Theodore J. Tucci

Partner

  • Overview

    Biography

    Ted Tucci is a member of the firm’s Health Law Group, and he chairs the firm's Health + Benefits Litigation Team. His clients include for-profit and nonprofit health care providers and hospital systems, home health agencies, nursing homes, pharmaceutical manufacturers and retail pharmacies, outpatient and imaging centers, assisted living facilities, and human services agencies.

    Health Law Litigation

    Mr. Tucci regularly defends health care clients and their officers and directors against a wide array of claims involving alleged wrongful acts arising out of health care operations. He handles government investigation responses, antitrust claims, commercial disputes, and class actions against health system clients. He has successfully defended whistleblower actions brought in a variety of jurisdictions pursuant to the False Claims Act. Mr. Tucci has also litigated the leading cases in Connecticut on matters involving restriction or termination of medical staff privileges and medical education. In addition, he contributes to the firm's Health Law Diagnosis blog.

    Administrative Advocacy

    Mr. Tucci counsels and represents health industry clients in risk management and administrative law proceedings. He has served as counsel for both hospitals and hearing committees in bylaw administrative proceedings involving staff privileges, peer review, and physician discipline issues. He regularly handles financial and reimbursement audit matters before state and federal agencies, licensure proceedings, certificate of need requests, and appeals of rate determinations by governmental agencies.

    Regulatory

    Mr. Tucci has appeared before state regulatory agencies on certificate of need, regulatory enforcement actions pertaining to reimbursement, and overpayment matters.

    Mr. Tucci has been listed in The Best Lawyers in America© in the area of Health Care Law since 2006 and in the area of Insurance Law in 2017 and 2018. He has also been selected to the Connecticut Super Lawyers list since 2006.

  • Experience
    • Experience

      Experience

        Health Law

      • Represent various hospitals as counsel for medical executive committee seeking to impose corrective action, suspension, reduction of medical staff privileges, or other peer review disciplinary action on practitioners. Representation includes medical staff bylaw compliance, administrative hearings, and negotiation of agreed settlements.
      • Represent various medical executive hearing and appellate review committees in peer review and practitioner disciplinary proceedings. Representation includes advice and counseling on hearing process and protocol issues, and legal guidance on the hearing deliberation process.
      • Represented hospital in claim of wrongful failure to certify resident's successful completion of surgical residency program. Defended case successfully through trial and on appeal, obtaining ruling from Connecticut Supreme Court, establishing discretion of hospital to make professional competence determinations, and rejecting claim of educational malpractice.
      • Representation of Health Net of the Northeast, Inc., in negotiating novel settlement arrangement that included corrective action plan and contingent payment in response to enforcement action by Connecticut attorney general under the Health Insurance Portability and Accountability Act (HIPAA) and the Health Information Technology for Economic and Clinical Health (HITECH) Act for alleged breach of protected health and financial information of members of health plan.
      • Represent hospitals and health care clients in regulatory and administrative proceedings before Connecticut Department of Public Health, Office of Healthcare Access and Office of Inspector General. Experience includes representation in certificate of need hearings, Medicare and Medicaid audits and fraud and abuse investigations.
      • ERISA and Health and Benefits Insurance

