D. Michael Reilly

D. Michael Reilly

Lane Powell PC

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ERISA: 9th Circuit — Does “Reopening” A Claim, AFTER The Statute of Limitations Has Run, Waive That Defense?

ERISA claims administrators sometimes are asked to “reopen” a claim, after appeal denial, to consider additional information. How does “reopening” a claim affect the statute of limitations defense? If the...more

4/15/2014 - Deloitte ERISA MetLife Reopening Laws Statute of Limitations

ERISA (7th Cir.): Beneficiary and Attorney Who Ignore Subrogation Lien for Medical Bills Paid by ERISA Plan “Better Call Saul”

You have seen this one before: The ERISA plan pays hundreds of thousands of dollars in medical bills and secures an equitable lien. Then, the ERISA plan beneficiary settles a tort claim, but refuses to reimburse the ERISA...more

3/27/2014 - Beneficiaries ERISA Liens Subrogation

ERISA – 2nd Circuit: Reversible Error To Deny Successful Claimant’s Attorney Fees Solely Because There Was No Evidence of Bad...

Can a court deny a successful ERISA claimant’s attorney fees solely because there is no evidence of bad faith? NO....more

3/18/2014 - Attorney's Fees Bad Faith Disability Disability Benefits ERISA Reversible Error

ERISA: 10th Circuit — How to Win Two Frequent Challenges to ERISA Benefit Denials

How do you defeat two arguments frequently used to challenge an ERISA-governed disability claim denial? Argument (1) the rationale for the claim denial changed, or Argument (2) the denial letter failed to tell...more

3/5/2014 - Denial of Benefits Disability Benefits Employee Benefits ERISA

ERISA: 6th Circuit — Failing to Disclose Disability Claim in Bankruptcy NOT Fatal to Disability Lawsuit

What happens when a long term disability claimant declares bankruptcy, and fails to list the long term disability claim in the bankruptcy estate? Is he judicially estopped from bringing the lawsuit alleging wrongful...more

2/7/2014 - Chapter 13 Consumer Bankruptcy Debtors Disability Benefits ERISA Judicial Estoppel

ERISA – 11th Cir. — Social Security Determinations Issued AFTER Initial Claim Denial Must Be Considered?

You already know that a Social Security disability (SSDI) decision should be considered in the context of deciding whether the claimant is disabled under the terms of the disability policy....more

2/5/2014 - Denial of Benefits ERISA Social Security Social Security Disability

ERISA: Court Disregards Three Decades of IRS Letter Rulings – “Church Plan” Exemption Applies Only if Plan Established by “Church”

You already know that a “church plan” is exempt from ERISA, unless the Plan specifically elects to be governed by ERISA under Internal Revenue Code Section 410(d). But what does it take to become a “church plan”?...more

1/14/2014 - Churches ERISA Exemptions IRS Religious Institutions

ERISA: Good News — Supreme Court Enforces Suit Limitations Provision

Are those three year suit limitations provisions in ERISA-governed long term disability plans enforceable? YES! Here’s today’s case, Heimeshoff v Hartford Life & Accident Insurance Co., __ U.S. __ (December 16, 2013)...more

12/18/2013 - Claims Limitations Period ERISA Heimeshoff v. Hartford Life & Accident Insurance Co. SCOTUS

ERISA – 6th Circuit: Reversing Decades of Precedent — Court Orders Disgorgement of Profits in Long Term Disability Case

Wow—You need to know what happened last week in the Sixth Circuit: Disgorgement of profits as a remedy in an ERISA long term disability case? Rochow v. LINA, __ F.3d __, 2013 WL 6333440 (6th Cir. December 6,...more

12/11/2013 - Disability Disgorgement ERISA

ERISA: Incorrect Statements During Claims Process Do Not Render ERISA Inapplicable

PROBLEM: During the claim process your claims administrator mistakenly tells the claimant that the ERISA-governed plan is NOT governed by ERISA. Uh oh. Do you lose ERISA as the governing law over the policy and claim?...more

11/26/2013 - Claims Procedures ERISA

ERISA — 4th Circuit: Clearer Language Now Needed to Confer Discretion

What language is needed in the ERISA plan to confer discretion? The bar was just raised in the 4th Circuit. Here’s the case of Cosey v. Prudential Insurance Company of America, [PDF] __F.3d__ (November 12,...more

11/26/2013 - Disability Employee Benefits ERISA

ERISA — Second Circuit: What does it take to assert an effective exhaustion of remedies defense in ERISA cases?

What does it take to assert an effective exhaustion of remedies defense in ERISA cases? Properly drawn plan documents that expressly impose the duty upon the claimant to exhaust remedies before bringing a lawsuit....more

10/14/2013 - Administrative Remedies ERISA

ERISA — When Will A Court DENY Attorney Fees To A Claimant?

