D. Michael Reilly

D. Michael Reilly

Lane Powell PC

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ERISA: Reviewing What Needs to Be Proved to Establish the Suicide Exclusion

For many reasons, some of the toughest cases to litigate involve the application of the suicide exclusion. There is a growing body of evidence challenging suicide exclusion determinations....more

5/23/2016 - ERISA Life Insurance Plan Administrators Policy Exclusions Preemption Suicide Summary Judgment

ERISA (6th Circuit): Mental Nervous Limitations and Dealing with Arguments of “Organic Cause”

You know that most ERISA disability plans contain a 24-month limitation related to mental/nervous disabilities. But what happens when the claimant alleges the mental illness is “organically caused”? Is that enough to...more

5/12/2016 - Abuse of Discretion Claims Limitations Period Disability Benefits ERISA Long Term Disability Insurance Mental Illness

What Constitutes “Reasonable Efforts” to Inform Plan Participants of Plan Amendments, Which Include a Forum Selection Clause?

You know that many Plans have forum selection clauses. Are they enforceable? YES When a Plan participant claims they “did not know of a plan amendment,” how do you prove the Participant received notice of the...more

4/28/2016 - ERISA Forum Selection Clause Pension Plan Amendments Plan Participants Retirement Plan Transfer of Venue Vesting

ERISA: Sixth Circuit — No Conflict of Interest with Multi-Employer Benefit Plan, Saving Abuse of Discretion Standard of Review

You already know that evidence of a “conflict of interest” can change the standard of review the court applies in ERISA claims. But proper structuring of multi-employer benefit plans can avoid an inherent conflict of...more

3/8/2016 - Abuse of Discretion Conflicts of Interest Denial of Benefits Disability Benefits ERISA Multiemployer Plan Standard of Review Workers' Compensation Defense

BIG NEWS: ERISA Preempts Hodgepodge of State Insurance Reporting Regulations

You know there has been a court trend toward narrowing ERISA preemption. But…that trend was brushed back today by the U.S. Supreme Court. Here’s today’s case: Gobeille v. Liberty Mutual Insurance Com., __ U.S. __ (March 1,...more

3/1/2016 - ERISA Gobeille v Liberty Mutual Insurance Com. Health and Welfare Plans Plan Administrators Preemption Recordkeeping Requirements Reporting Requirements SCOTUS

ERISA — 10th Circuit: What Happens When a “Procedural Irregularity” Occurs in an Appeal Denial?

You know that procedural irregularities in an appeal denial of a claim for ERISA-governed benefits can change the standard of review from arbitrary and capricious to de novo review. But not all the time. The claimant should...more

2/23/2016 - Abuse of Discretion Administrative Appeals Appeals Claim Denial Letters Corporate Counsel Disability Benefits ERISA Reversal

ERISA (5th Circuit): Are There Exceptions to the Exhaustion of Administrative Remedies Requirement

You already know that claimants with a denied claim must submit an appeal and exhaust administrative remedies before filing suit. But are phone calls sufficient to trigger the appeal process?...more

2/10/2016 - Administrative Remedies Appeals Bad Faith ERISA Plan Administrators Special Circumstances Doctrine

Business Success: How to Establish a Winning Company Culture

True business leaders are good at what they do — they are skillful planners, have passion for what they do and exercise good judgment. At a recent Seattle seminar for startup companies, I stressed that “company culture”...more

1/29/2016 - Corporate Culture Employee Engagement Job Promotions Leadership Performance Reviews

Bad News for ERISA Plan Reimbursements: Chase The Money Before Settlement Funds Dissipate, Supreme Court Rules

This just in…. A big debate was resolved today by the United States Supreme Court: Can an ERISA plan sue to recover medical expenses paid on the participant’s behalf after the settlement funds have dissipated?...more

1/21/2016 - Employee Benefits ERISA Medical Expenses Medical Liens Montanile v Board of Trustees Reimbursements SCOTUS Settlements

Avoiding ERISA Medical Treatment Class Actions with Arbitration Provisions?

Insurers are getting hit with more class actions regarding the denial of medical treatments, like behavioral therapy treatments for autism spectrum disorders. These can be expensive: In May 2015 ConAgra Foods Inc. and Blue...more

12/29/2015 - Aetna Arbitration Agreements Class Action Class Action Arbitration Waivers DirecTV v Imburgia ERISA Federal Arbitration Act SCOTUS

ERISA (6th Circuit): So How Many Hours Is Working “Full-time,” Anyway?