      • Robinson & Cole defended a manufacturer in a case brought by 11 retired employees who claimed that employer's termination of their health benefit coverage violated ERISA because such benefits were contractually vested. Robinson & Cole avoided all deposition discovery by persuading plaintiff's counsel to engage in a voluntary document exchange. Based on such informal discovery, we then moved for summary judgment on all of plaintiffs' subsequent claims. The court granted the motion for summary judgment, which resulted in significant litigation cost savings for employer and eliminated potential liability to hundreds of other retirees.
      • Represented aerospace manufacturer in a claim for disability benefits under the employee retirement plan. Convinced the Court that even though not expressly stated, pursuant to the only plausible interpretation of the Summary Plan Description, an employee was not entitled to receive benefits for a claim based on a disability that developed years after this employment ended.
      • Represented health insurer acting as third-party administrator in a claim for mental health benefits. Successfully obtained summary judgment on behalf of health insurer by demonstrating that insurer was not a plan administrator and did not act as a fiduciary to the plaintiff, and thus was not a proper defendant in the plaintiff's ERISA action.
      • Defended leading disability income insurer in a case involving subjective disability claim. Obtained summary judgment on all counts for defendant based upon the "arbitrary and capricious" standard of review. In granting defendant's motion for summary judgment, the Court noted that the policy did not contain the discretion and deference language that typically triggers application of the arbitrary and capricious standard. Nonetheless, the Court was persuaded that the terms of the policy read together as a whole created the "functional equivalent of discretionary authority."
      • Defended disability insurer in an ERISA disability benefits claim in which the record contained surveillance evidence of the claimant's functional capacity. Obtained summary judgment where court held that insured had substantial evidence to terminate disability benefits where burden to provide evidence was on plaintiff, there was lack of medical information, and doctor failed to address contradiction between plaintiff's activities and her disability.
      • Representation of Health Net against a medical doctor who has filed dozens of cases against Health Net over the past decade. Won summary judgment on breach of contract and unjust enrichment claims asserted by the nonparticipating provider on the grounds that he failed to comply with requirements for timely submission of claims. Preserved victory on appeal by persuading appellate court to affirm.
      • Represented leading disability insurer in what is believed to be the first reported federal court decision in the U.S. granting summary judgment based on an insured's failure to obtain surgery, which was viewed as a violation of the appropriate care requirement. The court held that insured's refusal to obtain release surgery for carpal tunnel syndrome was a violation of the unambiguous policy provision to seek and accept appropriate medical care for his disabling condition.
      • Representation of a Connecticut city and its firefighters' retirement board in federal court litigation alleging that the city and the board breached their respective fiduciary duties regarding the municipal retirement fund for city firefighters. The issue involves the city's ability to use funds in the plan to pay for health benefits coverage for retired firefighters.
      • Managed Care and Health Insurance

      • Provide regulatory and risk management counseling to administrators of special needs plans for dually eligible Medicare/Medicaid enrollees.
      • Representation as Health Net of the Northeast's lead litigation and regulatory counsel when Health Net administered the Connecticut Medicaid program. As regulatory counsel, advised Health Net regarding its legal obligations to the Medicaid state agency and represented the client in numerous administrative matters.
      • Appealed before Connecticut Supreme Court an issue of first-impression regarding reasonableness of utilization review criteria used to make medical necessity decisions for Medicaid recipients in the early prevention, screening, diagnosis and treatment (EPSDT) program.
      • Representation as outside counsel for health insurer concerning its administration of the Connecticut Medicaid program, including matters relating to provider reimbursement and compliance with Connecticut's Freedom of Information Act requirements, an area in which Robinson & Cole litigated the leading cases involving Medicaid managed care organizations.
      • Representation of a publicly traded workers' compensation insurer as a plaintiff in an arbitration involving claims that a repricing error by a managed care network preferred provider organization (PPO) caused our client to overpay Texas medical providers by more than $3 million. Robinson & Cole negotiated a settlement prior to arbitration through which the client received 100 percent of its compensatory damages.
      • Representation of HIP Health Plan of New York in private realtor qui tam action brought by several hospitals alleging that managed care insurers violated New York's health care reform law by failing to pay the state the appropriate surcharge amount on payments made to hospitals for member services. Defendants moved to dismiss the complaint in its entirety based on plaintiff's failure to adequately plead a false claims act claim and a violation of the surcharge statute. Motion to dismiss was granted.
      • Representation of Health Net in negotiating favorable monetary settlement against unfair and deceptive trade practices brought by eight-person physician group arising from health plan's administration of bonus payment "pay for performance" program. Plaintiffs alleged that bonus program deceptively claimed to reward quality medical care but instead drove physicians to deliver cheaper care.
      • Other Experiences

