Successfully Defended Client's Insurance Plan
Successfully defended a church plan by obtaining a voluntary dismissal of the church plan from litigation claiming breach of fiduciary duty under ERISA, state breach of contract, fraud and bad faith failure to pay accidental death benefits.
Representation of Large Multi-National Company in ERISA Litigation
Successful handling of multiple ERISA denial of benefits and breach of fiduciary duty lawsuits involving all aspects of ERISA litigation, plan drafting, standard of review, coverage and jurisdictional analyses for large employer-sponsored plans in defense of claims for denial of retirement, health, disability and other employee benefits under the plans. Representative cases:
- Bybee v. Procter & Gamble Co., et al
- Obtained court ruling in favor of employer-sponsored health plan after evidentiary hearing on the merits in ERISA denial of benefits case.
- Mechley v. Procter & Gamble Co. Disability Benefit Plan, et al.
- Decision in favor of disability benefit plan affirmed by Sixth Circuit on appeal of ERISA denial of disability benefits claim.
- Halcomb v. The Procter & Gamble Disability Benefits Plan, et al.
- Reached successful early resolution of ERISA denial of disability benefits claim.
Representation of Large National Health Insurer in ERISA Litigation
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.
Representation of National Insurer/Third-Party Administrator in ERISA Litigation
Successful handling and resolution of short-term and long-term disability denial of benefits claims under ERISA. Representative cases:
- Storer v. Prudential Insurance Co. of America, et al.
- Early resolution of case after successful mediation.
- Wheeler v. Prudential Insurance Co. of America, et al.
- Obtained decision in favor of long-term disability benefits plan leading to resolution on appeal.
Alleged ERISA Violations
Abels v. Kaiser Aluminum & Chemical Corp. et al., (S.D. W.Va. 1993)
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.
Bond v. General Motors
Hanifen, et al. v. Ball Corporation, et al.
Huber v. S&S Healthcare, et al
Katherine J. Phillips v. Plan Administrator Delphi Hourly-Rate Employees Pension Plan, N.D. Ohio
1) Perez v. United Airlines, Inc., 1999 U.S. Dist. LEXIS 17987 (E. Dist. Mich. 1999): Discharged employee sued his former employer alleging that he was terminated because of his race in violation of Title VII and 42 U.S.C. § 1981. Employer moved for summary judgment on the basis that the plaintiff failed to establish a prima facie case under Title VII or 42 U.S.C. § 1983. The district court granted the motion and dismissed the case.
2) Williams v. Large National Insurance Company, Court of Common Pleas, Franklin County, Ohio, Case No. 03-CVH 12-14029 (2005): Discharged employee sued her former employer alleging that she was terminated in retaliation for complaining of religious discrimination and/or because of her race. Case settled.
3) Rexroat v. Winn Dixie, Inc., Jefferson Circuit Court, Louisville, Kentucky, Case No. 3-CI-08182 (2004): Discharged employee sued her former employer alleging that she was terminated because of disability, in violation of Kentucky Civil Rights Act. Case settled.
4) Joyce Smithson v. Jewish Hospital Healthcare Services, Inc., Jefferson Circuit Court, Jefferson Circuit Court, Louisville, Kentucky, Case No. 04CI00762 (2005): Discharged employee sued her former employer alleging that she was terminated because of her age and in retaliation for exercising her civil rights, in violation of the Kentucky Civil Rights Act. Case settled in private mediation.
5) Mahoney v. Akebono, et al., Hardin Circuit Court, Kentucky, Case No. 04-CI-01424 (2007): Discharged executive employee sued his former employer and individual corporate officers alleging that he was wrongfully discharged in retaliation for threatening to report violations of federal anti-trust law and/or as part of a conspiracy to violate anti-trust law. Case involved complex questions of first impression in Kentucky. Case settled after two days of private mediation.