D. Michael Reilly

D. Michael Reilly

Lane Powell PC

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ERISA: Winning Tactic on Summary Judgment to Prove Claimant Received the Policy: Get Key Evidence into the Administrative Record

You know that to apply an exclusion in a policy, the claims administrator must show that the claimant received the policy. But what happens when the claimant submits a declaration disputing your proof that she received...more

2/22/2017 - Disability Insurance ERISA Policy Exclusions Summary Judgment

ERISA: 7 Things to Know About Limited Discovery in ERISA Long Term Disability Cases

You already know that discovery in ERISA cases is generally limited because of the “significant ERISA policy interests of minimizing costs of claim disputes and ensuring prompt claims-resolution procedures.”...more

2/15/2017 - Aetna Disability Benefits Discovery ERISA Life Insurance Long Term Disability Insurance

ERISA: Fibromyalgia – “[D]iagnosis is not the automatic equivalent to a finding of disability.”

Fibromyalgia cases often are difficult to assess in determining eligibility for benefits. But the mere diagnosis of a condition (like fibromyalgia) is not enough to qualify for disability benefits under most policy...more

2/8/2017 - Denial of Benefits Disability Disability Benefits ERISA Summary Judgment

ERISA (7th Circuit): Four Ways To Inoculate Claims Denials From Allegations That a ‘Conflict of Interest’ Affected Your Decision

In the back and forth of the disability claims process, decisions on whether someone is disabled can change. Claims administrators are “entitled to seek and consider new information and, in appropriate cases, to change its...more

1/10/2017 - Conflicts of Interest Disability Benefits ERISA

ERISA: Happy New Year? 10 Things You Need to Know About the Newly Published Regulations Affecting Future ERISA Claims/Appeals

The Department of Labor’s Employee Benefits Security Administration just published final regulations that change the ERISA disability claims and appeals process. Here are 10 things you should know about these new...more

1/9/2017 - Disability Benefits DOL EBSA Employee Benefits ERISA

ERISA (D.C. Cir.): Do You Know the Difference Between a “Payroll Practice,” and Short Term Disability Benefits Governed by ERISA?

What happens when an employer provides a disabled employee continued regular wages, paid out of general employer assets? This is known as a “payroll practice”… and ERISA may not apply. A new case that highlights the...more

12/6/2016 - Denial of Benefits Disability Benefits ERISA

What Employers Need to Know NOW About Washington State’s Minimum Wage and Paid Sick Leave Laws

Elections matter for employers in Washington. Although the November election results have not yet been certified, Washington voters appear to have passed Initiative 1433, the ballot measure requiring paid sick leave and...more

11/28/2016 - Ballot Measures Minimum Wage Paid Leave Paid Sick Leave Act Sick Leave Sick Pay Wage and Hour

ERISA (9th Circuit): How Long Can a Sedentary Person Sit? You Better Check the Dictionary of Occupational Titles

So how do you define “sedentary work”? Can you define it by using a Functional Capacity Assessment? Can you disregard the Dictionary of Occupational Titles (DOT) in your assessment? Probably not. Here’s the case of...more

11/7/2016 - Appeals Disability ERISA Functional Capacity Evaluations

ERISA: Failure to Present “Objective Findings of Impairment” Supports Denial of Mental Disability Claim

You know that courts can expect a claimant to establish “objective evidence of impairment” from a physical condition. But does this apply to claims arising out of a mental condition?...more

11/1/2016 - Disability Benefits ERISA Life Insurance Mental Health

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

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