      • Represented professional liability insurer seeking to rescind policy issued to reinsurance company as a result of claims made against reinsurer for improperly calculating collateral requirements and wrongfully failing to release collateral, which claims were known to reinsurer at time of professional liability renewal policy application.
      • Defense of a national actuarial services organization against contract claims arising out of the alleged failure to forecast plan funding requirements and cost of living adjustments.
      • Representation of an eye-surgery center in Massachusetts regarding the sale of interest in the center. Mediated with private mediator and settled favorably with one of partners buying plaintiff's interest.
      • Representation of a national specialty pharmacy company in a qui tam case brought by the former sales manager of a pharmaceutical manufacturer. The relator alleged violations of the Anti-Kickback Statute and the federal and state False Claims Act because of kickbacks the pharmaceutical manufacturer allegedly paid the specialty pharmacy to induce its purchase of Risperdal Consta, an antipsychotic medication. Obtained dismissal of all federal claims before discovery.
      • Representation of Health Net in a case challenging its legal right to seek subrogation recoveries as part of its administration of the Medicaid–managed care program. Health Net used a third-party subcontractor to seek subrogation recovery in cases where injured Medicaid enrollees obtained tort recoveries or settlements. Plaintiffs alleged that Health Net violated the Connecticut Anti-Subrogation Act because it did not have statutory authority to seek repayment directly from enrollees. The court found that the Connecticut Department of Social Services had such statutory authority and that the department had delegated its rights to Health Net by contract. Therefore, there was no legal impediment to Health Net seeking repayment directly from its members.
      • Spearheaded legislation excepting customers of commercial printers from Connecticut nexus.
      • Class Action

      • Defended Health Net of Connecticut against a class action lawsuit filed by three participating podiatrists and a podiatric medical association in Connecticut Superior Court. Plaintiffs alleged that the client violated the state unfair trade practices and unfair insurance practices statutes by unfairly discriminating against podiatrists by paying them a lower reimbursement rate than medical doctors for performance of the same foot and ankle related services. Robinson & Cole argued that Connecticut's unfair trade practices and unfair insurance practices statutes did not prohibit insurers from treating different types of health care providers differently, that podiatrists and medical doctors were not similarly situated such that they were required to be paid the same, and that recognizing these differences was not discriminatory. After extensive discovery, court granted Robinson & Cole's motion for summary judgment, holding that the state unfair insurance practices act was not intended to be an equal pay or pay parity statute and that reimbursing podiatrists and medical doctors at different rates for the same services does not constitute unfair discrimination.
      • Defended consumer class action against managed care organization ("MCO") alleging that MCO improperly sought subrogation recoveries for medical costs paid in personal injury actions. Plaintiffs sought to certify a class of thousands, including all insureds from whom MCO sought or may in the future seek reimbursement of medical costs. After extensive class certification hearings, succeeded in limiting size of class certified to under 200 members. Claims were settled through private mediation on a favorable basis and approved through fairness hearing process to bind the class.
      • Defended provider class alleged that managed care organization ("MCO") and independent physicians association ("IPA") had failed to apply withhold correctly over 3 year period. Class further claimed that MCO and IPA breached their agreement with providers over that period and that class members were owed payment of full, undiscounted charges. Claims involved potential monetary exposure in excess of $25 million. Before class certification, initiated mediation which spanned 5 sessions over 18 months. Successfully negotiated settlement with class and IPA that resolved all claims in return for non-monetary changes in provider relations policies administered by the MCO and supervised by the IPA. Settlement involved no payment of monetary relief to class. Claims against MCO released in return for alterations in the operations of the MCO and IPA as well as the provision of increased information to the class. Prepared settlement documents for submission to court for approval and obtained approval after initial rejection by the court.
      • Defended hospitals against consumer class action alleging that medical records billing policies and practices violated state regulatory law and unfair trade practice act. Represented a consortium of hospitals accused of overcharging patients and attorneys for copies of requested medical records. Plaintiffs claimed that hospitals violated state statutes governing medical records requests and engaged in unfair and deceptive conduct in the operation of the hospitals' business. Succeeded in limiting the size and scope of the class based on statute of limitations. Negotiated binding settlement on class that included prospective injunctive relief only. Monetary payment was limited to relatively modest contribution to local charity.
      • Other Experiences

