Speca v. Aetna: “Rush to Judgment” in Just 14 Days Violates ERISA Rights to Full and Fair Review and Appeal

Posted in: Disability Insurance, ERISA, Insurance Litigation Blog August 22, 2019

ERISA guarantees claimants a “full and fair review” as well as an appeal of any denial by the insurance company.  Can a disability claims insurer deny a claim too quickly and thus violate its duty to provide a full and fair review?  A recent decision answered “yes” to this question.  In Speca v. Aetna Life Ins. Co., 2019 WL 3754210 (D. Nev. August 8, 2019), the court ruled that Aetna Life Insurance Company (“Aetna”) did not provide a “full and fair review” and effectively cut off any meaningful access to an appeal when it denied a claim in just 14 days (without even waiting to receive any medical records).

Plaintiff, Paul Speca, worked at Home Depot until November 6, 2015 …

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The Basics of an ERISA Life, Health and Disability Insurance Claim – Part One: ERISA Background, Purpose and Timing Requirements

Posted in: ERISA August 12, 2019

In this several part Blog Series entitled The Basics of an ERISA Life, Health and Disability Insurance Claim, we will discuss the basics of an ERISA life, health and disability claim, from navigating a claim, handling a claim denial and through preparing a case for litigation.  In Part One of this Series, we discuss the background and purpose of ERISA, along with procedural rules and practical considerations for a disability claim.

Congress enacted the Employee Retirement Income Security Act of 1974 (“ERISA”) (29 U.S.C. § 1132(e)(2)) in response to public dissatisfaction with poorly funded pension plans, onerous vesting requirements and labor leader misuse of union benefit funds.  Senator Jacob Javits, a sponsor of ERISA, observed at the time that …

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The Basics of an ERISA Life, Health and Disability Insurance Claim – Part Four: Denial of an ERISA Disability Claim or Appeal

Posted in: Disability Insurance, ERISA, Insurance Litigation Blog August 11, 2019

In this several-part blog series titled The Basics of an ERISA Life, Health and Disability Insurance Claim, we discuss the basics of an ERISA life, health, accidental death and dismemberment and disability claim, from navigating a claim, to handling a claim denial and through preparing a case for litigation.  In Part Four of this series, we discuss ERISA claim denials.  Our focus in this article will be mostly on disability insurance claim denials.

When denying a claim, an insurer is required to provide a written explanation of the basis of its denial.  Under Section 503 of ERISA, “every employee benefit plan shall . . . provide adequate notice in writing to any participant or beneficiary whose claim for benefits …

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A “Three-Year” Limitations Period in a Disability Policy Can Extend California’s Two-Year Statutory Limitations Period for Insurance Bad Faith

Posted in: Disability Insurance, Health Insurance, Insurance Litigation Blog, Legal Articles August 06, 2019

Life, health and disability insurers are always looking for ways to deny insurance claims. When they do so unreasonably, insured policyholders may be able to sue them for insurance bad faith under California law. Count on insurers to argue everything they can to defeat a bad-faith claim, including asserting the statute of limitations for bad-faith claims. Life, health and disability insurance plaintiff attorneys must remain current as to changes in the law so they can defeat these insurance company tactics. One notable question they must answer is this: Can a disability policy provision setting forth the timing of a lawsuit against the insurer “extend” California state tort law (e.g., statute of limitations to three years) from the statutory two-year limitations …

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Robert J. McKennon Recognized as 2019 "America’s Top 100 Bet-the-Company Litigators for Southern California"

Posted in: Insurance Litigation Blog, News Blog August 06, 2019

McKennon Law Group PC is proud to announce that its founding shareholder Robert J. McKennon has been recognized as one of Southern California’s “America’s Top 100 Bet-the-Company Litigators.” With this honor, limited to only 100 attorneys in Southern California, Mr. McKennon joins the ranks of California’s most esteemed Bet-the-Company Litigators, including: Joseph Cotchett, Skip Keesal, Thomas Girardi, Patricia Glaser, and Thomas Bienert. Additional recipients can be seen on the website devoted specifically to recognizing the best High-Stakes Business Litigators throughout the country at www.Top100BetTheCompanyLitigators.com. Fewer than one-half percent (0.5%) of attorneys in the United States receive this award, making it the premier achievement for High-Stakes Business/Insurance Litigators throughout the nation.

