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Life, Health, Disability and ERISA

Life, Health, Disability and ERISA


Overview

Through decades of litigation experience and thoughtful advice, Smith Moore Leatherwood’s Life, Health, Disability and ERISA Team has earned a national reputation for excellence.

The Team is comprised of attorneys who have represented life, health, and disability insurance companies, ERISA plan sponsors, and third-party administrators in hundreds of cases in federal and state courts throughout the Southeast and elsewhere.  They defend claims to recover benefits and for breach of fiduciary duties under ERISA, class actions, discriminatory underwriting claims, allegations of agent misconduct, and breach of contract claims to recover life, accidental death, disability, and health insurance benefits.

The Team represents more than 50 life, health, and disability insurance companies, and its lawyers are leaders in organizations such as the Life, Health and Disability Committee of the Defense Research Institute and the Life Insurance Law Committee, Health and Disability Law Committee, and Employee Benefits Committee of the Tort Trial & Insurance Practice Section of the American Bar Association.  They are frequent speakers at national seminars on life, health, disability, and ERISA issues.

Experience
  • Joseph v. Northwestern Mut. Life Ins. Co., 2015 WL 1309648 (M.D. Ga. Mar. 24, 2015) (whether insured under individual disability income insurance policy failed to comply with policy's notice of claim provision)
  • Royal v. New York Life Ins. Co., 2015 WL 339781 (S.D. Ga. Jan. 26, 2015) (whether insured under individual disability income insurance policy failed to comply policy's 90-day proof of loss provision and three-year legal actions provision)
  • Smith v. Cox Enter., Inc., 2015 WL 331116 (N.D. Ga. Jan. 27, 2015) (whether administrator of self-funded ERISA plan abused its discretion in denying claim for disability benefits)
  • Dorsey v. Aetna Life Ins. Co., 2013 WL 1288165 (E.D. Va. Mar. 26, 2013) (whether self-funded plan was top hat plan exempt from disclosure obligations of section 104(b)(4) of ERISA and whether third-party administrator abused its discretion in denying claim for disability benefits)
  • Med. Ctr. v. Humana Military Healthcare Servs., 2012 WL 3295640 (M.D. Ga. Aug. 10, 2012) (whether TRICARE managed care support contractor properly offset amount of overpayments for medical claims against future claim payments owed to hospital)
  • Burnett v. Combined Ins. Co. of Am., 2011 WL 6012523 (M.D. Ga. Dec. 1, 2011) (whether second disabling injury sustained during period of continuous total disability entitled insured to a new maximum benefit period)
  • Muhammad v. Humanadental Ins. Co., 2009 WL 3365959 (N.D. Ga. Oct. 19, 2009) (whether claim for breach of dental insurance contract was preempted by ERISA)
  • Provident Life and Accident Ins. Co. v. Futch, 2008 WL 4724827 (S.D. Ga. Oct. 24, 2008) (whether surgeon was eligible to recover lifetime disability benefits based on claim that bilateral osteoarthritis of the hips was due to accidental bodily injuries, rather than due to sickness)
  • White v. New York Life Ins. Co., 564 F. Supp. 2d 1372 (S.D. Ga. 2008) (whether lapse of life insurance policy for failure to pay premiums was excused by insured's alleged mental incapacity)
  • Le Roux v. Woodgrain Millwork, Inc., 2008 WL 1836672 (D. Idaho Apr. 22, 2008) (whether claims against self-funded health benefits ERISA plan for equitable estoppel, breach of fiduciary duty, and class action were subject to dismissal under Fed. R. Civ. P. 12(b)(6))
  • Mitchell v. Globe Life and Accident Ins. Co., 548 F. Supp. 2d 1385 (N.D. Ga. 2007) (whether beneficiary under accidental death insurance policy timely complied with notice of claim and proof of loss provisions of policy and established accidental death within meaning of policy)
  • Cowart v. Metropolitan Life Ins. Co., 444 F. Supp. 2d 1282 (M.D. Ga. 2006), aff'd 199 Fed. App'x 870 (11th Cir. 2006) (whether individual disability policy was part of ERISA plan or came within Department of Labor "safe harbor," in view of evidence that employer paid premiums)