What happens when the ERISA long term disability benefit plan does not define “full-time”? The Department of Labor says “full-time” is defined by the employer....more

12/8/2015 - Affordable Care Act Disability Benefits DOL ERISA Full-Time Employees

Be On The Lookout: New Proposed Claims Procedures For ERISA-Governed Disability Benefits Are Coming

The Employee Benefits Security Administration (EBSA) announced plans to publish, on November 18, 2015, new proposed claims procedures for handling ERISA-governed disability benefits. ...more

11/25/2015 - Claims Appeal Procedures Comment Period Disability Benefits EBSA ERISA

ERISA: Medical Providers Lack Standing For Reimbursement — Anti-Assignment Provisions Enforceable

You know that patients typically assign rights under a health insurance plan to the provider of medical services. This is accomplished by signing an assignment form upon intake/admission. Then, the healthcare provider sends...more

11/17/2015 - Anti-Assignment Clauses ERISA Health Care Providers Health Insurance Reimbursements Standing

ERISA: Shutting Down Equitable Relief Claims — Disgorgement Claim Dismissed On Rule 12(c) Motion

You already know that in March 2015, the 6th Circuit issued an en banc decision rejecting disgorgement of profits claims. Rochow v. Life Ins. Co. of N. Am., 780 F.3d 364, 372 (6th Cir. 2015)(en banc) (rejecting $3.8 million...more

10/30/2015 - Breach of Duty Disability Benefits Disgorgement Equitable Relief ERISA Fiduciary Duty Motion to Dismiss Prejudgment Interest Prudential Insurance

ERISA — ATTORNEY FEES: What Happens When The Plan And The Insurer Don’t Agree On The Benefit Denial?

You already know that under ERISA the court has discretion to award attorney fees to a party that has “some success on the merits.”...more

10/28/2015 - Attorney's Fees Disability Benefits ERISA Indemnification Insurance Industry Prevailing Party

Three Quick Strategic Responses to Title III ADA Class Action Claims

Our firm is handling a growing tide of Title III of the Americans with Disabilities Act (ADA) claims. Public accommodations — which include retailers, mall owners and restaurants, are prohibited from discriminating against...more

10/26/2015 - ADA Class Action Class Certification Commonality Disability Discrimination Injunctive Relief Injury-in-Fact Public Accommodation Standing Title III Typicality

ERISA – Subrogation: Summary Plan Descriptions Can Be A “Controlling Document” Requiring Reimbursement… Sometimes

You already know that when a Summary Plan Description conflicts with ERISA plan language, the ERISA plan language controls. But what happens when all you have is a Summary Plan Description (SPD), and… no ERISA Plan? Can...more

9/30/2015 - ERISA Reimbursements Subrogation Summary Plan Description

ERISA — 7th Circuit: Illinois State Law Ban On Discretionary Clauses Upheld

You already know about the big trend in states to ban discretionary clauses in insurance policies that fund ERISA benefits. Chalk up another circuit deciding to enforce the ban....more

9/18/2015 - Arbitrary and Capricious De Novo Standard of Review Denial of Benefits Disability Benefits ERISA Insurance Industry Insurance Litigation MetLife Preemption

ERISA: When Does A Claimant Get To “Augment” The Administrative Record?

You already know that judicial review of ERISA claims generally will be limited to the administrative record considered by the claim administrator. But the courts will allow claimants to augment the record if ERISA...more

9/11/2015 - Abuse of Discretion Administrative Appeals Claim Procedures Disability ERISA Judicial Review Notice for Independent Medical Exam

ERISA: 3rd Circuit — Denial Letters That Fail to Detail Plan’s Limitation Period Are Invalid

The courts are expecting more detail in your denial letters about the limitations period. Here’s the case of Mirza v. Insurance Administrator of America, Inc.., No. 13-3535 (3rd Cir. August 26, 2015)(“One very simple...more

9/2/2015 - Adverse Action Claim Denial Letters Deadlines Denial of Benefits ERISA Judicial Review Limitation Periods Plan Administrators

Best Practices for Best Employers: How to Become a Best Workplace Starting Today! - August 2015

Top 5 Legal Developments Every Employer Needs to Know Now - Laws affecting employers are changing faster than ever. If you don’t keep up, you can get burned. Here are a few of the most recent big changes every employer...more

8/21/2015

ERISA: Clarity on When ERISA Applies to Working Owners of Small Companies

You probably already know that in small, wholly owned “mom and pop” businesses, benefits covering only the owners of the business may be exempt from ERISA....more

8/14/2015 - Benefit Plan Sponsors ERISA Family Businesses Preemption Shareholders Small Business Spouses

ERISA (Sixth Circuit) — Medical Reviews: You Need to Explain WHY You are Rejecting the Treating Physician’s Opinions; and Don’t...

You already know that you do not have to give special deference to the opinions of treating physicians. But you need to explain why the treating physician’s opinions are being rejected....more

8/7/2015 - Conflicts of Interest Denial of Benefits ERISA Long Term Disability Insurance Notice for Independent Medical Exam Physicians Plan Administrators Plan Documents Standard of Review

ERISA (11th Cir.): Tougher for Claimants to Win ERISA Statutory Penalty Claims

We see plaintiffs asserting an ERISA claim for statutory penalties more frequently now. These claims seek statutory penalties (up to $110 per day), alleging the plan administrator “fail[ed] or refus[ed] to comply with a...more

7/22/2015 - Disclosure ERISA Plan Administrators Plan Documents Statutory Penalties

The Cost of Bad Performance Reviews: ‘I’m Getting Sued Because My Evaluations Were Too Nice?’

For many companies, employee performance reviews are often an afterthought. A recent survey showed that only 10 percent of employers actually found their current performance review process a “good use of time.” Many...more

7/10/2015 - Collaboration Employee Engagement Employee Evaluations Employee Retention Employer Liability Issues Harassment Performance Reviews Poor Job Performance Retaliation Wrongful Termination

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