      • Defended hospital that belonged to multi-hospital trade association in federal class action brought by state office of protection and advocacy for disabled individuals. Plaintiff sought to certify a class of all deaf and hearing impaired citizens in the state. Complaint alleged violations of state constitutional law and federal civil rights arising out of hospital's alleged failure to provide reasonable means for deaf and hearing impaired patients to communicate with treatment providers. U.S. Department of Justice, Civil Rights Division, intervened as plaintiff in the case. Through mediation with federal magistrate, negotiated a consent decree for prospective relief. Avoided costly discovery and class certification proceedings.
      • Recently obtained an important victory in a class action against a major managed care organization (MCO). The case challenges the MCO's legal right to seek subrogation recoveries as part of its administration of the Medicaid managed care program. The MCO used a third-party subcontractor to seek subrogation recovery in cases where injured Medicaid enrollees obtained tort recoveries or settlements. Plaintiffs alleged that the MCO violated the Connecticut Anti-Subrogation Act because it did not have statutory authority to seek repayment directly from enrollees. The court held that, as assignee of the Department of Social Service’s (DSS) statutory rights, the MCO was permitted to seek repayment directly from its members. Therefore, there was no legal impediment to the MCO seeking repayment directly from its members. This ruling resolved the central legal issue in the case in the MCO's favor and dealt a significant blow to plaintiff’s remaining claims.
      • Represented client in all aspects of litigation involving appeals from administrative decisions regarding development permits for wireless communications facilities.
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    • Professional Associations

      Professional Associations

      The Association of Life Insurance Counsel

      Connecticut Health Lawyers Association

      Defense Research Institute
      Life, Health, and Disability Committee, Connecticut Liaison

      Connecticut Defense Lawyers Association

      American Health Lawyers Association

      American Bar Association
      Life and Disability Insurance and Health Law Committees

      Connecticut Bar Foundation
      James W. Cooper Fellow
    • Honors + Awards

      Honors + Awards

      Ranked in Chambers USA: America's Leading Lawyers for Business in the state of Connecticut in the area of Healthcare since 2012

      Listed in The Best Lawyers in America© as Hartford Lawyer of the Year in the area of Health Care Law for 2015 and 2018

      Listed in The Best Lawyers in America© in the area of Health Care Law since 2006 and in the area of Insurance Law in 2017 and 2018

      Selected to the Connecticut Super Lawyers list from 2006 to 2017.

      Listed as a Local Litigation Star in Benchmark Litigation since 2015

  • NEWS + PRESS
    • Publications

      Publications

      "Escobar Materiality Standard for Implied False Certification Claims Poses Acute FCA Compliance Challenge," published in AHLA Connections, co-authored with Conor O. Duffy and Kathleen E. Dion (September 2017)

      "The New Frontiers of Healthcare Batchclaim Liability," published in PLUS Journal, co-authored with Kristin McMahon, chief claims officer at IronHealth (April 2016)
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      "ERISA: Second Circuit," published in Misrepresentation in the Life, Health, and Disability Insurance Application Process: A National Survey, co-authored with Amanda Gordon Schreiber, Second Edition (2015)
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      "A Guide to Connecticut’s Certificate-of-Need Process," published in Connecticut Medicine Magazine, co-authored with Brian D. Nichols (June/July 2008)

      "A Discussion about Alternative Dispute Resolution in the Healthcare Field," published in Connecticut Lawyer (April, 2006)

      "Forget About the Health Insurance Fraud Act?: An underutilized weapon in the fight against insurance fraud," published in Connecticut Law Tribune (June 17, 2002)

