Benefit Claims

Much of ERISA litigation involves claims for benefits based on the terms of the plan, and these claims run the gamut from large class claims for benefits, to individual disputes over benefits. These claims often raise unique procedural issues, such as the requirement for administrative exhaustion and deference to the plan administrator’s interpretation of the plan.  Plans also may need to seek subrogation and reimbursement of medical expenses they have paid, which itself often raises complex practical and procedural issues.  Attorneys at HJRF have extensive experience in these areas. Some of the complex representative matters include:

  • Pension benefits – Defended against claim that plan conversion entitled class to enhanced benefits. Retained after loss at trial; on appeal argued plaintiff’s proposed construction was unlawful, and case amicably settled after filing of brief.
  • Pension Benefits – Defended Plan against claim by officer of employer for pension benefits. Successfully defended Plan and was able to obtain overpayment of pension from participant.
  • Pension Benefits – Filed suit on behalf of employer whose pension plan became underfunded due to mistakes of the third party administrator. Successfully prevented preemption claim and was able to obtain in settlement the full amount to fully fund the plan and pay for attorneys’ fees.
  • Retiree health benefits – Defended large class claim that plan terms imposed by tax requirements of Code § 420(h) created certain retiree benefit obligations. Won motion requiring exhaustion of the claims, and worked with healthcare actuaries to develop defenses and offsets that eventually led to an amicable settlement.
  • Pension benefits – Retained after judgment and won reversal of a $300 million judgment that plan terms of Fortune 50 company obligated the company to provide enhanced “minimum benefits.”
  • Severance benefits – Defended claim for approximately $3 million in severance benefits.
  • Health Plan Claim – Successfully avoided lawsuit being filed by health plan provider who had contracted with the Plan’s network. Plan and employer client was able to avoid any legal liability.

Attorneys at HJRF also have extensive experience in defending and resolving lawsuits involving individual claims for benefits, including by using the ERISA administrative claims process to facilitate the inexpensive resolution of these claims.  We advise companies and fiduciaries during the administrative claims process on complying with procedural and legal requirements in resolving complex benefit claims. We also speak and write extensively in this area, including:

  • Al Holifield, panel presenter at annual ABA JCEB National Institute ERISA Litigation on Benefit and Long Term Disability Claims (2014, 2015 and 2016).
  • Robert Rachal, panel presenter at ABA JCEB National Institute ERISA Litigation on “Benefit Claims Litigation” (June 2014, Chicago IL).
  • Dan Janich, panel presenter at ABA Employee Benefits Committee mid-winter meeting on “Current Hot Procedural Issues in ERISA – Conkright v. Frommert” (February 2010, San Antonio TX).
  • Al Holifield, presenter at National ASPAA Conference, “Using Your Service Agreement and Best Practices,” (October 2010).
  • Al Holifield, presenter at National ASPAA Conference, “Managing Your Liability Exposure as a TPA,” (November 2009).
  • Dan Janich, panel presenter at ABA Annual National Institute ERISA Basics on “Reimbursement and Subrogation” (June 2009, Chicago IL).
  • Robert Rachal, “Benefit Claim Litigation” at Glasser/Fordham University 12th Annual ERISA Litigation Conference (September 1999, New York NY).