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ERISA - Representative Experience

  • Issues
  • Venue
  • Client Type
  • Lawyers
  • Full Description
  • Result
  • Bad Faith
  • Alameda County Superior Court
  • Defendant Insurance Company
  • Pamela E. Cogan (Retired)
  • 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
  • Pamela E. Cogan (Retired)
  • 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
  • Pamela E. Cogan (Retired)
  • 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.

  • ERISA; insurance; bad faith; breach of contract; employee welfare plan; disability; employee benefits; claim determination
  • Ninth Circuit Court of Appeal; U.S. District Court for the Central District of California
  • Defendants employee welfare benefit plan, and insurance company
  • Robert M. Forni
  • This ERISA action arose from the termination of long term disability benefits.  The employee welfare benefit plan was insured under a group disability policy issued by Continental Casualty Company.   Hartford Life and Accident Insurance Company (“Hartford”) later acquired the policy, and thereafter assumed responsibility for administering claims under the plan.  Following a bench trial, the trial court entered judgment for the plan, concluding that Hartford did not abuse its discretion under the plan in terminating the plaintiff’s benefits even though Hartford had a “structural conflict” in that it both funded and decided claims under the plan.  

  • The trial court entered judgment for the defendants, which is on appeal.

  • ERISA, employee welfare plan, appeal, arbitration
  • United States Court of Appeals for the Ninth Circuit, U.S. District Court for the Northern District of California
  • Robert M. Forni
  • A former employee submitted a claim for disability benefits under an employee welfare benefit plan three months after she ceased working for the plan sponsor.  The employee did not advise the insurer and claim administrator for the plan that she had been terminated and on a leave of absence since August 28, 2001, or that she had released her claims for disability benefits under the plan pursuant to a severance agreement that she had previously signed.  The insurer determined she was not eligible for disability benefits because she was not disabled as of August 29, 2001 and throughout the plan's ninety-day elimination period.  The employee sued the insurer and plan to recover disability benefits under the Employee Retirement Income Security Act of 1974 (“ERISA”).  The district court granted the employee's petition to dismiss her entire action and compel the binding arbitration of her claims against the insurer under the Federal Arbitration Act and her employment agreement with her former employer.  She then submitted all claims  to the jurisdiction of the arbitrator.

  • The arbitrator convened a hearing counsel argued the merits of the parties’ claims and defenses.  The arbitrator subsequently issued a written ruling in the insurer's favor.  In doing so, the arbitrator found that the employee had knowingly and voluntarily released her right to plan benefits under the terms of the severance agreement, and that the agreement barred her claims against the insurer.  The district court granted the insurer's petition to confirm the arbitration award, and entered judgment in the insurer's favor.  The Ninth Circuit affirmed the judgment on appeal.

  • ERISA; insurance; bad faith; breach of contract; employee welfare plan; disability; employee benefits; claim determination
  • Ninth Circuit Court of Appeal; U.S. District Court for the Central District of California
  • Defendants employee welfare benefit plan, and insurance company
  • Robert M. Forni
  • This ERISA action arose from the termination of long term disability benefits.  The employee welfare benefit plan was insured under a group disability policy issued by Liberty Life Assurance Company of Boston.  Following a bench trial, the trial court entered judgment for the plan, concluding that Liberty did not abuse its discretion under the plan in terminating the plaintiff’s benefits even though Liberty had a “structural conflict” in that it both funded and decided claims under the plan.  

  • The Ninth Circuit Court of Appeal affirmed judgment for the defendant.

  • Defendant, Insurance Company, Insurance Plan
  • Pamela E. Cogan (Retired), Stacy Monahan Tucker
  • 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.

  • Claim for Disability Benefits Governed by ERISA
  • United States District Court, Northern District of California
  • Defendant; Insurance Company
  • Pamela E. Cogan (Retired), Stacy Monahan Tucker
  • 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.

  • Bad Faith
  • Alameda County Superior Court
  • Defendant Insurance Company
  • Pamela E. Cogan (Retired)
  • 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
  • Pamela E. Cogan (Retired)
  • 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.

  • ERISA; bad faith; breach of contract; employee welfare plan; disability; employee benefits; claim determination
  • Ninth Circuit Court of Appeal; U.S. District Court for the Northern District of California
  • Defendant employer and its insurer
  • Robert M. Forni, Susan H. Handelman
  • This ERISA action 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 company.  Following a bench trial, the trial court entered judgment for the plan, concluding that the insurer did not abuse its discretion under the plan in terminating the plaintiff’s benefits even though the insurer had a “structural conflict” in that it both funded and decided claims under the plan.  

  • Judgment for employer/insurer affirmed.
     

  • Insurance, severance agreement
  • Ninth Circuit Court of Appeals
  • Defendant - Insurance Company
  • Pamela E. Cogan (Retired), Stacy Monahan Tucker
  • 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.

  • 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
  • Pamela E. Cogan (Retired), Robert M. Forni
  • 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.