D. Michael Reilly

D. Michael Reilly

Lane Powell PC

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ERISA: Are Social Security Administration Disability Decisions, Made After the Final Claim Decision, Part of the Administrative...

Are Social Security Administration disability determinations, issued after the final appeal decision, part of the ERISA administrative record? NO. Plaintiffs often seek reversal of a denial of ERISA-governed disability...more

10/11/2016 - Disability Benefits ERISA Medical Records Notice for Independent Medical Exam Social Security Administration (SSA)

ERISA: How Do You Spell (Equitable) Relief?

In an ERISA case, what does it take to assert a claim for equitable relief? If the complaint does not assert an alleged breach of fiduciary duty, the claim for equitable relief should be dismissed… Here’s the case of...more

9/22/2016 - Breach of Duty Disability Benefits Equitable Relief ERISA Fiduciary Duty

ERISA: Court Establishes New Incentive to Bring Early Motions to Dismiss “Breach of Fiduciary Duty” Claims

You know that in ERISA cases most courts typically will limit review to the administrative record, absent special circumstances. Courts may also allow limited discovery when assessing whether a “conflict of interest” affected...more

9/22/2016 - Breach of Duty Conflicts of Interest Discovery ERISA Fiduciary Duty

ERISA Preempts State Law Requiring Insurer “Prompt Payment”

Alaska’s prompt pay statute—which requires insurers to pay benefit claims within 30 days of submission—is preempted by federal laws governing employer-provided benefits and benefits for government workers, a federal judge...more

8/24/2016 - Alaska Employee Benefits Employer Group Health Plans ERISA FEHBA Health Insurance Preemption Prompt Payment

ERISA: “Key Evidence Needed to Prove the Intoxication Exclusion”

You know that many insurance policies and ERISA-governed plans exclude from coverage disabilities “resulting from, or related to…any accident related to the voluntary influence of any drug, narcotic, intoxicant or chemical….”...more

8/16/2016 - Blood Tests Burden of Proof ERISA Evidence Intoxication Long Term Disability Insurance Policy Exclusions

DOL Increases Penalties on ERISA Plans – August 2, 2016

The Department of Labor (“DOL”) just increased civil monetary penalty amounts that may be assessed for violations of Title I of the Employee Retirement Income Security Act of 1974 (ERISA)....more

8/16/2016 - Civil Monetary Penalty DOL ERISA Form 5500 Summary of Benefits and Coverage

ERISA — 7th Circuit: Under De Novo Review, the Court “Should NOT Resolve[] Doubts or Gaps in the Evidence in [the Claimant’s]...

You know that claimants have the burden to establish eligibility for ERISA-governed disability benefits. Sometimes gaps in coverage can occur when, for example, a claimant alleges disability while using accrued vacation....more

8/1/2016 - Burden of Proof De Novo Standard of Review Denial of Benefits Disability Benefits ERISA Long Term Disability Insurance Vacation Leave

ERISA: Is It Wrong to Take an Offset for Social Security Benefits Received by the Children of a Long Term Disability Claimant?

Is it wrong to take an offset for Social Security benefits received by the children of a long term disability claimant? No, says a new decision. And… just because you reinstate benefits does not mean you have to provide...more

6/21/2016 - Benefit Off-Sets Disability Benefits ERISA Long Term Disability Insurance Social Security Benefits SSDI

For ERISA Section 502(c) Penalties — Must Plaintiff Prove “Actual Injury”? A Recent U.S. Supreme Court Decision Creates the...

These Section 502(c) penalty claims seem to be added to most every ERISA lawsuit... Does a claimant have to prove “actual injury” to win ERISA Section 502(c) penalty claims? MAYBE. Here’s why...more

6/20/2016 - Actual Injuries Article III ERISA FCRA Injury-in-Fact Penalties Plan Administrators Section 502 Spokeo v Robins Standing

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

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