Life, Health, Disability & ERISA

GRSM’s Life, Health, Disability & ERISA team has extensive experience handling disputes involving all types of employee welfare benefit plan claims, including life, health, disability, pension, and retirement plans, annuities, and long-term care insurance. We also represent fiduciary defendants in pension and ESOP-related disputes.

We have comprehensive knowledge of ERISA and extensive experience litigating ERISA claims in the federal trial and appellate courts throughout the United States. As ERISA litigation continues to increase, we have a team of experienced attorneys with substantial experience in the planning of ERISA litigation strategy and advising clients in the assessment of a wide range of risks.

Additionally, we have extensive experience representing health plans, health insurers and other payors in health care disputes related to the reimbursement of medical provider charges.

Our lawyers leverage the combination of deep experience in health care contract litigation with extensive insurance coverage experience. We have resolved many contract claims brought by providers against payors, including insurers, HMOs, and self-insured plans.

We have handled claims ranging from benefit entitlement disputes and contract terms, to appropriate treatments and medical necessity determinations, to unbundling and usual and customary charges.

Our lawyers have a broad range of experience representing health care providers and health, life and disability insurance carriers in high profile litigation in state and federal courts throughout the United States. We have a record of substantial success throughout the country and continue to serve as national counsel for several of the largest insurance carriers.

Defense of suits seeking disability benefits under both insured and self-insured employer sponsored plans
Disputes over the application of ERISA exemptions, including government sponsored and church plans
Disputes arising from alleged misrepresentation or fraud, including related remedies such as rescission
Interpleader and related actions to resolve life insurance coverage issues, such as beneficiary disputes (including application of slayer statutes)
Breach of fiduciary duty claims against ERISA plan fiduciaries for alleged self-dealing and violation of pension plan terms
Sales Practices Class Actions based on RICO and California Business & Professions Code § 17200, including extensive e-discovery relating to financial products including annuities
Vicarious liability suits involving alleged broker-dealer and agent malpractice
FINRA investigations and arbitrations
Premium financing litigation
Stranger-owned life insurance (“STOLI”) disputes
Regulatory disputes and related litigation, including
Department of Insurance and Attorney General claims against insurers
Financial elder abuse claims
Incontestability disputes based upon concealment or fraud
Life settlement claims
Long-term care insurance litigation
Health plan claims seeking benefits denied as not medically necessary or experimental
Disputes over applicable plan regarding primary versus secondary status
Disputes about whether benefit plans comply with ERISA
Claims involving ERISA preemption against life insurer for agent’s negligence in failing to establish IRS-compliant ESOP
Claims for authorization and reimbursement of health benefits which are denied as experimental, investigational or not medically necessary
Fraudulent claims by health care providers seeking reimbursement for services either not rendered, not medically necessary, or in excess of usual and customary fees
Defense of claims by health care providers under contracts with payors, including insurers, health care service plans, and employers
Disputes among payors regarding applicable plan provisions and determining primary versus secondary payor
Disputes regarding application of stop-loss provisions, interpretation of maternity benefits, and proper case rates

Life, Health, Disability & ERISA

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Representative Experience