Goldberg Segalla LLP

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Life, Health, Disability, and ERISA

Goldberg Segalla’s Global Insurance Services Practice Group has a nationally recognized team of insurance lawyers and litigators focused on life and health insurance, disability benefits, and Employee Retirement and Income Security Act (ERISA) matters. We serve the comprehensive needs of insurers, plan administrators, and others operating in the LHD and ERISA space.

Our team brings to each situation deep industry knowledge and proficiency navigating the nuances and complexities that characterize LHD and ERISA work. Our mastery of this area and our experience across the U.S. and international markets drive more practical counsel, more creative solutions, and stronger advocacy in coverage disputes. This is especially true in matters that cross jurisdictional lines, when understanding the interplay of varying rules and caselaw is critical to efficiency and success.

These are a few reasons why several of the world’s largest insurers trust us with their most complex, high-exposure LHD and ERISA matters.

A small sampling of the ways our team partners with clients follows.

Life Insurance
  • Claims involving questions whether a death was “accidental”
  • Contestability, fraud, and material misrepresentation (including foreign death schemes)
  • Lapsed or canceled policy issues
  • Beneficiary concerns and disputes, including those involving beneficiary changes and unique slayer statute scenarios
  • Policy rescission
  • Premium disputes and policy administration
  • Stranger-originated life insurance (STOLI) and corporate-owned life insurance (COLI)
Health Insurance
  • Disputes over payor submission deadlines and third-party billing
  • Health insurance and provider audits
  • Health Insurance Portability and Accountability Act (HIPAA) compliance and litigation
  • Health care subrogation and third-party lien disputes
  • Billing agent errors and omissions
  • Mandatory insurance reporting to Centers for Medicare and Medicaid Services (CMS)
  • Affordable Care Act compliance
  • Guidance regarding health insurance exchanges
Disability Benefits
  • Defeating challenges to discretionary clause language
  • Benefits limitation determinations, such as limits to an “own occupation” period as opposed to “any occupation”
  • Resolving disputes among overlapping disability policies
  • Litigation over plan conflicts of interest affecting the standard of review
  • Heightening efficiency by limiting discovery to the administrative record
  • Fraud investigations
  • Policy rescission
Employee Retirement and Income Security Act (ERISA)
  • 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.
  • Discretionary standards
  • Interference and retaliation claims under ERISA Section 510
Regulatory Guidance
  • Organization and licensing of life insurance companies
  • Guidance with life insurance and group disability insurance policy form filings
  • Compliance with state insurance laws regarding corporate governance and disclosure rules
  • Compliance with New York Insurance Law requirements for first-year agent compensation
  • Filings submitted to demonstrate compliance with Section 4228 of the New York Insurance Law (agent compensation limitations)
  • Compliance with replacement rules for life and annuity contracts, including notifications and disclosures
  • Compliance with rules governing advertisement of life insurance and annuity contracts
  • Representation in market conduct examinations and agent disciplinary proceedings
Representative Matters
  • In a federal court action involving a long-term disability policy governed by ERISA, we successfully litigated the review of the insurer’s benefit decision under the plan. With benefits of $850,000 at stake, we efficiently and effectively minimized litigation costs by aggressively defending against discovery and proceeding to early dispositive motions seeking judgment on the administrative record. We successfully argued the motion and overcame allegations of a conflict of interest through the use of carefully crafted client affidavits. This litigation resulted in a lengthy reported decision that created positive precedent in the ERISA benefits field.
  • An ERISA insurer retained Goldberg Segalla to enforce its rights regarding an eligibility decision under an employee benefits plan. The case involved an intricate issue regarding interpretation of the plan’s terms surrounding “active work” and the effect of payments to a previous employee under a severance agreement. The federal district court upheld the insurer’s interpretation of the plan terms and cited wholesale from the brief prepared on behalf of our client. Additionally, we were successful in defending against the admission of extrinsic evidence outside of the administrative record.
  • In a case of first impression in New York, we used offensive interpleader to help a life insurer avoid impending litigation and rightfully prevent the vast majority of a $500,000 policy’s benefits from going to the mentally ill fiancé who murdered her. What made the case novel and complicated was the fact that a jury found the fiancé guilty but not criminally responsible for the policyholder’s murder — leaving the question of whether New York’s slayer statute, which had recently changed, applied. We convinced the court our client should be entitled for interpleader relief, and the court allowed the parties to negotiate an agreement amongst themselves. In addition, we guided the life insurer through establishment of a trust for the policyholder’s children, taking steps to minimize the risk of future litigation.
  • A health insurer called on our team to protect it from paying approximately $100,000 in medical treatment benefits to a serial fraudster. We acted for and guided the insurer through a number of legal and regulatory steps to counter the attempted fraud, including petitioning the state regulatory agency to give our client relief from the non-cancellable, guaranteed-renewable policy that had essentially handcuffed the insurer and the doctors from whom the policyholder repeatedly sought unnecessary treatment. We also filed notice to the state’s bankruptcy trustee to report the policyholder’s failure to disclose as income, when she filed for bankruptcy, the $35,000 in benefits she had already received from her fraudulent doctor visits.
  • Goldberg Segalla was regulatory counsel for a Japan-based life insurer in its $5 billion acquisition of a New York Stock Exchange-traded financial holding company and its nationwide U.S. insurance operations. Our role included contract drafting, regulatory due diligence, structuring corporate governance of the new combined insurance holding company group, and handling all regulatory approval applications, hearings and related activities, and preparation of enterprise risk-management reports.
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. Our team includes:

