D. Michael Reilly

D. Michael Reilly

Lane Powell PC

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ERISA: Public School Teacher’s Employee Benefits Governed by ERISA? Yes!

When you see a claim for disability or life insurance benefits by a public school teacher, you might assume the claim is not governed by ERISA because of the governmental plan exception....more

5/1/2015 - Disability Insurance Employee Benefits ERISA Life Insurance Public Employees Public Schools Teachers

ERISA: Supreme Court to Determine Whether Money is Fungible…When it Comes to Recovery of Overpayments from ERISA Beneficiaries

When it comes to recovery of overpayments from ERISA beneficiaries… money is a fungible commodity in the Eleventh Circuit, but is not a fungible commodity in the Ninth Circuit....more

4/7/2015 - ERISA Medical Reimbursement National Elevator v Montanile Overpayment SCOTUS Subrogation

ERISA: 6 New Trends in DOL Enforcement Actions

The U.S. Department of Labor (DOL) and the Employee Benefits Security Administration (EBSA) just issued a “Fact Sheet” describing Fiscal Year 2014 civil and criminal enforcement activity under ERISA....more

3/30/2015 - DOL Employer Liability Issues ERISA Strategic Enforcement Plan

ERISA — 5 Quick Points: Blowing a Deadline for Decision is Not Necessarily Fatal to Abuse of Discretion Standard

You already know that ERISA regulations require the plan administrator to render a decision on an administrative appeal within 45 days....more

3/24/2015 - Abuse of Discretion Administrative Appeals ERISA Plan Administrators

ERISA: 6th Circuit — Plop Plop, Fizz Fizz: Oh What A RELIEF It Is: No Disgorgement For Arbitrary Denial Of Benefits

Does an arbitrary and capricious denial of ERISA governed disability benefits create a right to disgorgement of profits? NO....more

3/12/2015 - Appeals Denial of Benefits Disability Benefits Disgorgement ERISA

ERISA: Sometimes A Government Employee’s Benefits Could Be Governed By ERISA?

You already know that employee benefit plans established by governmental entities are exempt from ERISA. But ERISA might apply if the employee benefit for the government employee is established through an association....more

2/27/2015 - Benefit Plan Sponsors Employee Benefits ERISA Government Entities Public Employees Public School Boards Public Schools School Districts Trade Associations

ERISA – 9th Cir. Telephonic Beneficiary Designation Enforced — Beneficiary Designation Forms Are NOT Plan Documents

Can a participant designate a beneficiary merely with a phone call? You need to look at the plan documents. But are beneficiary designation forms ERISA “plan documents”? It depends, and it makes a difference....more

2/11/2015

The BYOD Question - Sound advice on ‘Bring Your Own Device’ to work.

The “Bring Your Own Device” to work movement, or BYOD, has drastically changed today’s workplace. In a recent study, Cisco Systems found that 95 percent of the 600 companies surveyed permitted the use of personal devices at...more

2/2/2015 - Bring Your Own Device Data Protection Employer Liability Issues Popular Privacy Concerns Wage and Hour

ERISA-Disability: 1 in 3 Social Security Administration Disability Determinations Involve Mental Disorder Diagnosis

As you know, ERISA plan administrators must consider Social Security Administration (SSA) disability determinations when making the disability benefit decision. ERISA plan administrators are not bound by the SSA’s...more

1/29/2015 - ERISA Mental Health Mental Illness Social Security Adminstration Social Security Benefits Social Security Disability

ERISA: 8th Circuit: Choice-Of-Law Provision Trumps Insurance Regulation Banning Discretionary Review

You already know that when a claimant brings suit alleging wrongful denial of ERISA-governed disability benefits, the first issue the court looks at is: what standard of review applies. If the plan or policy includes...more

1/9/2015 - Abuse of Discretion Choice-of-Law De Novo Standard of Review Disability Benefits ERISA Standard of Review

ERISA: 4th Circuit: When Is A Plan Administrator Obligated To Obtain Medical Records?

