Life, Health, Disability & ERISA Litigation

The Life, Health, Disability & ERISA Litigation Group at Hinshaw & Culbertson LLP represents leading insurers, welfare and pension benefit plans, self-insured retention groups, plan administrators, fiduciaries, and managed health care organizations across the United States. Our clients know and respect us for our ability to provide practical advice and tailored solutions. These are skills we have mastered through a comprehensive appreciation for and understanding of our clients' business and legal challenges; the law (including local, regional and national trends); and rules and customs in the many jurisdictions throughout the country where we practice regularly.

Our Life, Health, Disability & ERISA Litigation Group is regional counsel for several companies. Given our team's experience and national footprint, we also are ideally positioned to represent clients nationally.

Experience

The lawyers in Hinshaw's Life, Health, Disability & ERISA Litigation Group have a track record of obtaining favorable results in the full range of matters involving group and individual life, health and disability policies. We also provide skilled representation and counsel in disputes arising from agreements between benefit plans and the companies that provide administrative and other services for them. We have successfully litigated claims for plan benefits, statutory penalties, equitable relief, and fiduciary breaches arising from plans governed by ERISA and state law.

Our experienced litigators in this arena handle matters for many of the nation's leading insurance companies and managed care organizations. Our team has extensive court and regulatory experience and a thorough understanding of federal and state regulations in the dozens of jurisdictions across the United States where we practice.

Depth

With more than 25 attorneys located from coast to coast who focus their practices in this field, our Life, Health, Disability & ERISA Litigation Group is among the largest in the United States. Collectively, we have centuries of invaluable experience. We bring this breadth and depth to bear as we provide skilled representation and offer effective solutions.

Geographic Scope

The attorneys in our Life, Health, Disability & ERISA Litigation Group practice in jurisdictions across the United States—including California, the entire greater Midwest, and Florida. We have handled cases in most U.S. district courts, almost every federal circuit, and the U.S. Supreme Court. Our regional and local depth enables us to partner with our clients to plan for and achieve the best possible outcomes, whether in the context of counseling and advice, alternative dispute resolution, or litigation.

Dedicated to Advancing the Industry

The excellent reputation in the industry that we have earned is best demonstrated by the fact that the nation's leading companies consistently seek our counsel and entrust us with their legal matters. But it also has been achieved through our many other efforts to advance the industry. These include:

• Hinshaw's biennial Definitive Disability Conference, which has become one of the industry's most anticipated educational events
• Leadership positions within leading industry organizations, including: DRI's Life, Health and Disability Committee; the American Bar Association Employee Benefits Committee; the International Association of Defense Counsel; and Stafford Publications' Insurance Law Advisory Board
• Presentations on timely topics at national industry events, including DRI's Life, Health, Disability and ERISA Seminar
• Tailored, continuing education credit-qualifying presentations onsite at our clients' offices
• Educational articles on important issues in leading industry publications such as DRI's The Voice, and Westlaw Journal Insurance Coverage

Life and Disability Insurance

We routinely take on cases involving plaintiffs who challenge the denial, termination or computation of benefits under individual life and disability insurance policies. Our substantive knowledge of this area and tenacious courtroom advocacy have enabled us to compile a track record of favorable outcomes for the disability and life insurers we represent. Our victories occur in mediation, at the trial and summary judgment stages of litigation, and before appellate courts across the United States. We regularly handle cases involving:

• Accident versus sickness, total versus partial disability, regular and appropriate care, independent medical evaluations/functional capacity evaluations, legal versus factual disability, mental/nervous limitation issues, etc.
• Accidental death and dismemberment claims
• Agent/Producer misrepresentation and fraud
• Churning and twisting claims
• Class actions
• Competing claimants and interpleaders
• Conditional receipt issues and temporary insurance
• Disputed policy lapse, alleged improper notice, assertions of waiver and estoppel
• Life and disability claims
• Long term care claims
• Misrepresentation and "vanishing premium" disputes
• Policy rescissions
• Post-claim underwriting claims
• Stranger-owned life insurance (STOLI) disputes
• Suicide exclusion
• Suitability issues

ERISA

Much of our group's practice focuses on the litigation of disputes—including class actions—arising under ERISA. Our seasoned ERISA attorneys have put in the time and dedication that is essential to becoming conversant with the nuances of the act's statutory scheme. This equips our team to provide valuable, practical advice and solutions. We handle disputes over every type of benefit that is provided for under ERISA-governed pension and welfare benefit plans, including contested claims for life insurance, accident insurance, disability benefits and pension benefits.

