Publication

Ronald Alberts, Partner
ERISA and Life, Health and Disability Insurance
Ph: (213) 576-5000
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In the September 2009 edition of DRI Magazine For The Defense, the attorneys of Gordon & Rees published an article entitled A Year After Glenn-No Clear Path that discussed the impact of the United States Supreme Court decision in Metropolitan Life Ins. Co. v. Glenn, 128 S.Ct. 2343 (2008) on ERISA claims, specifically how circuit courts are handling the relatively-new discovery issues and the ultimate decisions on the claims themselves. Lisa Garner and Ronald Alberts review recent noteworthy decisions handed down by several of the circuit courts in which Gordon & Rees litigates. Learn more about recent developments in ERISA case law

Tad Devlin and Elizabeth Vanalek (San Francisco) successfully defended an employer in a breach of fiduciary duty case under ERISA. Plaintiff alleged that the employer failed to notify plaintiff of approval of her request for an increase in death benefits and failed to deduct higher premium payments for plaintiff's policy, resulting in lower-than-expected death benefits after plaintiff's husband passed away. After the Gordon & Rees team thwarted plaintiff's multiple attempts to save her defective lawsuit, the district court granted a motion to dismiss with prejudice in favor of Gordon & Rees's client. Read the complete case summary

Ronald Alberts (Los Angeles) and Shannon Ross (San Francisco) obtained a defense judgment in an ERISA denial of disability benefits case in federal court. The plaintiff went off work per the recommendation of his physician due to poorly controlled diabetes, stress and anxiety. On de novo review, the court upheld the insurer's denial of LTD benefits. Although plaintiff's primary treating physician opined that plaintiff was disabled from working, the court concluded that the doctor recommended disability prematurely, based largely on plaintiff's self reports, and in the absence of much objective data. The court also found persuasive the opinions of plaintiff's two treating specialists and two external reviewing physicians that plaintiff was capable of working. The court disagreed with plaintiff that the insurer should have given more weight to the Social Security Administration's disability determination, and the court denied plaintiff's request to take judicial notice of extra-record evidence. Read the complete case summary

Ronald Alberts and Lisa Garner (Los Angeles) obtained a verdict in favor of our clients Aetna Life Insurance Company and Boeing, Inc. in an ERISA disability benefits case, which distinguished recent unfavorable Ninth Circuit case law. Letvinuck v. Aetna, et. al was initially tried in August of 2007, with the federal district court in California finding for the clients. Plaintiff appealed, and the Ninth Circuit remanded for a new trial, instructing the district court to consider certain issues in light of Saffon v. Wells Fargo & Co. Long Term Disability Plan and the Supreme Court decision of Metropolitan Life v. Glenn. In September of 2009, before the new trial, the Ninth Circuit issued its decision in Montour v. Hartford Life & Accident Insurance Co. which criticized the insurance company for relying on "paper reviews" by its medical reviewers and for failing to explain to the claimant its reasons for coming to a different conclusion about disability than the Social Security Administration. On December 15, 2009, the district court retried the case. On December 17, 2009, the district court issued a 23 page Findings of Fact and Conclusions of Law that addressed in detail all of the issues raised by the Ninth Circuit. More importantly, the district court articulated sound reasons for distinguishing the facts of this case from that of Glenn, Saffon and Montour along the lines of the arguments raised by Gordon & Rees. Plaintiff has filed another appeal to the Ninth Circuit. Read the complete case summary

Bob Bragalone and Eric Jaegers (Dallas) obtained summary judgment in an ERISA long-term disability benefits matter (Patterson v. Prudential, No. H-08-CV-2127). On January 13, 2010, the Southern District of Texas (Houston Division) granted summary judgment in favor of Gordon & Rees's clients, The Prudential Insurance Company of America and AON Benefits Committee, after more than a year of litigation. Read the complete case summary

Ronald Alberts and Shannon Victor (Los Angeles) obtained a victory for client Prudential in a federal court trial involving a plaintiff's claim for accidental dismemberment benefits under ERISA. The plaintiff was as an employee at Disneyland when he accidentally fell and injured his knee and ended up undergoing an above-the-knee amputation. However, the plaintiff had an extensive history of leg and knee injuries pre-dating his fall, which substantially contributed to, if not compelled his decision to amputate. The court, applying a de novo standard of review, affirmed Prudential's decision to deny the plaintiff's claim for dismemberment benefits under the terms of Disney's employee group welfare benefit plan. Read the complete case summary

Franz Hardy (Denver) obtained a judgment for client, Prudential, in a matter involving the denial of long term disability benefits. The plaintiff, a long-time employee of a large beer manufacturer, asserted that his alcoholism was so severe he could not meet the "regular care" requirements under the applicable plan. He also asserted that Prudential's request that he attend daily Alcoholics Anonymous meetings was improper as AA is not medical treatment. The court found that daily attendance at AA meetings was "appropriate treatment and care" under the policy provisions of the plan and entered judgment in favor of Prudential. Read the complete case summary

Ronald Alberts (Los Angeles) and Leslie Crary (San Francisco) obtained a dismissal following a demurrer to a complaint filed by a provider to recover amounts allegedly due from a patient's health insurer, and Gordon Rees's client, Aetna. Ron and Leslie successfully argued the complaint was barred by the application of the statute of limitations. The plaintiff provider, Enloe Medical Center has appealed, raising an issue as to the inception of the limitations period. Leslie is also a member of Gordon & Rees's Appellate Practice Group, and Gordon & Rees will be representing Aetna on the appeal. Read the complete case summary