• Life, Health & Disability Insurance & ERISA Litigation

    The stakes have been raised in the insurance game
    Insurance products are based upon one thing: calculated risk. And these days the risks for insurers are often higher than the rewards. More lawsuits, greater scrutiny of industry practices, and increased regulation are among the many challenges facing insurers. Here are some others: 

    • Rescissions based on material misrepresentations in policy applications are being closely scrutinized, with proposed legislation seeking to limit or eliminate rescissions. 
    • Stranger Owned Life Insurance policies are facing increased regulation and lawsuits. 
    • Sales of insurance products to seniors are under heightened scrutiny by regulators. 
    • Policyholder lawsuits alleging bad faith denial of claims and improper rescission are going to trial more often in front of increasingly sympathetic juries. 

    With the stakes rising higher and the margin for error becoming narrower, it’s more important than ever to have a partner who can help you stay ahead of the game. Manatt’s breadth and depth of experience are insurance for the insurance industry. 

    Key Areas of Practice

    • We represent life, health, disability, accidental death and dismemberment, and long-term care insurers in lawsuits ranging from complex class actions to interpleaders, including rescission actions, lawsuits involving pre-existing condition provisions, drug, alcohol and felony exclusions, lapse, accidental death vs. natural causes, suicide, impostor defense, disappearance, foreign death claims, murder of the insured by the beneficiary, insurance fraud and disputes with agents. We also counsel our insurance clients on a wide variety of regulatory issues.
    • Few firms have Manatt’s experience litigating significant health insurance cases in trial courts and various courts of appeal. We have obtained dismissals at the pleading stage in a variety of significant healthcare and health insurance class actions. We have been at the forefront of virtually every significant health plan and health insurer litigation issue in California in the past five years, including rescission, capitation, vicarious liability and ERISA preemption.  
    • Manatt regularly handles complex class actions for a wide array of insurance companies. We have thorough knowledge of procedural issues, practical experience with the mechanics of class-action litigation and a track record of success in class actions including significant victories at the pleading stage. Our lawyers have represented insurers in class action litigation challenging the application and interpretation of certain policy provisions, alleging unfair business practices and unlawful discrimination in underwriting, and claiming that particular policy exclusions do not comply with California law.   

    Representative Matters

    • The entire HMO system in California was on trial in a significant lawsuit for our client Blue Shield. At issue was whether the state’s health plans can be held responsible for decisions they delegate to medical groups. We prevailed before a Los Angeles jury at trial, while also blocking filmmaker Michael Moore from turning the jury trial into a circus. The California Court of Appeal subsequently handed down a unanimous opinion, adopting our legal arguments and making new law in California.  
    • We defended ReliaStar Life Insurance Company in a class action alleging that the drug exclusion in our client’s group accidental death and dismemberment policy did not comply with California law and therefore could not be used to deny claims for accidental death benefits submitted by California insureds. We settled the case on favorable terms after the court refused to certify a class. 
    • We obtained summary judgments (affirmed on appeal) on behalf of Metropolitan Life Insurance Company in 17 “vanishing premium” cases in which plaintiffs claimed they were misled by misrepresentations that the dividends on their life insurance policies would be sufficient to pay all future premiums after they had paid premiums out of pocket for a specified number of years. 
    • We recovered substantial attorneys’ fees for Monumental Life Insurance Company—as well as most of the accidental death insurance proceeds—in the infamous “Black Widows” case in which two elderly women befriended homeless men, took out accidental death insurance on them, named themselves as the beneficiaries, and then murdered them.  
    • We represented Blue Shield of California in a significant RICO action brought by a nationwide class of 900,000 physicians.  The suit alleged that plans throughout the country had engaged in a RICO conspiracy to underpay physicians. Most of the defendant insurers settled for hundreds of millions of dollars in cash payments to the class, plus commitments to make significant business changes over a multiyear period. Our client did not settle, and the District Court subsequently granted our motion to dismiss with prejudice. 
    • We defended SwissRe in a coverage action involving Catholic archdiocese priest molestation claims involving hundreds of priests over a 40-year period. That case was settled on very favorable terms for our client. 
    • On behalf of a New York health plan, we challenged the New York Insurance Department’s denial of proposed reconfiguration of our health insurer client’s rating region and obtained an order from the New York State Supreme Court requiring the Department to grant our client’s request. 
    • With only months to go before trial, SwissRe asked us to help design and lead a defense trial strategy against allegations that the company was liable for covering thousands of asbestos injury-related claims. Soon after we appeared in the case, the opposing side agreed to discuss settlement, and the matter was successfully resolved for our client. 
    • We defended and reached a mutually agreeable settlement of a lawsuit arising out of the death of actor Heath Ledger that challenged an insurer’s right to conduct a contestable investigation.  
    • We currently advise the largest workers’ compensation carrier in California on corporate indemnification issues and coverage claims under its own directors and officers liability policies.

