Life Health Disability & ERISA

Our proven knowledge extends to most aspects of our clients' insurance and managed care business, including advising on coverage, underwriting procedures, rescission, and working with the Centers for Medicare and Medicaid Services, the Department of Labor, the Federal Trade Commission, Departments of Insurance and the California Department of Managed Health Care.

We work closely with our clients to draft insurance policy and health plan language. We advise on high-profile or sensitive claims, appeals, and grievances. 

We have substantial experience defending class action and unfair competition claims directed at allegedly improper benefits and business practices, and experience in representing insurers and plans in provider disputes. We represent insurers and plans which have been called upon to respond to documents subpoenas issued by litigants in multidistrict class actions.

REPRESENTATIVE MATTERS

The following are among the types of cases we handle successfully for our clients:

Class Action Representation

Pitluck v. Beverly Enterprises (2005 WL 3008579): Plaintiff, acting as an aggrieved taxpayer, sued a number of skilled nursing facilities for declaratory relief and an injunction, contending that these facilities and entities unlawfully obtain insurance coverage for their willful and wrongful acts. The trial court sustained the nursing homes' demurrers without leave to amend. The Court of Appeal affirmed in an unpublished decision.

De Nuccio v. Health Net of California, Inc.: Plaintiff brought this class action against her Medi-Cal HMO alleging that it denied payment for out of network services to Medi-Cal members. After discovery, plaintiff dismissed the class allegations.

Wolf and Maher v. Health Net Life Insurance Company: Plaintiffs brought this class action challenging Health Net's underwriting and rescission practices. After investigation, the class allegations were dropped.

Luna v. Health Net Life Insurance Company: Motion to compel arbitration granted in this proposed class action involving an allegedly misleading contract.

HIPAA and Patient Privacy

Pharmaceutical Industry Average Wholesale Price Litigation: In this federal multidistrict litigation pending in Boston, Massachusetts, involving 361 named pharmaceuticals, several of our clients were served with an "all documents" third party subpoena by a group of drug manufacturer defendants. Through a combination of negotiation, litigation, and targeted depositions over a period of two years, we significantly limited the scope of the subpoena to protect the privacy rights of our clients' members, and our clients' own interests in the commercially sensitive information that the defendants demanded.

Fiduciary Breach Disputes

Donovan v. Schmoutey: This action brought by the Department of Labor against the trustees of the Southern Nevada Culinary and Bartenders Pension Trust Fund, was, at the time, the single largest civil enforcement action brought under the Employee Retirement Income Security Act of 1974 for alleged breaches of fiduciary duty and prohibited transactions. In defending attorneys who advised the trustees, we became involved in a number of Freedom of Information Act suits to compel disclosure of government files, and two Senate hearings.

Carpenters Pension Trust Fund v. Cox, Castle & Nicholson: This action was brought by newly elected trustees of a Taft Hartley multi-employer trust fund against their predecessors and their legal, accounting, and actuarial advisors for alleged breaches of fiduciary breach and prohibited transactions. Our clients, the attorneys for the labor trustees, were extricated via Rule 12(b)(6) motion to dismiss granted with prejudice. The remaining defendants paid a substantial amount of money to settle the case.

Southern California Carpenters Pension Trust Fund v. Kaminar, Sorbo, Andreen & Thorne: This action was brought against attorneys for a variety of alleged misuses of trust assets. The insured parties' defense was complicated by the fact that one attorney and a number of the trustees had been convicted under ERISA's criminal provisions. The case settled favorably after defense experts, including the head of the Pension and Welfare Benefits Plan, testified that defendants' conduct did not violate ERISA and that the U.S. Attorney's Office had taken advantage of outmanned defense counsel.

Member Disputes

Boales v. Health Net (2005 WL 712324): Plaintiff, a Medicare HMO member, claimed his prior plan improperly denied medical care. He then transferred to Health Net, and claimed that Health Net had a duty to obtain his medical records from his prior group. The order sustaining our demurrer without leave to amend was affirmed in an unpublished decision.

Charnaux v. Health Net (2004 WL 2645976): Plaintiff claimed that his HMO improperly declined to reinstate a continuation policy under Cal-COBRA after the member was canceled a second time for nonpayment of premium. We prevailed on cross-motions for summary judgment in an unpublished district court decision.

Andal v. AIG Life Ins. Co. (2003 WL 22475866): The applicant misrepresented his health history and died of cancer before receiving his life insurance policy. The trial court granted summary judgment on the ground that the applicant was not insurable at the time he applied for insurance. There was no policy in force to rescind, because the conditions precedent to coverage were not met. The Court of Appeal affirmed in an unpublished decision.

Banks v. AIG Life Ins. Co.: Plaintiffs' decedent committed suicide within two years of the policy inception, and argued that the suicide exclusion should not apply because decedent was on Halcion at the time of his death and so was legally insane. The jury agreed there was no breach of contract, but found that the insurer performed an inadequate investigation. We handled the appeal, as well, where the court completely exonerated the insurer. 

Jackson v. Health Net of California: After the member was involuntarily disenrolled from his Medicare + Choice plan for disruptive and uncooperative behavior, he challenged the disenrollment regulation in a district court action. His challenge to the regulation (including his claim that he has a fundamental vested interest in remaining a Medicare + Choice member) is now pending in the Ninth Circuit.