Source: https://jjconwaylaw.com/category/uncategorized/
Timestamp: 2019-04-19 23:16:29+00:00

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ERISA lawyers are familiar with the use of review standards and how an application of those standards can make it easier for a plan to deny a claim and have that claim upheld upon judicial review. Legal terms such as “arbitrary and capricious,” “de novo,” and “abuse of discretion” are regularly cited as standards in deciding ERISA benefit claims.
Many states have used their regulatory authority to ban the use of discretionary clauses. These bans have been upheld as applied against ERISA fully-insured long-term disability plans. That is, when the benefits are underwritten by an insurance company, the bans apply through a state’s power to regulate insurers.
Sometimes overlooked, however, is whether discretionary authority was properly delegated in the first place. It is the classic “cart before the horse” argument. In Miller v. PNC Financial Services Group, Inc., No. 1:16-CV-25142-KMM, 2017 WL 4404469 (S.D. Fla. Oct. 2, 2017), the district court held that an employee benefit plan failed to properly delegate fiduciary review authority to a third-party, thereby eliminating discretionary review.
It is unclear whether Liberty has the full discretion PNC reserved for itself; in particular it is unclear whether Liberty’s determinations are final, or whether Liberty’s authority extends to making such determinations during an administrative appeal.
The case serves as a reminder that all plan documents should be reviewed to determine whether there was proper delegation of discretionary authority to render a decision during all phases of an ERISA claim, or merely just to determine initial eligibility, and also whether that delegation is revocable by the plan sponsor. Without a proper delegation, the plan may not be able to assert the applicability of deferential review.
 The Supreme Court has noted that discretionary clauses are “highly prized” by insurers. Rush Prudential HMI, Inc. v. Moran, 536 U.S. 355 (2002).
 See, among others, Am. Council of Life Insurers v. Ross, 558 F.3d 600 (6th Cir. 2009); Standard Ins. Co. v. Morrison, 584 F.3d 837 (9th Cir. 2009).
 Miller v. PNC Financial Services Group, Inc., No. 1:16-CV-25142-KMM, 2017 WL 4404469 at *2 (S.D. Fla. Oct. 2, 2017).
 Id. at *16 (quoting Cagle v. Bruner, 112 F.3d 1510, 1517 (11th Cir. 1997)).
On December 6, 2017, U.S. News & World Report published “What to Wear to Work,” a discussion of workplace rules and dress codes. The article explored the legal permissibility of dress codes and instances where neutral dress code and appearance policies can run afoul of state and federal law. The article featured J.J. Conway, Esq. as a legal analyst for the national publication. The online version article may be found here, https://money.usnews.com/money/careers/company-culture/articles/what-to-wear-to-work.
No one should ever be subject to sexual harassment in the workplace. That is both state and federal law. It is also a matter of basic morality.
With the explosion of sexual harassment revelations that have occurred during the past year – what some are now calling “Hurricane Harvey” – employers and employees are, again, confronting one of the most challenging problems in the workplace.
Sexual harassment usually stems from a bizarre psychology. The complaints that have become public are not only offensive, but many of the allegations are strange. The allegations against Harvey Weinstein, for example, make one wonder if, had he not been a powerful executive at a major production company, would he have been a playground flasher or peeping tom? These are the actions of disordered persons. The only difference is one seeks out victims in public places. Weinstein, by contrast, apparently performed his stunts in a $5,000 a night hotel room at the Peninsula Hotel in Beverly Hills.
Similarly, Bill O’Reilly must have confronted real, hard evidence (not mere allegations) that would have proven he did something unspeakable or so damaging to his brand that it was better to pay $32 million to secure a confidentiality agreement than to have the evidence made public. Previously, O’Reilly had been tape recorded using graphic and vulgar language during phone calls. No one pays $32 million to settle a “frivolous” lawsuit. Plenty of lawyers would be willing to “vigorously” contest the allegations for fees of 1/100th that amount.