     

    Attorneys & Professionals

    Email
    Name
    Office
    Phone
    Alazraki, Marcia D. New York 212.830.7273
    Bloomgarden, Craig S. Los Angeles 310.312.4240
    Laska, Joseph E. Los Angeles 310.312.4352
    Levy, Margaret Los Angeles 310.312.4368
    Martin, Jay B. Albany 518.431.6707
    Pimstone, Gregory N. Los Angeles 310.312.4133
    Rosen, Jessica Shpall New York 212.790.4599
    Sheehan, Jeremiah P. New York 212.830.7205

    Life, Health & Disability Insurance & ERISA Litigation

    Selected Clients

    • Aflac
    • American Heritage Life Insurance Company
    • Blue Shield of California
    • ING Americas
    • Liberty Life Insurance Company
    • MEGA Life and Health Insurance Company
    • ReliaStar Life Insurance Company
    • Transamerica Life Insurance Company

    Life, Health & Disability Insurance & ERISA Litigation

    Representative Matters

    • The entire HMO system in California was on trial in a significant lawsuit for our client Blue Shield. At issue was whether the state’s health plans can be held responsible for decisions they delegate to medical groups. We prevailed before a Los Angeles jury at trial, while also blocking filmmaker Michael Moore from turning the jury trial into a circus. The California Court of Appeal subsequently handed down a unanimous opinion, adopting our legal arguments and making new law in California.  
    •  We defended ReliaStar Life Insurance Company in a class action alleging that the drug exclusion in our client’s group accidental death and dismemberment policy did not comply with California law and therefore could not be used to deny claims for accidental death benefits submitted by California insureds. We settled the case on favorable terms after the court refused to certify a class.
    •  We obtained summary judgments (affirmed on appeal) on behalf of Metropolitan Life Insurance Company in 17 “vanishing premium” cases in which plaintiffs claimed they were misled by misrepresentations that the dividends on their life insurance policies would be sufficient to pay all future premiums after they had paid premiums out of pocket for a specified number of years.
    • We recovered substantial attorneys’ fees for Monumental Life Insurance Company—as well as most of the accidental death insurance proceeds—in the infamous “Black Widows” case in which two elderly women befriended homeless men, took out accidental death insurance on them, named themselves as the beneficiaries, and then murdered them.  
    • We represented Blue Shield of California in a significant RICO action brought by a nationwide class of 900,000 physicians.  The suit alleged that plans throughout the country had engaged in a RICO conspiracy to underpay physicians. Most of the defendant insurers settled for hundreds of millions of dollars in cash payments to the class, plus commitments to make significant business changes over a multiyear period. Our client did not settle, and the District Court subsequently granted our motion to dismiss with prejudice.
    • We defended SwissRe in a coverage action involving Catholic archdiocese priest molestation claims involving hundreds of priests over a 40-year period. That case was settled on very favorable terms for our client.
    • On behalf of a New York health plan, we challenged the New York Insurance Department’s denial of proposed reconfiguration of our health insurer client’s rating region and obtained an order from the New York State Supreme Court requiring the Department to grant our client’s request.
    • With only months to go before trial, SwissRe asked us to help design and lead a defense trial strategy against allegations that the company was liable for covering thousands of asbestos injury-related claims. Soon after we appeared in the case, the opposing side agreed to discuss settlement, and the matter was successfully resolved for our client.
    • We defended and reached a mutually agreeable settlement of a lawsuit arising out of the death of actor Heath Ledger that challenged an insurer’s right to conduct a contestable investigation.  
    • We currently advise the largest workers’ compensation carrier in California on corporate indemnification issues and coverage claims under its own directors and officers liability policies.