Life + Disability Litigation

Robinson+Cole has successfully defended disability, life, and accident claims brought in state or federal court against insurers, plan administrators, employers, and managed care organizations, including cases governed by the Employee Retirement Income Security Act (ERISA), the Federal Employees Health Benefits Act (FEHBA), Medicare, Medicaid, and the Federal Employees' Group Life Insurance (FEGLI) program. We also provide guidance, advice, and assistance to our clients regarding policies and procedures for managing life, health and disability claims.

The learning curve for this type of claim work can be steep. State insurance departments and federal regulators frequently change the rules and procedures governing coverage and claim evaluation, and it is necessary to know what has changed and why. Appellate courts, including the United States Supreme Court, regularly change the rules governing claim litigation. The language of insurance policies and benefit plans can sometimes be complex, requiring an experienced eye to comprehend them, and it is often necessary to master a wide range of medical issues to fully understand, evaluate, and defend a claim. Our Managed Care lawyers can maneuver the complexities of this environment. They know the framework inside and out and have worked on “building the law” in terms of life, health, and disability claims.

Our Services

Our lawyers have deep-seated experience in all areas of life, health, and disability litigation, including the following:

Disability Claim Litigation

Trials of individual claims
Appeals
Wrongful denial/termination of LTD benefits
Interference with employee benefit rights
ERISA preemption
Recoupment of overpaid benefits/subrogation
Breach of fiduciary duty
Bad faith
Deceptive/unfair business practices

Life + Accident Claim Litigation

Interpleader of life insurance benefits where there are conflicting claims for benefits
Disputes over whether insured’s death was “accidental” or caused by self-inflicted injury
Drug or alcohol intoxication
Retained asset account litigation and disputes

Our wide spectrum of clients includes insurance companies and life, health, disability, and accidental death and dismemberment (AD&D) benefit claim administrators. We have represented claim administrators and plan sponsors in individual and class actions alleging breaches of ERISA fiduciary duty, violations of mental health parity laws, improper offsets against benefits for Social Security disability income benefits, and third-party tort settlements.

Experience

Beneficial Interest

Represented a nonprofit educational foundation in claims in connection with beneficial interest as remainder beneficiary under a trust.

Disability Benefits Denial Related to M.S.

Ingravallo v. Hartford Life and Accident Insurance Company, as Administrator of the Delta Airlines Inc. Long-Term Disability Group Policy, 563 F. App’x 796 (2d Cir. 2014) — Obtained a favorable appellate ruling in the U.S. Court of Appeals for the Second Circuit reversing judgment for the plaintiff and entering judgment in favor of the defendant on the grounds that the District Court erred by finding that the defendant, the insurer/administrator of an ERISA regulated long-term disability benefit plan, acted arbitrarily and capriciously in denying plaintiff's claim for continuing disability benefits related to her multiple sclerosis diagnosis because her condition had improved and she no longer met the ERISA plan's definition of disabled. *

* Attorney Bernstein was counsel in this representative matter before joining Robinson+Cole.

Breach of Fiduciary Duties Under ERISA

Carol D. Faber v. Metropolitan Life Insurance Co., 648 F.3d 98 (2d Cir. 2011) — Obtained an affirmance from the U.S. Court of Appeals for the Second Circuit of the district court's order dismissing a putative class action against our client, which alleged that it had breached its fiduciary duties under ERISA by paying life insurance benefits through establishing and funding a retained asset and issuing beneficiaries checkbooks to access the fully funded account instead of issuing a lump sum settlement check. The Secretary of Labor filed a brief in which it essentially agreed with the defendant's argument that it had discharged its ERISA fiduciary duties once the beneficiaries' checkbook accounts were established. *