  • Author of the Second Circuit chapter in the American Bar Association’s ERISA Survey of Federal Circuits
  • An author of the “Life Insurance Claims Adjusting and Fraud” chapter in the LHD installment of Appleman on Insurance 3d, with an expanded section on stranger-originated life insurance (STOLI)
  • Frequent speakers and authors on issues related to discretionary language, insurance claw-backs in ERISA plans, and a broad range of life, health, disability, and ERISA topics

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  • 5.0/5.0 Review for Michael Rubin by a Partner on 05/28/15 in Civil Litigation

    Mike is an excellent attorney, a strong client advocate and worthy adversary.

    Mike is an excellent attorney, a strong client advocate and worthy adversary. Read less

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  • 5.0/5.0 Review for Marc W. Brown by a Judge on 08/13/13 in Appellate Practice

    Mr Brown served as a law clerk at the Appellate Division, Fourth Dept., one of New York's intermediate appellate courts while I was Presiding Justice of that Court. His work was outstanding.

    Mr Brown served as a law clerk at the Appellate Division, Fourth Dept., one of New York's intermediate appellate courts while I was Presiding Justice of that Court. His work was outstanding. Read less

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Diversity

Both within our own firm and across the wider business and legal communities, Goldberg Segalla’s commitment to diversity is strong, sincere, and a critical component of our firm’s mission and culture. Our philosophy has always been that we hire people who are excellent at what they do, and even better human beings. Period. We feel we would be doing a disservice to our firm and to our clients if we didn’t include contributions from every available resource.


We are extremely proud that our commitment has received regional and national recognition for the innovative programs we have developed and the results we have been able to achieve. The following is a sampling of the firm-wide or individual honors we have received for implementing initiatives that make a difference:


  • George B. Vashon Innovator Award, Minority Corporate Counsel Association
  • MCCA Firm Affiliate Network
  • Vault/MCCA Commitment to Diversity
  • Community Service Award, Defense Research Institute
  • Good Works Award, American Bar Association Section of Litigation
  • Outstanding Committee Chair, ABA Section of Litigation
  • Diversity Trailblazer Award, New York State Bar Association
  • Legal Service Award, Minority Bar Association of Western New York
  • Lawyer of the Year, Bar Association of Erie County
  • Legal Community Leader Award, National Federation for Just Communities of Western New York
  • Diversity Excellence Award, Buffalo Niagara Human Resource Association
  • Value Award for Diversity, Leadership Buffalo
  • Western New York Game Changers, Buffalo Spree magazine

What we are most proud of, though, is that our efforts have shown significant results and continue to make a lasting impact on the lives of many.

