and accidental death and dismemberment (AD&D) benefit claim administrators
  • health maintenance organizations (HMOs)
  • preferred provider organizations (PPOs)
  • third-party administrators (TPA)
  • PBMs
  • managed behavioral health care claim administrators
  • chiropractic health care claim administrators
  • self-funded plan sponsors

In particular, we have represented claim administrators and plan sponsors in class actions alleging breaches of ERISA fiduciary duty, violations of mental health parity laws, improper offsets against benefits for Social Security disability income benefits, and third-party tort settlements.

Our Team

Our lawyers routinely speak and write on ERISA ligation topics and are leaders in professional associations and industry groups involving the business of life, health disability, and AD&D insurers. We are active participants in the following organizations:

  • the Defense Research Institute's (DRI) Life, Health, and Disability Committee
  • the ABA's Tort and Insurance Practice (TIPS) Committee on Life, Health, and Disability Insurance
  • the Association of Life Insurance Counsel (ALIC).

Additionally, our team members regularly contribute to the ERISA Claim Defense Blog at www.erisaclaimdefense.com.

    • Experience
      • Successfully obtained dismissal of ERISA benefits claim due to expiration of a contractual limitations period, and had that dismissal affirmed on appeal to the U.S. Court of Appeals for the Second Circuit, in Heimeshoff v. Hartford Life & Accident Insurance Co. The U.S. Supreme Court affirmed the Second Circuit’s decision, resolving a conflict among circuit courts regarding the interplay between contractual limitations provisions and case law regarding accrual of ERISA claims.

      • Obtained a favorable appellate ruling in the U.S. Court of Appeals for the Second Circuit reversing judgment for the plaintiff and entering judgment in favor of the defendant on the grounds that the district court erred by finding that the defendant, the insurer/administrator of an ERISA-regulated long-term disability benefit plan, acted arbitrarily and capriciously in denying the plaintiff's claim for continuing disability benefits related to her multiple sclerosis diagnosis because her condition had improved and she no longer met the ERISA plan's definition of disabled. *

      • Obtained an affirmance from the U.S. Court of Appeals for the Second Circuit of the district court's order dismissing a putative class action against our client, which alleged that it had breached its fiduciary duties under ERISA by paying life insurance benefits through establishing and funding a retained asset and issuing beneficiaries checkbooks to access the fully funded account instead of issuing a lump sum settlement check. The secretary of labor filed a brief in which it essentially agreed with the defendant's argument that it had discharged its ERISA fiduciary duties once the beneficiaries' checkbook accounts were established. *

      • Obtained appellate ruling of first impression from the U.S. Court of Appeals for the Second Circuit that an insurer’s dual status as both claims reviewer and payor did not establish per se good cause to allow the introduction of evidence outside the administrative record. The case has had broad implications for procedures in ERISA matters.

      • Obtained summary judgment for a manufacturer in a case brought by 11 retired employees who claimed that the employer's termination of their health benefit coverage violated ERISA because such benefits were contractually vested. 

      • Represented a health insurer acting as third-party administrator in a claim for mental health benefits. Successfully obtained summary judgment on behalf of the health insurer by demonstrating that the insurer was not a plan administrator and did not act as a fiduciary to the plaintiff and, thus, was not a proper defendant in the plaintiff's ERISA action.

      • Represented Health Net against a medical doctor who had filed dozens of cases against Health Net over the past decade. Won summary judgment on breach of contract and unjust enrichment claims asserted by the nonparticipating provider on the grounds that he failed to comply with the requirements for the timely submission of claims. Preserved victory on appeal by persuading appellate court to affirm.

      • Represented a leading disability insurer in what is believed to be the first reported federal court decision in the United States granting summary judgment based on an insured's failure to obtain surgery, which was viewed as a violation of the appropriate care requirement. The court held that insured's refusal to obtain release surgery for carpal tunnel syndrome was a violation of the unambiguous policy provision to seek and accept appropriate medical care for his disabling condition.

      • Represented a Connecticut city and its firefighters' retirement board in federal court litigation alleging that the city and the board breached their respective fiduciary duties regarding the municipal retirement fund for city firefighters. The issue involves the city's ability to use funds in the plan to pay for the health benefits coverage for retired firefighters.

      • Successfully defended a municipality, city council members, and retirement board members against a breach of fiduciary duty claim by certain employees, their union, and retirees contesting the legality of an ordinance amending a benefit fund to create an account to pay the cost of retiree health benefits. Prevailed on a motion to dismiss on grounds that the plaintiffs lacked standing due to lack of actual or imminent harm.

      • Successfully defended a financial institution and its pension plan against a claim by plan participants for additional retirement benefits. The case involved an issue of first impression concerning the effect of a retroactive amendment to the plan and whether the plan was in operational compliance with the applicable laws. We prevailed on summary judgment at the district court level, and the decision was affirmed by the Second Circuit Court of Appeals.

      • Obtained a favorable appellate ruling on two issues of first impression in the Second Circuit Court of Appeals in an ERISA-governed long-term disability claim for a benefits action on behalf of our client, a major insurer. In affirming the district court's grant of summary judgment to the insurer and reversing the district court on its denial of the insurer's counterclaim for return of overpaid plan benefits, the Second Circuit split with other circuits and made two precedential rulings favorable to ERISA plans. First, the Second Circuit ruled that the ERISA plan documents control whether the plan vests discretionary authority with a claim administrator and that ERISA does not require that the participant receive notice for the arbitrary and capricious standard of review to be applied by courts. Second, the Second Circuit ruled that recovery of overpayments of benefits caused by a plan participant's simultaneous receipt of "other income" benefits created an equitable lien by agreement, which permitted the insurer to seek return of the overpaid benefits under ERISA § 502(a)(3), even though the participant had dissipated the funds. In doing so, the Second Circuit reversed the district court's denial of the insurer's counterclaim under ERISA § 502(a)(3) to recover overpayment of short-term disability benefits. *

      • Plaintiff, on behalf of herself and her late husband's estate, brought a state court suit against an employee benefits plan administrator and others, asserting state law medical malpractice claims. Defendants removed action to federal court. The U.S. District Court for the Eastern District of New York denied the plaintiff's motion to remand and dismissed the action on grounds that it was preempted by ERISA. The plaintiff appealed. Following partial affirmance, 321 F.3d 83, and remand, 542 U.S. 933, 124 S. Ct. 2902, 159 L.Ed.2d 808, the Court of Appeals held that claims were preempted by ERISA, affirming the district court's ruling. This case was a companion case to Aetna Health Inc. v. Davila, in which the U.S. Supreme Court set forth a bright-line test for complete ERISA preemption. *

      • Obtained affirmance in the Second Circuit of a district court order granting summary judgment dismissing plaintiff's state law action alleging that she was entitled to $440,000 regarding her deceased husband's failure to convert his ERISA-based life insurance coverage to an individual life insurance policy on the grounds that the claim was completely preempted by ERISA. *

      • Obtained summary judgment for our client, a health insurance company, dismissing a claim for benefits under an ERISA-regulated health benefits plan seeking coverage for growth hormone replacement therapy (GHRT) for an adolescent on the grounds that the requested treatment was not medically necessary. * 

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      * Atty. Michael Bernstein was counsel in these representative matters before joining Robinson+Cole.

Our Team

Members