To be eligible for consideration as a “Bet-the-Company Litigator” for …

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Cassim v. Allstate Insurance: Attorney’s Fees in Contingency-Fee “Bad Faith” Cases

Posted in: Attorneys' Fees, Bad Faith, Disability Insurance, ERISA, Health Insurance, Insurance Litigation Blog, Legal Articles July 26, 2019

Since 2004, when the California Supreme Court ruled that a “portion” of contingency attorney’s fees are recoverable in bad-faith insurance cases, plaintiffs and their lawyers have been able to recover attorney’s fees based in part on the specific terms of the contingency-fee retainer agreement.  For starters, in order to recover attorney’s fees in these actions, a policyholder must prove that (1) contractual benefits were withheld in bad faith, and (2) reasonable fees were incurred by the policyholder to recover those benefits.  However, any attorney’s fees incurred merely to prove the alleged “bad faith” claims are not recoverable at all; only fees incurred to prove actual coverage are recoverable.  Cassim v. Allstate Insurance, 33 Cal.4th 780, 811 (2004).

In Cassim

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McBean v. United of Omaha Life: Judge Anello Finds Employer Liable for Breach of Fiduciary Duty, Orders Payment of Life Insurance Policies’ Face Value under Equitable Surcharge Theory

Posted in: ERISA, Insurance Litigation Blog, Legal Articles, Life Insurance July 02, 2019

McBean v. United of Omaha Life: Judge Anello Finds Employer Liable for Breach of Fiduciary Duty, Orders Payment of Life Insurance Policies’ Face Value under Equitable Surcharge Theory

Application of the doctrine of “equitable surcharge” in ERISA has become a very significant theory of recovery for ERISA plan participants in obtaining their life insurance and medical insurance benefits.  In a recent decision by the U.S. District Court for the Southern District of California, McBean v. United of Omaha Life Insurance Company, 2019 WL 1508456, the ERISA surcharge theory was used to overturn the denial of a life insurance claim, thus salvaging substantial life insurance benefits that would otherwise have been lost through breach of fiduciary duty and misrepresentation.

In McBean

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In Harlow v. MetLife, Judge Bernal Brings Clarity to Disputes Involving “Reasonable” Attorneys’ Fees Adopting Standards Favorable to ERISA Claimants

Posted in: Attorneys Fees, Disability Insurance, Disability Insurance News, ERISA, Insurance Litigation Blog, Legal Articles June 19, 2019

The topic of attorneys’ fees has long been of interest to insurance lawyers and clients alike.  Recently, the courts have grappled with issues such as: When are attorneys’ fees recoverable? What types of billing practices are reasonable?  What are reasonable hourly rates?  Attorneys want the assurance that the fees they charge will be deemed “reasonable,” and defendants (the insurance companies) want to know when they can raise defenses to the amount of an attorneys’ fees they may be expected to pay.  In this article, we will consider a recent case that has helped bring some clarity to the issue of “reasonable” fees for legal work.  Robert J. McKennon of McKennon Law Group PC acted as an expert in this case …

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Court Finds Regional Claims Administrator Qualifies as a “Managing Agent” of an Insurance Company, Justifying an Award of Punitive Damages

Posted in: Auto Insurance, Bad Faith, Breach of Contract, Duty to Settle, Insurance Litigation Blog, Punitive Damages May 29, 2019

When insurance companies, including those offering disability, life, health or accidental death policies, engage in conduct that is sufficiently egregious, a court may award punitive damages against the insurance company.  California Civil Code Section 3294 (“Section 3294”) provides that where the defendant is guilty of oppression, fraud or malice, the plaintiff may recover punitive damages for the sake of example and by way of punishing the defendant.  If the defendant is a corporation, such as an insurance company, the defendant is liable for punitive damages if the act of oppression, fraud or malice was authorized or ratified by an officer, director or managing agent of the corporation or if the officer, director or managing agent was personally guilty of such …

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Robert J. McKennon and Joseph S. McMillen to Present “ERISA and California Bad Faith Litigation, Hot Topics and Trends in Disability, Life and Health Insurance Claims” Seminar for OCBA on June 13, 2019

Posted in: Insurance Litigation Blog, News Blog May 17, 2019

McKennon Law Group PC’s founding and managing shareholder, Robert J. McKennon and senior attorney, Joseph S. McMillen, will speak on an MCLE panel for the Orange County Bar Association on June 13, 2019, discussing “ERISA and California Bad Faith Litigation, Hot Topics and Trends in Disability, Life and Health Insurance Claims.”  Mr. McKennon has been practicing in the areas of ERISA, life, disability and health bad faith insurance litigation and business litigation for 33 years.  Mr. McMillen has been practicing in the areas of insurance and bad faith litigation for two decades, including numerous ERISA-governed disputes over disability and life insurance benefits.  The MCLE event is scheduled to take place at the OCBA headquarters from 12:15 P.M. – 1:30 P.M. …

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