In the sexual harassment cases our firm has handled, it has been remarkable how many times the case was resolved when we moved to have the harasser examined by a forensic psychologist. Sexual harassment is not always what it seems. Clearly, there are cases where persons in management or coworkers use the workplace to try to secure dates or romantic adventures, but in many cases there is no actual sexual attraction to the victim. It is often about bullying a person whose vulnerability is somehow revealed in the workplace. The victims tend to have certain identifiable vulnerabilities that bring out the inner bully in certain management types or coworkers.
For example, the workplace harassment is visited upon a single mother who is trying to date again, or an employee is struggling with weight and body image issues, or, perhaps most unsettlingly, a person who has been subject to bullying and putdowns all their life.
The cruelty of bullies doesn’t disappear when a person gets a promotion or makes a lot of money.
It is one of the reasons that the number of complaints against a harasser is important. Again, to be clear, all sexual harassment, even a single situation, is unlawful. The reason that the number of complaints matter is that it is evidence of a pattern and practice. It is also suggestive of evidence proving the occurrence of the conduct is more likely than not to have occurred.
The women who have come forward against Weinstein, O’Reilly, and recently Matt Lauer have rightly been called “courageous” and “brave” because most employees understand that human resources departments are totally useless in sexual harassment cases. Generally, H.R. doesn’t like problems, and a complaint of sexual harassment certainly qualifies as one. Given H.R.’s ineffectiveness, this also highlights why the large number of complaints is revealing. First, if H.R. were on the ball, this likely would not have happened (think of the now dead Roger Ailes at Fox, where he was the H.R. department).
The large number of complaints is also reflective of basic human nature. Human nature suggests that repeat patterns of behavior are associated with desired results. For all the complainants who have come forward there are likely many, many more who fell victim, submitted to the advances, and carry with them feelings of guilt and shame. This fact has remained largely unspoken during these public cases, but it is safe to assume that if ten complaints are made public, there are likely many more which no one will ever know about.
Charlie Rose likely didn’t invite women to his house in the evening and put a robe on in one solitary occasion. Based on the allegations, we know that Harvey Weinstein didn’t conduct a meeting in a hotel room with a robe on and a shower running just one time. Bill O’Reilly didn’t book hotel rooms where company events were being held on just one occasion. Matt Lauer went so far as to have a button installed on his desk to lock his office door remotely when women were present. It is unlikely that Lauer pushed that button only one time. Likely, these acts were part of a pattern that had worked before, and these men thought it would work again.
What is truly troubling, beyond all the numbers of victims, is just how premediated it all seems. Perhaps, this has been the greatest revelation of all. Harassers think through the harassment. It also seems that many employers knew about the premediated harassment and did little to stop it. This is now the new challenge in the workplace. Employers must not simply work to make the workplace free of sexual harassment, but seek to identify and break down the patterns which enable it in the first place.
Our clientele is quite diverse. We represent as broad a range of clients as you can imagine. Since our litigation practice focuses on employee benefits — like disability insurance disputes – we serve people of all ages and backgrounds. Presently, we are handling the disability insurance claims of everyone from line-workers to senior management of corporations. We represent managers, nurses, clerical support, and just about every occupation you can imagine. We also represent executives and professionals such lawyers, doctors, nurses, and college professors who have had health issues and problems with their disability insurance contracts.
Who is your success rate in disability insurance cases?
We enjoy a high percentage of cases resolved to our clients’ satisfaction. We want our clients satisfied. “Client satisfaction” is the standard by which we measure our success. Sometimes this means achieving a courtroom victory. Sometimes, it means helping achieve a fair settlement.
Our success level is attributable to two primary factors. First, our cases are directly affected by level of preparation devoted to them. Most litigation cases do settle. The difference in settlement values is based on the level of preparation. The more preparation time spent on a case, the better the result.
The second factor is based on our singular focus on winning the case. We have heard successful college basketball coaches use an expression that pretty much sums up our litigation philosophy, we “hate losing more than we enjoy winning.” We have returned millions of dollars to our clients through judgments, verdict, and settlements. This was based on preparation, hard work, and a dedication and knowing the case inside and out.
Is there something to which you attribute your success? Can you provide some examples?