  • Karp v. Guardian Life Ins. Co. of Am., 456 F. Supp. 2d 1375 (S.D. Ga.), aff'd, 199 Fed. App'x 870 (11th Cir. 2006) (whether termination of disability benefits under ERISA plan or award of Social Security disability benefits was a "qualifying event" requiring former employer to offer continuation of health insurance under COBRA)
  • Moorman v. UnumProvident Corp., 464 F.3d 1260 (11th Cir. 2006) (whether disability insurance plan was "established and maintained" by employer and therefore governed by ERISA, and whether plan satisfied safe harbor exemption from ERISA based on actions of employer)
  • Perry v. Unum Life Ins. Co. of Am., 353 F. Supp. 2d 1237 (N.D. Ga. 2005) (whether insured could pierce corporate veil or establish tortious interference claim against insurer's parent company based on insurer's alleged breach of contract resulting from denial of benefits)
  • Powers v. Paul Revere Life Ins. Co., 2005 WL 6075373 (N.D. Ga. Oct. 19, 2005), aff'd, 181 Fed. App'x 939 (11th Cir. 2006) (whether letter to insured from insurance agent amended disability policy to add cost of living benefits)
  • Kocer v. New York Life Ins. Co., 340 F. Supp. 2d 1351 (N.D. Ga. 2004) (whether disability benefits were payable to physician whose license to practice medicine was revoked, thereby resulting in "legal disability" before the onset of factual disability)
  • Dixon v. Life Ins. Co. of N. Am., 389 F.3d 1179 (11th Cir. 2004) (whether death resulted "directly" from accident and "no other causes" where insured's preexisting cardiac condition substantially contributed to automobile accident resulting in death)
  • Transamerica Occidental Life Ins. Co. v. Miles, 317 F. Supp. 2d 1373 (N.D. Ga. 2003), aff'd, 107 Fed. App'x 184 (11th Cir. 2004) (whether term life insurance policy went into effect where application required owner's personal receipt of policy while in good health and applicant's health changed after policy was received by agent, but before policy was delivered to applicant)
  • Worsham v. Provident Cos., Inc., 249 F. Supp. 2d 1325 (N.D. Ga. 2002) (whether merger clause of disability policy barred plaintiff's fraud and RICO claims based on representations allegedly made by agent)
  • Yessick v. Midland Life Ins. Co., 178 F. Supp. 2d 1301 (N.D. Ga. 2001) (whether proof of customary, computerized procedures was sufficient to establish that premium invoice and lapse notice were mailed to insured)
  • McAfee v. Transamerica Occidental Life Ins. Co., 106 F. Supp. 2d 1331 (N.D. Ga. 2000), aff'd, 252 F.3d 1362 (11th Cir. 2001), cert. denied, 534 U.S. 994 (2001) (whether insured's death in shootout with police was covered under accidental death insurance policy)
  • Suarez v. Mass. Mut. Life Ins. Co., 132 F. Supp. 2d 1382 (N.D. Ga), aff'd, 232 F.3d 216 (11th Cir. 2000) (whether loss of medical license was legal disability, precluding recovery of disability benefits based on subsequent factual disability)
  • Adair v. Boston Mut. Life Ins. Co., 24 F. Supp. 2d 1380 (M.D. Ga. 1998) (whether insured's death from apparent medication overdose was by accidental means)
  • Cosby v. Transamerica Occidental Life Ins. Co., 860 F. Supp. 830 (N.D. Ga. 1993), aff'd, 16 F.3d 1232 (11th Cir. 1994) (whether insured's breach of common law duty to advise insurer of change in health warranted rescission of life insurance policy)

* Past success does not indicate the likelihood of success in any future legal representation.

Thought Leadership

Publications

February 23, 2017
November, 2016
November, 2016
April, 2016
Adverse Tax Impact Not Remediable under ERISA , ERISA and Life Insurance News
April, 2016
September 14, 2015
September 14, 2015
May 12, 2015
May 30, 2014
August 21, 2012
August 21, 2012
February 6, 2012
October 17, 2011
Insurer May Waive Policy Provisions, ERISA and Life Insurance News
October 17, 2011
Plan Participant May Be Able to Claim Benefits, ERISA and Life Insurance News
April 22, 2011
CIGNA v. Amara, ERISA and Life Insurance News
April 20, 2011
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