Leadership and Action

To put our philosophy and commitment into practice, we have a Diversity Task Force, which includes our managing partner, in place to conceptualize and implement diversity-focused programs as well as give diversity a voice in our decision-making at the highest level. The individuals on this task force share the firm’s strong commitment to increasing diversity, and they use their unique experiences and backgrounds to support and advance that goal. The team meets regularly to create programs, schedule events, establish diversity initiatives both inside and outside of the firm, set long-term goals, and develop the strategy to recruit and retain people from diverse backgrounds.


The chair of our Diversity Task Force, Joseph M. Hanna, has spearheaded numerous diversity initiatives in various organizations and outreach programs, serves on several diversity-related committees, and is a frequent author and speaker on diversity. Among other positions, he is co-chair of the American Bar Association (ABA) Young Lawyer Leadership Program, former chair of the association’s Minority Trial Lawyer Committee and its Special Committee on Human Rights, and former editor-in-chief of the ABA’s Minority Trial Lawyer; a 2014 fellow of the Leadership Council on Legal Diversity (LCLD); a past president of the Minority Bar Association of Western New York (MBAWNY) and the MBAWNY Foundation; and the Diversity Liaison for several committees at the 22,000-member DRI.


For more than a decade, Goldberg Segalla has proudly supported the ABA’s Judicial Internship Opportunity Program, which provides racial and ethnic minority law students, along with members of other groups underrepresented in the legal profession, opportunities to serve as an intern with a judge during the summer after their first or second year of law school. Joe Hanna — an alumni of the program himself — acts as a mentor and leader in the program, through which he has conducted more than 100 interviews for students across the country.

In 2017, Goldberg Segalla participated in the Thurgood Marshall Summer Law Internship Program, the New York City Bar Association’s flagship pipeline program for high school students. As a participating legal employer, we hosted high-achieving inner-city students for the summer and collaborate with the NYC Bar to provide them with additional programming before, during, and after the summer designed to help them prepare for a legal career.

Each summer, Goldberg Segalla proudly welcomes interns through a formal Diversity Clerkship Program that was conceived by Joe while he served as president of the MBAWNY. The program was developed in collaboration with the MBAWNY and the SUNY Buffalo Law School to provide opportunities for minority UB Law students to gain firsthand experience in the legal system. Since it was launched in 2011, the program has placed more than 100 students in clerkships in area courts as well as in several area law firms, with more judges and law firms asking to participate every day. It provides participants with an in-depth look at the legal process and the interaction between the bench and the bar that they would not otherwise get. At our firm, a dedicated team of partners monitors the work of these law clerks and ensures they obtain valuable experience to help develop important legal research, writing, case management, and client service skills critical to their long-term success. Our program earned the firm the Minority Corporate Counsel Association’s 2012 George B. Vashon Innovator Award.


We also have sponsored Success in the City, an annual diversity networking and mentoring event developed by Joe that brought together students, legal and business professionals, educators, nonprofits, and political leaders to make lasting partnerships. Many employment, business, and mentoring relationships resulted from this event. Past events have drawn more than 500 political and business leaders, legal professionals, and students. Success in the City has influenced the development of similar programs in Baltimore, Cleveland, Birmingham, Dallas, and elsewhere.


Our firm is committed to spreading the message throughout the broad legal and business communities that embracing diversity contributes to greater overall success. We conduct training sessions for in-house counsel at Fortune 500 corporations on increasing and promoting diversity. Our attorneys have authored articles and delivered presentations on diversity for various legal organizations, including DRI and the ABA, and our efforts and accomplishments in this area have been profiled in publications such as Law360, the New York State Bar Association’s State Bar News, Business First of Buffalo, the Buffalo Law Journal, and others.


