A common battle ground in ERISA claims involves the argument that ambiguous terms should be construed against the party that drafted the document. This is known as the doctrine of contra proferentem. See generally E. Erlich, [How to]
Lane Powell PC
Lane Powell PC is a law firm that has recently combined with Ballard Spahr to form a nationally recognized firm with a broad geographic presence across the United States. The firm has a long history and focuses on providing legal services with an emphasis on client service, diversity, inclusion, and community engagement. Its published content frequently addresses legal issues related to employee benefits and insurance law, particularly ERISA-governed long term disability claims. The firm analyzes court decisions and procedural requirements in ERISA litigation, offering insights into claims administration, judicial review standards, and evidentiary burdens in disability benefit disputes.
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Roundup of White Collar News: False Statements and Fake Accents
Happy new year! While the shutdown has slowed DOJ, it has not stopped it. And we have fraud documentaries from Netflix and Hulu.
- Just after the new year, the Senate confirmed Brian Moran as the Western District of Washington’s new
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Roundup of White Collar News
Happy holidays after a long break. While we may have been quiet, DOJ has not.
- The U.S. Attorney’s Office in Portland has charged three men with bank fraud and money laundering. The three allegedly used SnapChat to recruit students at
…
ERISA: Is Discovery Allowed When A Breach Of Fiduciary Duty Claim Is Asserted?
By Mike Reilly
You already know that discovery is usually limited in appeals of the denial of ERISA-governed benefits. This is especially true when there is de novo review.
But watch out if a breach of fiduciary duty claim is asserted. That same …
ERISA: California’s Ban on Discretionary Language does NOT Apply to Health Insurance
By Mike Reilly
Many states have banned discretionary clauses in life and disability policies. But remember to look closely at the language… to see if the ban actually applies to the policy at issue.
Here’s the case of Brian H and Alex H…
Roundup of White Collar News
There’s been a slew of white collar enforcement actions in the Pacific Northwest and around the country in the last six weeks:
- Don’t lie to federal agents. Some false statement charges in Oregon and Alaska. The Oregon case involves $6.4
…
ERISA: Winning the Self-Reported Diagnosis Limitation in Disability Claims
By Mike Reilly
Most ERISA plans contain provisions limiting benefits for disabilities “which are primarily based on self-reported symptoms” or “mental illness.” (Emphasis added).
So, what does “primarily” mean? And what evidence in the medical records justifies the conclusion that the diagnosis is…
ERISA: Easy Insights into Neutralizing the Effects of “Conflict of Interest” in Disability Determinations
By Mike Reilly
You already know that many ERISA plans contain discretionary language, which calls for a court to review the ERISA claim denial under an abuse of discretion standard.
But many times a structural “conflict of interest” can occur where the plan…
ERISA: Seven Tips on Whether Equitable Defenses Can Defeat Subrogation Claims for Overpayment After Tort Settlement
By Mike Reilly
ERISA plans and related disability or health policies contain language granting the right to reimbursement of overpayments made to the claimant. Overpayments usually occur when the claimant receives lump sum Social Security benefits, or the claimant receives a tort settlement.…
Financing Terrorism Through the Hawala System
You might have heard the term “hawala” mentioned over the last few weeks. Maybe you saw it discussed while watching Amazon’s new Jack Ryan series, or maybe you’re more of a C-SPAN fan, and caught it a few times while…