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Pamela E. Cogan (Retired) - Representative Experience

  • Issues
  • Venue
  • Client Type
  • Practice Areas
  • Full Description
  • Result
  • Insurance, Government Tort Claims Act
  • Alameda County Superior Court
  • Defendant - Insurance Company
  • Bad FaithInsurance Services
  • Plaintiff sued both her disability insurer and her employer, The Regents of the University of California, for the termination of her disability benefits.  She brought allegations against the The Regents of the University of California for fraud and intentional infliction of emotional distress for alleged misstatements in the Plan Booklet distributed by The Regents to all employees describing the insurance offered.

  • Plaintiff argued that an exception to the Gov't Tort Claims Act applied because The Regents should be held directly liable for violations of Cal. Ins. Code. Section 790.03, which imposes a duty on an entity "engaged in the business of insurance".  We successfully explained that The Regents is not "engaged in the business of insurance" simply by offering an insurance plan to its employees and forwarding premiums for that plan to the insurer, and the court dismissed The Regents from the action with prejudice.

  • Insurance, severance agreement
  • Ninth Circuit Court of Appeals
  • Defendant - Insurance Company
  • ERISAInsurance Services
  • Plaintiff sued Liberty Life and the Plan under ERISA for termination of her disability benefits. During litigation Liberty Life learned that Plaintiff had gone back to work, terminated her employment during her claim and entered into a severance agreement waiving her rights under ERISA .  Instead of informing Liberty Life of this fact, Plaintiff had claimed that she tried to return to work, was unable to manage it, and reopened her disability claim though she was actually no longer employed.  

  • The trial court held that the severance agreement was admissible though it was not in the administrative record and that it waived her ability to bring suit.  The Ninth Circuit affirmed this decision, holding that plaintiff had terminated her employment when she signed the severance agreement and therefore had no claim to pursue under ERISA.

  • Bad Faith
  • Alameda County Superior Court
  • Defendant Insurance Company
  • Bad FaithERISAInsurance Services
  • Defended an insurance company in a bad faith action arising from a denial of disability insurance benefits to a woman employed as a web developer whose alleged disability was due to a back injury following a fall from a horse.

  • After five week jury trial, the  jury found in favor of the plaintiff, but awarded contract benefits only, which was substantially less than offered before trial. The jury awarded zero emotional distress damages and no punitive damages. Brandt fees (attorneys' fees) were limited on a motion in limine ruling to $14,000.

  • Bad Faith
  • USDC: Northern District of California
  • Defendant Insurance Company
  • Bad FaithClass Action/Complex LitigationERISAInsurance Services
  • Defended an insurance company in a claim in which the plaintiff was a company that ran tours nationally and internationally. The tour guides filed a class action wage and hours claim, including claims that the tour guides were improperly excluded from participating in the company’s 401K plan. The tour company tendered its defense under the employee benefit liability coverage of its business insurance policy. The defense fee incurred exceeded one million dollars. The insurer refused to defend or indemnify and the insured filed suit for breach of contract and bad faith. The defense fees claimed were over $1 million.

  • Proved that there was no duty to defend or indemnify the insured, and the court granted summary judgment for the insurer, which the Ninth Circuit affirmed on appeal.

  • Bad Faith
  • USDC: Northern District of California
  • Defendant Insurance Company
  • Bad FaithERISAInsurance Services
  • Defended an insurance company in a bad faith action which was filed by the insured under a personal auto policy for an alleged failure to pay the value of a car recovered after auto theft.  Fraud investigation took place during the claim due to its suspicious nature.

  • The case settled for minimal gain at the close of evidence,  and the plaintiff was referred by the trial judge to the US attorney for perjury charges based on its trial testimony.

  • Defendant, Insurance Company, Insurance Plan
  • Business And Commercial LitigationEmployment Litigation and Dispute ResolutionERISAInsurance Services
  • Plaintiff sued for ERISA benefits valued at over $3 million.  Investigation proved that while seeking benefits, Plaintiff had accepted a severance package from her employer and signed a release without informing her insurance company.  Plaintiff claimed she was told the release would not affect her ability to receive benefits.

  • The court concluded that the severance agreement released all ERISA claims against the employer, its insurance plan and the insurer if Plaintiff signed the release knowingly and voluntarily.  The court conducted a bench trial on the issue of knowing and voluntary release and ruled that Plaintiff was not credible and she had knowingly and voluntarily her rights to her ERISA benefits. The court entered judgment in favor of defendants.

  • Breach of Contract; Bad Faith
  • United States District Court; Northern District of California
  • Defendant; Insurance Company
  • Bad FaithBusiness And Commercial LitigationInsurance Services
  • A limited partnership created for real estate development was sued for construction defects after the sale of a property they developed.  The partnership sought a defense from their insurance company both for the partnership and the individual partners sued.  Because the partnership had rented out the property as apartments prior to selling the property, the insurer maintained that the claim was excluded due to an exclusion in the policy for damage to “property you own, rent or occupy.”  The insured’s argued that they rented out individual units but not the entire building, and that the “you” applied only to the partnership, not the individual partners.

