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Mr. Begos has nearly 30 years of commercial and insurance litigation, arbitration, mediation and negotiation experience, representing companies and individuals in a wide array of industries. He has a national reputation in handling litigation under the Employee Retirement Income Security Act (ERISA) and, in particular, denial of group benefits claims. Mr. Begos has litigated hundreds of ERISA cases and has been involved in shaping the development of ERISA law across the country. He is a regular speaker at ERISA and insurance conferences around the country and has written extensively for various nationwide publications. Read his full rc.com bio here.

In Williams v. FedEx Corporate Servs., 849 F.3d 889 (10th Cir. 2017), plaintiff sued FedEx for violating the Americans with Disabilities Act (ADA) by requiring him to enroll in the company’s substance abuse and drug testing program. He also sued Aetna, FedEx’s STD insurer, for breach of fiduciary duty for reporting to FedEx that plaintiff had filed a disability claim for substance abuse. The district court granted summary judgment for defendants on both claims.

The Court reversed the ADA decision, and remanded to the district court for further evaluation of one of FedEx’s defenses.
Continue Reading Insurer Did Not Breach Fiduciary Duty by Disclosing Substance Abuse Claim to Employer

In Geiger v. Aetna Life Ins. Co., 845 F.3d 357 (7th Cir. 2017), Aetna initially determined that plaintiff qualified for disability benefits due to bilateral avascular necrosis in her ankles, which prevented walking and driving. When the definition of disability was about to change, Aetna conducted an Independent Medical Exam, which found her capable of sedentary work, and had plaintiff surveilled, which showed her driving and visiting multiple stores. Aetna terminated benefits. On appeal, Aetna reinstated benefits in May 2013, after one of two peer reviewers determined  she was not capable of sedentary work.

Aetna later conducted additional surveillance, again showing plaintiff driving and shopping, and terminated benefits again in May 2014, based on a nurse’s clinical review and a Transferrable Skills Analysis. On appeal, Aetna had obtained a third peer review, which concluded that plaintiff could perform sedentary work. Aetna also sent the peer review and surveillance to plaintiff’s doctors; only one responded, and said that the surveilled activities were the result of substantial amounts of pain medication. A follow up peer review did not  change the initial conclusion.
Continue Reading Disability Plan Administrator Can Reasonably Change its Mind About Sufficiency of Evidence

In Milby v. MCMC LLC, 844 F.3d 605 (6th Cir. 2016), the plaintiff had her claim for disability benefits terminated following a peer review by a doctor engaged through MCMC. The plaintiff lived in Kentucky, and the peer reviewer was not licensed there. Accordingly, the plaintiff sued MCMC for negligence per se for practicing medicine in Kentucky without a license. The district court granted defendants’ motion to dismiss, and the Sixth Circuit affirmed.
Continue Reading ERISA Preempts Negligence Claim Against Disability Peer Reviewer

In Soehnlen v. Fleet Owners Ins. Fund, 844 F.3d 576 (6th Cir. 2016), an employer, its CEO, and an hourly employee (for themselves and as representatives of a putative class of similarly situated employees) sued the defendant for violating ERISA and PPACA (Obamacare) by maintaining per-participant and per-beneficiary caps on benefits. Plaintiff employer bought supplemental health insurance to eliminate those caps. The Plan asserted that it was a grandfathered plan and therefore not required to eliminate the caps.

The district court dismissed plaintiffs’ claims for lack of standing, and the Sixth Circuit affirmed, providing another example of the tightening of federal standing after Spokeo, Inc. v. Robins, 136 S.Ct. 1540 (2016). Spokeo is discussed in more detail in a previous post.
Continue Reading Employer lacks standing to sue multi-employer plan for violation of ERISA and PPACA

In Prime Healthcare Servs. – Landmark LLC v. United Nurses & Allied Prof’ls, Local 5067, 848 F.3d 41 (1st Cir. 2017), the First Circuit ruled that an arbitration agreement required the arbitrator to determine whether ERISA preempted the claims at issue.

Plaintiff purchased a financially troubled hospital that had a pension plan, and a collective bargaining agreement (CBA) with defendant. The CBA contained a broad arbitration provision. After the acquisition, the pension plan was terminated by the Pension Benefit Guaranty Corp. (PBGC), and the defendant union sought arbitration of its grievance that the termination violated the CBA. Ultimately, the district court ruled that the union’s claims were preempted by ERISA.

The Court noted that courts will determine questions of arbitrability only when there is a dispute of “substantive arbitrability” – whether the parties are bound by an arbitration clause, or whether the particular clause governs a particular type of controversy. “Procedural arbitrability” questions, in contrast, are presumptively determined by the arbitrator; these questions include things like defenses of waiver, delay, or any other procedural rule that grows out of the dispute and bears on its final disposition.
Continue Reading First Circuit rules that ERISA preemption of claim is an arbitrable issue

Those of us who finished law school more than five or ten years ago learned about personal jurisdiction through the lens of International Shoe Co. v. Washington, 326 U.S. 310 (1945), and its focus on “minimum contacts” analysis. We learned that a company can be sued in any state with which it has significant, ongoing contacts, such as an office, employees or bank accounts.

That was then. Recently, the Supreme Court has begun to tell us we were all wrong for thinking that way. Daimler AG v. Bauman, 134 S. Ct. 746 (2014). Though the Daimler majority would have us think they are simply reinforcing what International Shoe really held, Justice Sotomayor described it as “a new rule of constitutional law that is unmoored from decades of precedent.” Daimler, 134 S. Ct. at 773. Our world has changed, and anyone suing or defending corporations must understand the new rules.
Continue Reading Personal Jurisdiction Under ERISA: Forget About Minimum Contacts

On December 19, 2016, the Department of Labor ended a year-long process to update the regulations governing claim procedures for disability plans, 29 C.F.R. §  2560.503-1. The text of the new regulations, and the DOL’s explanation of changes and the comment process, can be found here.

The DOL’s express goal in establishing these new regulations is to “strengthen[] the current rules primarily by adopting certain procedural protections and safeguards for disability benefit claims that are currently applicable to claims for group health benefits pursuant to the Affordable Care Act.” The DOL concluded that a stronger regulation was needed, in part, because “disability cases dominate the ERISA litigation landscape today[.]”
Continue Reading DOL Issues New Regulations for Plans Providing Disability Benefits