Having handled thousands of ERISA matters—including employee benefit disputes relating to disability insurance, health insurance and managed care, life insurance and waiver of premium, and pension and retirement plans—we have a comprehensive understanding of how benefit plans work. We bring our unique knowledge and experience to bear in every instance, whether it is a straightforward dispute over a claimant's benefits or one involving claims of prohibited transactions and breach of fiduciary duty in the handling of a large pension plan.

Examples of specific ERISA issues we have deep experience with include:

• Abuse of discretion
• Accidental death
• Attorneys' fees recovery
• Claims for statutory penalties based on untimely production of plan documents, summary plan descriptions, and administrative records
• Complete preemption under ERISA § 502(a)
• Computation of benefits and offsets for personal injury recoveries, workers compensation, and Social Security Disability Insurance
• Conflict of interest
• Conversion to individual coverage
• Deadlines for internal appeals and filing suit on denied claims
• Eligibility
• Equitable relief
• Estoppel
• Exempt plans
• Exhaustion of administrative remedies
• Express preemption under ERISA § 514
• Pre-existing condition limitations
• Recovery of benefit overpayments
• Standard of review, including issues presented by Department of Insurance regulations that limit or ban grants of discretionary authority

Managed Care Litigation

Hinshaw's Life, Health, Disability & ERISA Litigation Group attorneys also have deep experience with the managed care industry and the complex body of laws regulating it. We have litigated the full spectrum of issues that arise in the operation of health care plans—from contested medical-necessity determinations to denials of stop-loss coverage, claims for recoupment based on improper medical billing practices, and disputes over performance under administrative-service only (ASO) agreements. Our experience with this industry and the nationwide scope of our practice enable us to efficiently litigate, defend and resolve disputes involving health benefit plans across the country.

Hinshaw's litigators and regulatory lawyers who practice in this area are located in offices throughout the United States and have successfully handled hundreds of matters for many of the nation's leading insurance companies and managed care organizations. Our experience includes resolution of complex disputes involving the largest nonprofit health care service plan in California and one of the largest government plans in the Midwest, as well as health plans in other jurisdictions. Given the national scope of our practice, we can provide highly skilled representation to benefit plans and managed care companies from coast to coast.

Employee Benefits Disputes

Our managed care practice includes experienced courtroom advocates who regularly litigate disputes involving health plan benefits in courts across the country, at both the trial and appellate level. We regularly defend cases involving:

• Amara-based equitable relief claims under ERISA § 502(a)(3)
• The application of standard plan exclusions, including exclusions for experimental therapies, services for the convenience of the member, services rendered to ineligible persons, and services for which the plan member is not obligated to pay
• Claims for breach of fiduciary duty under ERISA §§ 409 and 502(a)
• Claims for common-law fraud, consumer fraud and Racketeer Influenced and Corrupt Organizations Act (RICO) violations based on conduct occurring in the administration of health benefit plans
• Claims for statutory penalties under ERISA § 502(c) based on the failure to produce plan documents
• Contested medical-necessity determinations

Disputes over a denial of benefits by a health care plan governed by state law often precipitate the assertion of state law claims for bad faith, fraud, or other claims for extracontractual damages. We regularly defend against these claims—in both state and federal courts—including in jury trials when resolution through summary judgment or settlement is unobtainable.

Service Provider Litigation

Our group regularly litigates disputes arising from the provision of services to health care benefit plans and their employer sponsors. This includes defending and prosecuting claims between the managed care companies that administer health benefit plans and those plans' employer sponsors.

We have successfully defended high-exposure actions in which plan sponsors asserted that third-party administrators breached ASO agreements by overpaying claims; failed to furnish accurate claims information; or failed to disclose plan documents as allegedly required by ERISA § 104(b)(4), 29 U.S.C. § 1024. We have also litigated and resolved complex disputes arising from stop-loss insurance policies and preferred provider organization (PPO) contracts.

Fraudulent and Abusive Billing

Managed care companies review reimbursement claims submitted by in- and out-of-network medical providers to determine whether the claims are reimbursable under a plan. If a claim is covered, the managed care company administering the plan must determine how much should be paid, often with funds provided by the plan sponsor, rather than the managed care company itself. Our group has extensive experience investigating, defending against and prosecuting disputes over reimbursement claims and the billing practices of both in-network and out-of-network medical providers. We regularly litigate claims for the recoupment of overpaid funds by plans and managed care companies in cases involving medical providers that have overbilled a plan or insurer, or obtained reimbursements that were not due under the plan. We also have extensive experience defending reimbursement actions filed by both in-network and nonparticipating medical providers and facilities.

Class Action Litigation

Hinshaw has a national class action litigation practice and our clients frequently call on us to defend putative class proceedings arising from the administration of pension and welfare benefit plans. We have achieved favorable results for plan fiduciaries, third-party administrators, plan insurers, and managed care companies in putative class actions filed in courts across the country. 

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