Fox’s Life, Health, Disability & ERISA Litigation Team features a deep bench of attorneys with experience representing insurance companies, ERISA plan sponsors and third-party administrators in cases before the federal and state courts.
We assist the nation’s leading life, health and disability insurance companies. Our clients also include a diverse range of employers.
Our skilled advisers have deep experience in the full range of breach of contract claims seeking recovery under life, accidental death, disability and health insurance policies.
We also defend against:
- Agent misconduct allegations
- Breach of fiduciary duties under ERISA
- Class actions
- Discriminatory underwriting claims
Members of our team are frequently invited to speak at national seminars on life, health, disability and ERISA issues. We also serve in key roles within organizations such as the American Bar Association's Tort Trial & Insurance Practice Section and its Life Insurance Law Committee, Health and Disability Law Committee, and Employee Benefits Committee. We play leading roles in the Life, Health and Disability Committee of the Defense Research Institute and the Law Committee of the International Claim Association.
The attorneys on our ERISA Litigation Team have decades of experience litigating a range of disputes, including:
- Whether insured under individual disability income insurance policy failed to comply with policy's notice of claim provision. (Joseph v. Northwestern Mutual Life Insurance Co., Middle District of Georgia)
- Whether insured under individual disability income insurance policy failed to comply with policy's 90-day proof of loss provision and three-year legal actions provision. (Royal v. New York Life Ins. Co., Southern District of Georgia)
- Whether administrator of self-funded ERISA plan abused its discretion in denying claim for disability benefits (Smith v. Cox Enter., Inc., Northern District of Georgia)
- Whether self-funded plan was top hat plan exempt from disclosure obligations of Section 104(b)(4) of ERISA and whether third-party administrator abused its discretion in denying claim for disability benefits. (Dorsey v. Aetna Life Insurance Co., Eastern District of Virginia)
- Whether TRICARE managed care support contractor properly offset amount of overpayments for medical claims against future claim payments owed to hospital. (Medical Center, Inc. v Humana Military Healthcare Services, Middle District of Georgia)
- Whether second disabling injury sustained during period of continuous total disability entitled insured to a new maximum benefit period. (Burnett v. Combined Insurance Company of America, Middle District of Georgia)
- Whether claim for breach of dental insurance contract was preempted by ERISA. (Muhammad v. Humanadental Insurance Co., Northern District of Georgia)
- Whether surgeon was eligible to recover lifetime disability benefits based on claim that bilateral osteoarthritis of the hips was due to accidental bodily injuries, rather than due to sickness. (Provident Life and Accident Insurance Co. v. Futch, Southern District of Georgia)
- Whether lapse of life insurance policy for failure to pay premiums was excused by insured's alleged mental incapacity. (White v. New York Life Insurance Co., Southern District of Georgia)
- Whether claims against self-funded health benefits ERISA plan for equitable estoppel, breach of fiduciary duty, and class action were subject to dismissal under Fed. R. Civ. P. 12(b)(6). (Le Roux v. Woodgrain Millwork, Inc., District of Idaho)
- Whether beneficiary under accidental death insurance policy timely complied with notice of claim and proof of loss provisions of policy and established accidental death within meaning of policy. (Mitchell v. Globe Life and Accident Insurance Co., Northern District of Georgia)
- Whether individual disability policy was part of ERISA plan or came within Department of Labor "safe harbor," in view of evidence that employer paid premiums.(Cowart v. Metropolitan Life Insurance Co., Middle District of Georgia)
- Whether termination of disability benefits under ERISA plan or award of Social Security disability benefits was a "qualifying event" requiring former employer to offer continuation of health insurance under COBRA. (Karp v. Guardian Life Insurance Company of America, Southern District of Georgia)
- Whether disability insurance plan was "established and maintained" by employer and therefore governed by ERISA, and whether plan satisfied safe harbor exemption from ERISA based on actions of employer. (Moorman v. UnumProvident Corp., 11th Circuit)
- Whether insured could pierce corporate veil or establish tortious interference claim against insurer's parent company based on insurer's alleged breach of contract resulting from denial of benefits. (Perry v. Unum Life Insurance Company of America, Northern District of Georgia)
- Whether letter to insured from insurance agent amended disability policy to add cost of living benefits. (Powers v. Paul Revere Life Insurance Co., Northern District of Georgia, affirmed 11th Circuit)
- Whether disability benefits were payable to physician whose license to practice medicine was revoked, thereby resulting in "legal disability" before the onset of factual disability. (Kocer v. New York Life Insurance Co., Northern District of Georgia)
- Whether death resulted "directly" from accident and "no other causes" where insured's preexisting cardiac condition substantially contributed to automobile accident resulting in death. (Dixon v. Life Insurance Company of North America, 11th Circuit)
- Whether term life insurance policy went into effect where application required owner's personal receipt of policy while in good health and applicant's health changed after policy was received by agent, but before policy was delivered to applicant. (Transamerica Occidental Life Insurance Co. v. Miles)
- Whether merger clause of disability policy barred plaintiff's fraud and RICO claims based on representations allegedly made by agent. (Worsham v. Provident Companies, Inc., Northern District of Georgia, affirmed 11th Circuit)
- Whether proof of customary, computerized procedures was sufficient to establish that premium invoice and lapse notice were mailed to insured. (Yessick v. Midland Life Insurance Co., Northern District of Georgia)
- Whether insured's death in shootout with police was covered under accidental death insurance policy. (McAfee v. Transamerica Occidental Life Insurance Co., Northern District of Georgia, affirmed 11th Circuit, cert. denied)
- Whether loss of medical license was legal disability, precluding recovery of disability benefits based on subsequent factual disability. (Suarez v. Massachusetts Mutual Life Insurance Co., Northern District of Georgia, affirmed 11th Circuit)
- Whether insured's death from apparent medication overdose was by accidental means. (Adair v. Boston Mutual Life Insurance Co., Middle District of Georgia)
- Whether insured's breach of common law duty to advise insurer of change in health warranted rescission of life insurance policy. (Cosby v. Transamerica Occidental Life Insurance Co.)
- Whether the Medicare Secondary Payer Act private cause of action permits a Medicare Advantage Organization to sue a primary payer that refuses to reimburse the MAO for a secondary payment. (Griffin v. Humana Employers Health Plan of Georgia, Inc., Northern District of Georgia, affirmed 11th Circuit)
- Whether federal law is appropriately applied as to the enforceability of a contractual jury waiver. (Birdette v. Saxon Mortgage)
- Whether a national Medicare Managed Care insurer owed $20 million on a risk contract with a managed services organization in South Florida.
- Whether a large insurer in a confidential arbitration owed a $5 million contract claim made by a managed services organization, and whether the managed services organization’s new plan improperly enrolled the payor’s members.