In one example of our work to provide inspiration and raise awareness of diversity and women’s issues in the legal community, Caroline Berdzik, chair of our Employer and Labor Practice Group, spoke to Law360 for the publication’s “Female Powerbrokers” series. In the interview, Caroline discussed her career, the challenges of being a woman at a senior level at a law firm, the work-family life balance, and the importance of taking risks. She also offered guidance to female attorneys on moving their careers forward and advice to law firms on both increasing the number of women partners and retaining top female talent. Her longtime advocacy for women (at her previous firm, she served on the Women’s Business Development Committee and was a member of what became the national Women’s Presidents Organization) helped earn her a spot on the 2015 NJBIZ list of New Jersey’s Best 50 Women in Business.


Joe Hanna also was featured by Law360 in its “Minority Powerbrokers” series, in which he shared his perspective on breaking the glass ceiling in the legal industry, the challenges of being a lawyer of color at a senior level, how law firms can increase diversity in their partner ranks, and Goldberg Segalla’s core commitment to diversity.

Partnerships

Goldberg Segalla is proud to be a member of the Minority Corporate Counsel Association Firm Affiliate Network, which was created by the MCCA to assist and acknowledge law firms that are committed to advancing diversity and inclusion in the legal profession.


We are also a member of the Leadership Council on Legal Diversity (LCLD), a national organization of leaders in law firms and corporate legal departments dedicated to creating a truly diverse legal profession. As noted earlier, Joe Hanna was a fellow of the LCLD in 2014. In this position, he played a critical role in organizing the first-ever New York City LCLD Fellows Roundtable event, and he was instrumental in establishing a mentorship program in Hartford for local diverse first-year law students.


We support the diversity efforts of numerous organizations, including:

  • American Bar Association
  • Asian American Bar Association of New York
  • Columbian Lawyers Association
  • Defense Research Institute
  • Federal Bar Association
  • Korean American Association of Greater New York
  • League of First Nations
  • Minority Bar Association of Western New York
  • National Bar Association
  • Native American Rights Fund
  • National Association of Asian American Professionals
  • National Congress of American Indians
  • New York State Bar Association
  • Seneca Free Trade Association
  • SUNY Buffalo Law School
  • Women’s Bar Association of the State of New York

Our outreach efforts led to the creation of a comprehensive database of more than 500 minority law organizations throughout the United States. Contact between these organizations takes place in anticipation of bringing CLE and legal programs together. This group of minority bar associations includes both local and national organizations, such as:

  • National Association of Women Lawyers
  • National Association of Muslim Lawyers
  • Hispanic National Bar Association
  • National Asian Pacific American Bar
  • Black Women Lawyers Association of Los Angeles
  • South Asian Bar Association of Philadelphia
  • Vietnamese American Bar Association of North Carolina

A Talented and Diverse Team

Diversity is further evident within our firm through the many languages and dialects spoken by members of our team, including Albanian, Arabic, Croatian, French, German, Greek, Hebrew, Hindi, Italian, Korean, Malayalam, Mandarin, Marathi, Norwegian, Portuguese, Punjabi, Russian, Spanish, Swedish, Tagalog, Tamil, Thai, and Urdu.


Goldberg Segalla’s culture is one that values team-spiritedness, collegiality, and interpersonal harmony within our working community. We are a firm that believes in diversity in the workplace, and we are proud to offer a professional and positive work environment for each and every member of our team.


On these values, and on our commitment to diversity, we will never waver. We are proud of what we have accomplished thus far, but we also realize that this is a long-term mission. We will continue to innovate and to improve diversity in law and business — both within Goldberg Segalla and across the communities in which we live and work.

Diversity Matters — Join the Conversation

If you have questions regarding any of the firm’s diversity initiatives or would like to discuss ideas regarding increasing diversity in the legal profession, please contact Joe Hanna (716.566.5447; [email protected]) or another member of our Diversity Task Force:

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