  • The parties filed cross motions for summary judgment. The court upheld the insurer’s interpretation of the contract and dismissed the complaint with prejudice.

  • Claim for Disability Benefits Governed by ERISA
  • United States District Court, Northern District of California
  • Defendant; Insurance Company
  • Business And Commercial LitigationERISAInsurance Services
  • Insured sought reinstatement of disability benefits despite admissions that she could work in her family store.  Plaintiff argued that such work did not meet her status in life.

  • The parties filed cross motions for judgment.  The court determined that the “status in life” standard was a state law standard which was preempted by ERISA, and the insurance contract provided no obligation to maintain an insured’s status in life.  As plaintiff was able to work in an occupation, she was not disabled and not entitled to benefits under the policy.  Plaintiff’s complaint was dismissed with prejudice.

  • Defendant, Insurance Company. Practice Areas, Business and Commercial Litigation, Insurance Services, Arbitration
  • Business And Commercial LitigationInsurance Services
  •  Plaintiff insured filed an uninsured motorist claim.  After rejecting a series of settlement offers from the insurer, the case went to mandatory arbitration where plaintiff was awarded less than the insurer’s final settlement offer.  Plaintiff sued the insurer for bad faith for its alleged conduct in the investigation of her claim and in the arbitration.

  • Defendant demurred twice to plaintiff’s complaints. The court sustained each demurrer.  It granted plaintiff leave to amend after the first demurrer but sustained the second demurrer without leave to amend, finding that plaintiff was not able to allege a cognizable cause of action based on the allegations in the complaints filed in the litigation.

  • Bad Faith
  • Alameda County Superior Court
  • Defendant Insurance Company
  • Bad FaithERISAInsurance Services
  • Defended an insurance company in a bad faith case involving insurance agent malpractice which arose from a property and business interruption claim following a fire at a glass business. The plaintiff alleged that he had asked the agent to increase his business interruption coverage shortly before fire. The plaintiff claimed the coverage was not increased, resulting in inefficient funds to cover the damage.

  • Following five week trial, a defense verdict was obtained for our client and 75% of the fault for the case was attributed to the plaintiff. Net judgment against the agent was only $12,000.

  • ERISA
  • USDC: Central District of California; US Court of Appeals for the Ninth Circut
  • Defendant Insurance Company
  • Bad FaithERISAInsurance Services
  • Defended an insurance company against an ERISA action brought by the former in-house counsel in a large corporation against the company's ERISA plan. The plaintiff stopped working due to emotional stress and depression. The claim was paid and then closed at the end of the two year limitation period for disability due to mental illness. The plaintiff did not challenge the termination of benefits at that time. Years later, the plaintiff demanded that the insurer reopen her claim as a “late appeal” or as a “new claim” based on alleged newly discovered information that she suffered from chronic fatigue syndrome all along,  requiring benefits to be paid on the basis of physical disability until age 65.

  • Our client prevailed on two grounds: (1) the plaintiff’s right to challenge the original decision to apply the two year mental illness limitation was barred by failure to exhaust administrative remedies and (2) the insurer’s denial of her alleged “new claim” on the basis she was no longer an active employee was upheld. The Ninth Circuit affirmed the judgment for the defendant.

  • Disability insurance; judicial estoppel, fraud, discrimination, retaliation
  • USDC: Central District of California
  • insurance company
  • EmploymentInsurance Services
  • Plaintiff was a bank associate  at Wells Fargo who made a claim for disability benefits almost a year after being terminated from her position.  She refused to state the basis for her termination and simply stated that she began treatment for depression two weeks prior to her termination, and was disabled from that time forward.  Liberty Life investigated the claim and determined plaintiff was not disabled from her own job or any other job, and upheld its decision on appeal.  Plaintiff then sued under ERISA for denial of insurance benefits.

  • The court granted Liberty Life’s motion for summary judgment on the basis of judicial estoppel and dismissed the case with prejudice.  Where plaintiff had previously alleged in another court action against her employer that she was discriminated against for her national origin and terminated from her job pretextually after complaining, she was judicially estopped from later alleging that she was disabled from her job at the time of her termination.  The court dismissed the action with prejudice.

  • ERISA; Insurance; Bad Faith; Breach of Contract; Employee Welfare Plan; Disability; Employee Benefits; Claim Determination
  • US Court of Appeals for the Ninth Circuit Court; USDC: Northern District of California
  • Defendants Employee Welfare Benefit Plan; Insurance Carrier
  • AppellateBad FaithERISAInsurance Services
  • Defended an insurance carrier and an employee welfare benefits plan in an ERISA action which arose from the termination of long term disability benefits. The employee welfare benefit plan was insured under a group disability policy issued by an insurance carrier. Following a bench trial, the trial court remanded the case to the claim administrator for further investigation. On remand, the claim demand was again upheld and the plaintiff filed suit again.

  • The trial court entered judgment for our client concluding that the insurer did not abuse its discretion under the plan in terminating the plaintiff’s benefits even though they had a “structural conflict” in that it both funded and decided claims under the plan. The ninth circuit affirmed on appeal.