You already know that under ERISA a court may, in its discretion, award reasonable attorney’s fees and costs to a claimant seeking benefits if there is a showing of “some degree of success on the merits.”...more

10/3/2013 - Attorney's Fees ERISA

ERISA – 5th Circuit: Ambiguities In Plan Terms CANNOT Be Construed Against Plan Administrator When Plan Confers Discretion “To...

How will a court construe ambiguities in ERISA plan terms? If the plan confers discretion to the administrator “to interpret plan terms,” ambiguities may NOT be construed against the plan administrator....more

10/1/2013 - Abuse of Discretion Death Benefits ERISA Plan Administrators

How will a court construe ambiguities in ERISA plan terms?

If the plan confers discretion to the administrator “to interpret plan terms”, ambiguities may NOT be construed against the plan administrator. Here’s the case of Porter v. Lowe’s Companies, __ F.3d__ (5th Cir....more

9/30/2013 - Abuse of Discretion Ambiguous Death Benefits ERISA

ERISA: Deference to Claim Decision Should INCREASE When Partial Benefits Granted

Did you know that awarding at least some benefits, rather than denying benefits entirely, helps prove the claims administrator is “unbiased”? Also, when there are sharp conflicting opinions between the claimant’s...more

9/26/2013 - Denial of Benefits Employee Benefits ERISA Penalties Plan Administrators

ERISA 5th Circuit: Attorney’s Disability Case “Does Not Have A Leg To Stand On” After Scorned Boyfriend Provides Emails

What happens when an independent, unsolicited source provides evidence that a disability claimant may be committing fraud? Can you consider emails hacked from a computer? What must the claim administrator do to evaluate the...more

9/12/2013 - Disability Disability Discrimination Email Evidence Fraud Hackers

State Insurance Commissioner’s “Non-Binding” Opinion Banning Discretionary Language Has No Effect in Court

An Insurance Commissioner’s non-binding opinion banning discretionary language in an ERISA governed plan has no effect. Here’s the case of Frazier v. Life Insurance Company of North America, __ F.3d __ (6th Cir. August...more

8/20/2013 - Disability ERISA Insureds Insurers Social Security

Airline Pilot’s Disability Claim Does Not “Fly” In Federal Court — Must Be Arbitrated

Where do you litigate an ERISA disability claim governed by a collective bargaining agreement? It has to be sent to arbitration, not to federal court, if the Railway Labor Act applies....more

7/31/2013 - Arbitration Collective Bargaining Disability ERISA Railway Labor Act Subject Matter Jurisdiction

ERISA and Contractual Limitations Provisions: “Don’t worry, be happy”

Does telling a claimant that you “will be happy to reconsider the claim” waive a contractual limitations provision? No. Here is a great new case that highlights virtually every argument that could be used to trump...more

7/23/2013 - ERISA Statute of Limitations

2nd Circuit — Hear This: “Subjective Evidence is Worth its Weight

How do you handle a claim supported only by “subjective” evidence? Can you reject the claim outright? No. You must weigh the subjective evidence. That’s a key point highlighted in a recent case....more

7/5/2013 - ERISA Evidence Medical Examiners

Say What? Terminated Employees ‘Own’ Their LinkedIn Accounts (and the Company’s Trade Secrets)?

Companies are getting a big surprise these days: Employees are leaving with their LinkedIn accounts and the company’s proprietary list of business contacts. LinkedIn is a well-known, business-oriented social media website...more

6/25/2013 - LinkedIn Sensitive Business Information Social Media Social Media Policy Termination Trade Secrets

Supplemental Life Benefits, Paid for by Employee, Governed by ERISA

You know that many ERISA governed plans provide basic life insurance benefits. But what happens when the plan offers employees the choice to purchase supplemental life insurance? If the employee pays the entire premium...more

5/24/2013 - ERISA Life Insurance Premiums Safe Harbors Supplemental Benefits

6th Circuit: Plan Administrators are NOT Necessarily Required to Obtain Vocational Evidence or an IME Before Making their LTD...

In Judge v. Metropolitan Life Insurance Company [PDF], 710 F.3d 651 (6th Cir. 2013), the Sixth Circuit rejected plaintiff’s proposed bright-line rule requiring plan administrators to obtain vocational evidence and an IME...more

5/17/2013 - Delta Airlines Evidence MetLife Vocational Experts

Government Plans are Exempt from ERISA… But What is the Definition of “Government”?

You already know that an employee benefit plan qualified as a “government plan” is exempt from ERISA’s framework....more

5/16/2013 - Employee Benefits ERISA

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