    • Presentations

      Presentations

      "Managed Care Litigation Update 2017," co-presented with Jean E. Tomasco, a webinar for a firm client in the specialty risk insurance industry. (4/19/2017)
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      "Risk Management and Litigation Issues Arising Out of the January 2017 Amendments to ERISA Disability Claim Regulations," co-presented with Patrick W. Begos (January 2017)
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      "Escobar: Mitigating Risk of Implied Certification Liability Under the False Claims Act," co-presented with Jean E. Tomasco, webinar, for a client in the specialty risk insurance industry (10/19/2016)
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      "Managed Care Litigation Update 2016," co-presented with Jean E. Tomasco, a webinar for a firm client in the specialty risk insurance industry (3/30/2016)
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      "Managed Care Litigation Update 2015," co-presented with Jean E. Tomasco, a webinar for a firm client in the specialty risk insurance industry (4/8/2015)
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      "E-discovery: Risk Management for Health Care Providers and Business Associates," co-presented with Andrea Donovan Napp, a webinar presented to over 100 brokers and health care insureds (9/17/2014)

      "Healthcare and Health Insurance Developments in 2013: The Year in Review and Forecasting Challenges and Opportunities Ahead," co-presented with Jean E. Tomasco (1/29/2014)
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      "Data Breach: Litigation and Regulatory Risk," co-presented with Andrea Donovan Napp and Jean E. Tomasco (10/13/13)
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      "Patient Protection and Affordable Care Act," (7/10/2012)
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      "ACO Liability and Risk Management Issues: The Managed Care Perspective," co-presented with Jean E. Tomasco and Michael J. Kolosky, webinar (5/2011)

      "Legal and Strategic Considerations in Defending Medicaid Audits," at Connecticut Community Providers Association, co-presented with Michael J. Kolosky (4/27/2011)

      "Navigating Department of Social Services Financial Audits," at Connecticut Hospital Association, co-presented with Michael J. Kolosky (11/19/2010)

      "Forecasting 2003: ERISA Fiduciary Risk Management Strategies," (Fall 2002)

      "Municipal Regulation of Group Homes for Recovering Substance Abusers," at Connecticut Bar Association's Zoning Section (2/2001)

      "State Regulation of Physician Offices as Surgical Facilities," at Connecticut Health Lawyers Association (11/2000)

      "Connecticut Regulation of Medical Record Confidentiality and Patient Privacy," presented to management of health care industry client (1999)

      "Antitrust Compliance in Provider Network Formation in Managed Care," presented to management of health care industry client (1997)

    • News

      R+C in the News

      • September 27, 2017

        Ted Tucci, Kate Dion, and Conor Duffy Co-author Article Published in AHLA Connections

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      • April 28, 2017

        R+C Attorneys Present an Update on Managed Care Litigation

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      • March 15, 2017

        Robinson+Cole Lawyers Conduct Roundtable on Claims Litigation

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      • November 7, 2016

        Robinson+Cole Lawyers Present Webinar on False Claims Act Liability Following Recent Supreme Court Case

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      • May 5, 2016

        Ted Tucci Publishes Article on Batchclaim Liability in PLUS Journal

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      • April 14, 2016

        Robinson+Cole Lawyers Present an Update on Managed Care Litigation

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      • July 20, 2015

        Robinson+Cole Lawyers Author Chapter for ABA Book

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      • April 22, 2015

        Robinson+Cole Lawyers Present Update on Managed Care Litigation

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      • November 6, 2014

        Hartford Lawyers Present Connecticut Law Tribune's Legal Department of the Year Awards

