Practice/Industry Group Overview
At Goldberg Segalla, we aggressively defend insurers and plan administrators in state and federal courts throughout the United States. As part of our Best Practices philosophy our attorneys maintain comprehensive knowledge of the complexities that frequently arise in life, health and disability benefits litigation. We understand that decisions in one jurisdiction or Federal Circuit are likely to have a spillover effect into other venues. Staying abreast allows us to offer critical guidance for plan and claim administrators with multiple similar claims in different jurisdictions.
Our attorneys have experience with all life insurance issues. Some recent claims include:
- Whether a death was “accidental”
- Contestability, fraud and material misrepresentation (including foreign death schemes)
- Policy cancellation issues
- Unique beneficiary issues
In order to help clients achieve the best possible outcome, we focus on the details of each case while also keeping an eye on the big picture. Recently, we have successfully handled health insurance matters including:
- Disputes over payor submissions deadlines and third-party billing
- Health insurance and provider audits
- HIPAA compliance issues and litigation
- Healthcare subrogation and third-party lien disputes
- Billing agent errors and omissions
- Mandatory insurance reporting to CMS
We know that results matter. Our recent achievements include:
- Successfully defeating challenges to discretionary clause language
- A determination that benefits are limited to an “own occupation” period as opposed to “any occupation”
- Resolving disputes among overlapping disability policies
- Litigation over a plan conflict of interest affecting the standard of review
- Limiting discovery to the administrative record
Employee Retirement and Income Security Act (ERISA)
Our attorneys have a heightened appreciation of the nuances associated with defending employee benefits claims under ERISA, and are adept at counseling clients on issues arising from overlay of this Act. At Goldberg Segalla, we focus on:
- Proactive and prompt removal of ERISA cases to the federal courts
- Evolving issues concerning ERISA preemption, including preventing claims of estoppel, waiver, bad faith, fraud, etc.
- Ensuring the proper confines of discovery, including limitation to the administrative record and limitation of discovery against an insurer or carrier regarding its claims process
- Aggressive motion practice to dismiss common law claims and preclude experts
Leaders in Life, Health, Disability, and ERISA Practice
Goldberg Segalla attorneys are nationally recognized leaders and authorities in the field of life, health, disability, and ERISA. A small sampling of highlights includes:
- Goldberg Segalla is included on Res Loquitor’s “Select List” of law firms for the defense of life, health, and disability matters.
- Richard J. Cohen and Daniel W. Gerber authored the chapter on life insurance for the seminal New Appleman on Insurance Practice Guide.
- The chapter on life insurance fraud in the life, health, and disability installment of Appleman on Insurance 3d, with an expanded section on stranger-originated life insurance (STOLI), was authored by our team of Dan Gerber, Anthony J. Golowski II, Fallyn B. Cavalieri, and Clayton D. Waterman.
- Dan Gerber is immediate-past Chair of the Defense Research Institute’s Life, Health, and Disability Committee. In 2010, he received DRI’s Al Parnell Award for Best Seminar Chair for the Life, Health, Disability, and ERISA seminar.
- Dan also serves on the Life Insurance Committee of the International Claim Association and is a regular speaker on this topic at the ICA’s Annual Meeting.
- Sarah J. Delaney is the Online Community Chair, and a past Annual Meeting Chair, for DRI’s Life, Health, and Disability Committee.
- Anthony Golowski on the ICA’s Fraud and Claim Abuse Committee. He and Sharon Angelino spoke on "Proactive Insurance Fraud Investigations” at the ICA’s Annual Education Conference in 2011.
- Joanna M. Roberto and Paul C. Steck authored “Investing in Death Creates Judicial and Regulatory Issues” on STOLI transactions for DRI’s For the Defense.