Handled all aspects of health plan denial of benefits issues in numerous lawsuits and administrative claims, in particular analyzing whether plans were ERISA or non-ERISA plans, whether claims were governed by federal or state law, whether administrative process was followed, and defended against claims brought by participants for denial of benefits, breach of fiduciary duty, and other ERISA-related and/or state law claims.

We successfully defended a large medical practice accused of ERISA violations. Judgment was awarded to our client by a judge in the US District Court of Cincinnati, Ohio.

Lira has served as special counsel for amicus curiae, Michigan Manufacturers' Association and National Association of Manufacturers, on employment and employee benefit issues. Representative cases include:

1) Nord v. The Black & Decker Disability Plan, 538 U.S. 822 (2003): Employee sued employer-sponsored disability plan alleging that the plan wrongfully denied his claim for benefits by failing to give proper weight to his treating physician's opinion. The Court of Appeals for the Ninth Circuit agreed, and the United States Supreme Court granted certiorari to determine whether ERISA's requirement for a full and fair consideration of the employee's claim included giving deference to the treating physician's opinion. The Court held in favor of the benefit plan and reversed the Ninth Circuit's ruling, a position advocated by the National Association of Manufacturers' amicus brief.

2) Chambers v. Trettco, 463 Mich. 297, 614 N.W.2d 910 (2000): Employee sued employer under Michigan's Civil Rights Act alleging sexual harassment by a supervisory employee. The employer argued that it was not vicariously liable under the Michigan Civil Rights Act, citing key differences in the Michigan statute and Title VII. The Michigan Court of Appeals applied an analysis consistent with Title VII and held the employer liable. The Michigan Supreme Court reversed, following position advocated by the Michigan Manufacturers' Association's amicus brief, relying on differences in the text of the state law to hold that the principles stated in the federal civil rights cases did not control.

3) Sniecinski v. Blue Cross & Blue Shield of Michigan, 469 Mich. 124, 666 N.W.2d 186 (2002): Employee sued employer under Michigan's Civil Rights Act alleging pregnancy discrimination. The trial court denied the employer's motion for summary disposition and the matter was tried to a jury, which found in favor of the employee. The Court of Appeals affirmed. The Michigan Supreme Court granted leave to appeal and reversed and remanded, following position advocated by the Michigan Manufacturers' Association's amicus, with direction to enter a finding of no cause of action as a matter of law.

Lira has also represented appellants in federal and state courts. Representative cases include:

4) Taunt v. General Retirement Sys. of the City of Detroit (In Re: Wilcox), 233 F.3d 899 (6th Cir. 2000), cert. denied, 533 U.S. 929 (June 2001): Bankruptcy trustee sought access to debtor's retirement benefits on behalf of creditors, and debtor's municipal retirement plan sought to protect the benefits under 11 U.S.C. § 541(c)(2). The bankruptcy court held that the plan's anti-assignment provision was not enforceable under § 541(c)(2), and the district court agreed. The Court of Appeals reversed, holding that the anti-assignment provision satisfied § 541(c)(2) and that the benefits could not be reached by creditors.

5) Preston v. John Alden Life Ins. Co., et al., 2006 U.S. Dist. LEXIS 48260 (S. Dist. Ohio 2006): Former employee sued his employer and insurance company administrating the employer's disability benefit plan, contending that he was wrongfully denied benefits. The insurer and employer moved for judgment as a matter of law on the basis that ERISA preempted the employee's claims and that the employee failed to state an actionable claim. The court ruled in favor of defendants and granted summary judgment.

6) Prudential Property and Casualty Ins. v. Delfield Co. Group Health Plan, 1999 U.S. App. LEXIS 18708 (Sixth Circuit 1999): Plaintiff insurance carrier sued defendant self-funded employee benefit plan, contending that the employee benefit plan was primarily responsible for medical expenses incurred by its insured in an automobile accident. The employee benefit plan sought to require the insurer to pursue its claim administratively before resorting to litigation. The district court ruled in favor of the benefits plan, but the appeals court reversed on the basis that it was bound to follow a prior panel's ruling and allow litigation, although the concurrence pointed out that the prior ruling was inconsistent with subsequent case law. 

7) Alstork v. AIG Life Ins. Co. et al., United States Court of Appeals for the Sixth Circuit, Case No. 08-4339 (2008): Plaintiff beneficiary of employee's life insurance policy sued defendant employer, employee benefit plan, and insurer, contending that Plaintiff should have been paid accidental death benefits when employee died following an automobile accident. Defendants denied benefits based on the terms of the benefit plan and results of post-accident medical review. The United States District Court for the Southern District of Ohio upheld denial of benefits, and Plaintiff appealed. Case successfully settled on appeal.

8) Hodges v. American Heritage Life Ins. Co., United States Court of Appeals for the Sixth Circuit, Case No. 08-5777 (2008) (pending): Plaintiff former employee sued defendant employer, employee benefit plan, and insurer, contending that Plaintiff should have been paid disability benefits for chronic condition characterized by subjective complaints of pain. Defendants denied benefits based on the terms of the benefit plan and results of independent medical reviews. The United States District Court for the Western District of Kentucky upheld denial of benefits, and Plaintiff appealed. Case is pending.

Plaintiffs brought a class action against the Company and pension plan administrator.  All claims were eventually dismissed on summary judgment, resulting in a complete dismissal of the class action litigation.

Plaintiff alleged violation of ERISA notice requirements. Matter was dismissed for consideration by Plan Administrator.

Dinsmore & Shohl represented General Motors Corporation in a suit filed by the surviving spouse of one of it's employees seeking in excess of $300,000 in benefits under the deceased husband's employee pension plan.  The district court ruled, as a matter of law, that Plaintiff was not entitled to receive surviving spouse benefits under her deceased husband's ERISA-qualified employee pension plan, because her husband had not changed the designation of his former wife as beneficiary under the GMC plan prior to his death.  The case was dismissed upon Motion for Summary Judgment.