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      • September 25, 2014

        Hartford Lawyers Present Risk Management Webinar

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      • February 11, 2014

        R+C Lawyers Speak About Health Care and Health Insurance Developments

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      • November 21, 2013

        R&C Attorneys Speak About Data Breach Issues

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      • May 13, 2013

        Hartford Lawyers Provide Pro Bono Services to Nonprofit Corporation

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      • February 11, 2013

        Ted Tucci Quoted in Law360 Article for Health Law

      • December 14, 2012

        Bruce Leshine Honored for Mass Dash Fundraising Efforts

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      • October 19, 2012

        Bruce Leshine Presenting at CAUCUS Information Technology Procurement Summit

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      • August 7, 2012

        Bruce Leshine Leads Cancer Fundraiser Across Massachusetts

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      • June 15, 2012

        Robinson & Cole Attorneys Win False Claims Act Cases

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      • June 8, 2011

        Robinson & Cole Attorneys Present Webinar on Accountable Care Organizations (ACOs)

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      • May 5, 2011

        Robinson & Cole Attorneys Present Medicaid Audit Defense Seminar

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      • December 15, 2010

        Health and Benefits Litigators Win “Appropriate Care” Disability Insurance Case

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      • December 6, 2010

        Health Care Attorneys Talk Strategy with Hospitals

      R+C News Releases

      • October 17, 2017

        Robinson+Cole Lawyers Recognized by Super Lawyers®

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      • September 29, 2017

        Robinson+Cole Recognized by Benchmark Litigation

      • August 15, 2017

        Fifty-Nine Robinson+Cole Lawyers Listed in The Best Lawyers in America© 2018

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      • May 26, 2017

        Chambers USA Recognizes Robinson+Cole Lawyers and Practice Groups

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      • October 18, 2016

        Robinson+Cole Lawyers Recognized by Super Lawyers®

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      • August 15, 2016

        Robinson+Cole Receives Top Listing in Connecticut Lawyer Count in The Best Lawyers in America® 2017

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      • May 27, 2016

        Chambers USA Recognizes Robinson+Cole Lawyers and Practice Groups

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      • November 3, 2015

        Robinson+Cole Recognized in Benchmark Litigation 2016

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      • October 19, 2015

        Robinson+Cole Lawyers Recognized by Super Lawyers®

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      • August 18, 2015

        Robinson+Cole Receives Top Listing in Connecticut Lawyer Count in The Best Lawyers in America® 2016

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      • May 19, 2015

        Robinson+Cole Earns Six Practice Area Rankings in Chambers USA 2015

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      • October 30, 2014

        Robinson+Cole Recognized by Benchmark Litigation

      • October 17, 2014

        Robinson+Cole Lawyers Recognized by Super Lawyers

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      • August 19, 2014

        Robinson+Cole Receives Top Listing in Connecticut Lawyer Count in Best Lawyers National Peer Review Survey

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      • May 29, 2014

        Robinson+Cole Earns Rankings in Chambers USA 2014 in all Connecticut Practice Areas

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      • August 16, 2013

        Robinson & Cole Receives Top Listing in Connecticut Attorney Count in Best Lawyers National Peer Review Survey

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      • June 21, 2013

        Local Organizations Recognize Robinson & Cole’s Pro Bono Service

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      • June 10, 2013

        Chambers USA Ranks Robinson & Cole in Five Practices, Names 17 Attorneys as Leading Lawyers

      • October 22, 2012

        Super Lawyers® Names 49 Robinson & Cole Attorneys to 2012 List and Recognizes 26 as Rising Stars

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      • August 28, 2012

        Robinson & Cole Receives Top Listing in Connecticut Attorney Count in Best Lawyers National Peer Review Survey

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      • June 7, 2012

        Chambers USA Ranks Robinson & Cole in Five Practices, Names 16 Attorneys as Leading Lawyers

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      • September 12, 2011

        Robinson & Cole Receives Top Listing in Connecticut Attorney Count in Best Lawyers National Peer Review Survey

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    • Newsletters

      Newsletters

      Life Insurance Litigation Update, Court Rejects Annuity Class Action (2/2003)

      ERISA Litigation Update, co-authored with Michael J. Kolosky, Second Circuit Erodes ERISA Preemption (2/2003)