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Overview

ERISA and Health & Disability Insurance

McDowell Hetherington has extensive experience litigating and advising clients on ERISA, health, life and disability matters nationwide, including but not limited to:

  • ERISA matters involving individual and group life, health, and disability coverage disputes as well as complex ERISA-based class actions
  • Non-ERISA life, accident, and disability law claims, including
    • Fraud and rescission
    • Bad faith
    • Prompt pay
    • Deceptive or unfair practices
  • Pre-litigation coverage consultation
  • Subrogation and reimbursement
ERISA

The ERISA landscape is ever-changing and MH attorneys are cognizant of the risks such changes pose to their clients. By remaining current on the developments and status of the law on a nationwide basis, we are equipped to handle ERISA disputes anywhere in the United States, and have represented carriers on ERISA-related matters in more than 50% of all states and before the United States Courts of Appeals for the 5th, 6th, 8th, 9th, 10th, and 11th Circuits. We have also pursued a Petition for Writ of Certiorari with the United States Supreme Court.

Our attorneys regularly develop unique and novel strategies to solve complex problems while providing cost-effective representation on a case-by-case basis. Our ERISA team has successfully defended clients in class action suits, complex matters alleging breaches of fiduciary duties, and litigation related to health, welfare, and pension benefits. We represent plan sponsors, fiduciaries, administrators, carriers, and others involved in employee benefit plans and plan asset administration.

Health Care

McDowell Hetherington represents healthcare payors on a wide variety of matters in federal and state courts and arbitrations across the nation.  MH represents some of the largest insurers and administrators in the country, as well as employers who sponsor self-funded plans for their employees.

MH defends against in-network and out-of-network providers seeking to recover payment for services rendered, ranging from single-claim lawsuits to multi-million-dollar arbitrations.  MH has significant experience with ERISA, pricing mechanisms, medical necessity issues, mental health parity laws, prompt pay penalties, the Affordable Care Act, Medicare and Medicaid issues, surprise billing, and fraud, waste, and abuse investigations.

MH attorneys manage high volume cases efficiently and aggressively by using the depth and breadth of their experience to filter through thousands of claims, put providers to their burden of establishing entitlement to payment on each claim, and attacking threshold issues through effective briefing. MH has a track record of obtaining take-nothing awards and favorable dispositive findings.

In addition to the firm’s defense work, MH has developed a robust plaintiff’s practice seeking recoupment from providers for claim overpayments. Additionally, MH also successfully pursues claims against administrative services customers who have failed to fund claims in the ordinary course.

MH also provides advice on health plan language and assists in interacting with regulatory authorities.

Stop Loss

With significant experience in handling health care issues, MH attorneys also represent stop loss carriers and managing general underwriters in connection with issues concerning eligibility for reimbursement under stop loss policies. Our team understands that stop loss is not reinsurance, and that there are unique issues presented in stop loss coverage disputes, including the push-and-pull dynamic among stop loss carriers, managing general underwriters, third party administrators, brokers, and employer groups. MH is adept at managing multi-party disputes, routinely resolving issues pre-litigation, but also obtaining favorable results in litigation and arbitration nationwide when necessary.

ERISA and Health & Disability Insurance

MH Prevails in California AD&D Case

09.14.21

September 14, 2021

MH Wins ERISA Preemption Motion

02.25.14

February 25, 2014

ERISA and Health & Disability Insurance

MH Prevails in California AD&D Case

09.14.21

September 14, 2021

MH Wins ERISA Preemption Motion

02.25.14

February 25, 2014

5 Tips To Avoid Bad Faith

02.07.13

February 7, 2013