You already know that the primary responsibility for providing medical proof of disability undoubtedly rests with the claimant. But does the plan administrator sometimes have an obligation to obtain medical records and...more

1/6/2015 - Appeals Disability ERISA Medical Records Plan Administrators Wells Fargo

ERISA: 11th Circuit Says “Show Me The Money” In Equitable Recovery Of Medical Expenses Even After Disbursement Or Commingling Of...

Can the Plan get reimbursed even when the beneficiary’s settlement funds have been disbursed or commingled? Yes in the 11th Circuit. But watch out in the 9th Circuit....more

10/7/2014 - Beneficiaries Equitable Lien ERISA Insurers Qualified Settlement Funds

ERISA: Plaintiff’s Attorney Fees Denied — Filing Of Lawsuit Was Not Reason Why Benefits Were Granted

You already know that in ERISA cases a court may, in its discretion, award attorney fees if a party achieved “some degree of success on the merits.”...more

8/29/2014 - Attorney's Fees Disability Disability Benefits Employee Benefits ERISA

More Disabled Employees But Fewer Employees Covered With Long Term Disability Coverage

Here is a recent news item showing the scope of the employee disability problem. In a nutshell...more

7/25/2014 - Disability Disability Benefits Disability Insurance Employee Benefits

ERISA (1st Cir.): Lack of Cooperation During Functional Capacity Evaluation Bars Disability Claim

But what happens when the claimant refuses to perform tasks requested, or does not try hard enough during the FCE?...more

6/23/2014 - Disability ERISA Functional Capacity Evaluations

Internships: Yea or Nay? A good program will generate benefits, but be sure to do it right.

Steve Jobs and Bill Gates were interns. Best companies use internships to win the war to recruit talent. The website Internships.com indicates that 56 percent of employers plan to hire more interns this year, up 9 percent...more

6/23/2014 - Employer Liability Issues Internships Young Lawyers

ERISA: “Derivative Standing” Allows Medical Provider To Obtain Reimbursement From ERISA Plan

Medical providers often have a patient/ERISA plan participant assign rights under an ERISA health care plan to allow the medical provider to seek payment for medical services provided....more

6/12/2014 - Employee Benefits ERISA Healthcare Standing

ERISA: Self-Funded Benefit Plans May Not Have To Cover Same-Sex Spouses?

You already know that the Defense of Marriage Act (DOMA), which prohibited recognition of same-sex marriages, was declared unconstitutional. United States v. Windsor, 133 S.Ct. 2675 (2013)....more

5/21/2014 - DOMA Employee Benefits ERISA Marriage Same-Sex Marriage SCOTUS US v Windsor

ERISA 8th Circuit: Deciding Who Is The Beneficiary — The Abuse Of Discretion Standard Trumps The Substantial Compliance Doctrine

Sometimes determining the correct beneficiary for ERISA-governed life insurance benefits can present real challenges. Can the deceased’s will prove the deceased’s intent designating the correct beneficiary? It...more

5/15/2014 - Abuse of Discretion Beneficiaries ERISA Life Insurance Summary Plan Description Wills

ERISA – 9th Circuit: Are There Advantages To De Novo Review Versus Arbitrary And Capricious Review?

You already know that plans that contain “discretionary language” should enjoy a more deferential review by the trial court. But when the plan administrator decides and funds the benefit decision, courts view this as a...more

5/9/2014 - De Novo Standard of Review Disability Benefits ERISA Social Security Adminstration Social Security Disability

ERISA: Plans Waive Defenses If Not Asserted In Administrative Process

Does the claim administrator waive the timeliness defense if it failed to deny the claim on that basis during administrative review? YES! Here is a nice case that summarizes the point, and the status of waiver in the...more

4/28/2014 - ERISA Late Claims

ERISA Penalty Claims — How To Handle Them

Are you seeing more ERISA Plaintiffs asserting claims seeking penalties for delayed production of ERISA-related documents? 29 U.S.C. 1132(c)(1) allows the Court to impose penalties of up to $110 per day for delays in...more

4/22/2014 - Document Productions ERISA Penalties Plan Administrators

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

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