First, we listen. When we speak, we try to ask the right questions. Second, we are totally accessible to our clients thanks to the state of technology today. All email messages and telephone calls are returned in a day. We try to educate our clients about the law, what it says, and what it means to their case. We firmly believe that a client should never be in doubt as to where their case stands. We insure this by emailing copies of all documents filed or received in a given case. We prepare regular email messages with updates on settlement talks. The clients receive their own copies of court rulings in their cases.
What may a client expect if you take the case?
In its most basic form, the legal relationship is a partnership. That is why I like that our firm’s motto is “conquer tomorrow.” We need to achieve our future desired result together. We do ask that clients be involved in the process by supplying us with timely documentation and evidence gathering. When the client is involved, the case tends to be more a more fulfilling experience. We would never presume to know the facts better than our clients. Our clients will notice that we will be constantly rechecking or confirming of facts to make sure we have it right. . .every time.
Do most cases really settle?
Yes. It is a reality in law that both sides typically want to control the outcome and not leave a major legal claim to chance. The problem is we never know which cases will settle and which cases will not. Take the case of DeLisle v. Sun Life. In our view, Ms. DeLisle had an extremely strong claim against her insurer for ERISA disability benefits. This insurance company, however, fought her claims before two different federal judges, losing before both judges. The company then appealed the decision to the Sixth Circuit Court of Appeals, and having lost there, asked the entire Court of Appeals to overturn the case which it refused to do. In the process the insurance company hired two different huge law firms to fight this claim. Delisle took seven seven years. Who could have imagined this? And, yet in another case, the claim could be paid in 45 days. The only way to firmly address this reality is prepare every case as if it is going to judgment. There is no substitute for this level of preparation.
Can individuals file administrative appeals on their own?
The short answer is ‘yes.’ The answer should be ‘no.’ While an individual may file his or her own ERISA or LTD appeal, they should be represented by legal counsel. The reason is that, if a lawsuit is eventually filed, the lawsuit is about appeal. The court case will focus on the contents of the appeal. So, whether it is with our firm or another law firm, we believe an administrative appeal should be prepared by legal counsel.
What evidence is needed for a successful appeal?
The medical file is obviously the most important evidence. There is also other information, expert reports, vocational assessments, and the proper presentation of administrative agency decisions, such as Social Security. The appeal should address, directly, the reasons the claim was denied in the first place.
What is the standard fee charged to your clients for their representation? Is the fee the same for everyone?
Each case is customized based on the needs, goals, and objectives of the client. We are a people-centered firm which happens to practice law. That means we look at the situation the same way we would wish to be treated if we needed professional services.
In the typical case, we are able to estimate what the damages might be. A client who is unable to work because of their health may need to have the legal services rendered on a contingency-fee basis. This is sometimes called the “no-win, no-fee” arrangement. In these cases, the firm is paid an agreed upon percentage of any financial recovery based a judgment, settlement, or the securing of a monthly benefit.On the other hand, a client who is able to afford the case on an hourly basis may look at the damages and see that paying by the hour is more suitable. Either way, we strive to make it work for the client.
What distinguishes you from other law firms practicing in the area of disability insurance?
I think we bring a unique set of skills to a case that other firms may not possess. First, my personal litigation background in law is rooted in complex commercial litigation and employment law. With this background training, I have been able to see the overlap among employment, employee benefits and contract law. I was trained in the commercial litigation context. Given my background in employment law, I learned about the different occupational demands of positions in the workplace – often because the cases required a precise analysis of job duties. These three areas come together in disability contract and ERISA disability cases.
Two things in every case. Honesty and patience. We need to know everything, completely and honestly at the beginning. We also need to ask for a bit of patience. The legal process can be challenging, but in the end, if we keep pushing, we usually end up in the right place.
https://jjconwaylaw.com/wp-content/uploads/2018/09/jjlogo.png 0 0 Staff https://jjconwaylaw.com/wp-content/uploads/2018/09/jjlogo.png Staff2017-01-20 10:54:202017-01-23 15:44:5110 Questions About Disability Insurance Claims for J.J. Conway, Esq.

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