For the most part insurance companies hold up their end of the bargain but sometimes they don’t. When this happens, I get involved. It’s like David & Goliath, I fight for the underdog. I help my clients battle the big insurance company giants and help them receive the benefits they paid for and earned” My objective is your objective – helping you secure the insurance benefits you paid for and deserve in your time of need.
Denied Insurance Claims Lawyer: Helping Secure Benefits in Boston, Massachusetts
Boston ERISA attorney can help
Dealing with an insurance company can be exhausting. For over 25 years I have been assisting people with their claims for long-term disability, health care, life insurance and other benefits whether secured through their employer or purchased on the individual market. I know how important your claim is whether it’s your financial future for you and your family, or your health outcome.
I want to help you. You’re not just another file or case number. That is one reason I enjoy my job as an attorney representing individuals rather than institutions. Your integrity is under attack. I know that you planned for an unlikely event and now when you need insurance coverage, you are not being treated with the respect and dignity you deserve.
In this modern age, staying in touch by email, text, Skype, Zoom or telephone is easy. I’m easy to find. Realizing that one of the biggest complaints about attorneys is not staying in touch, I strive to respond to you promptly.
Whether your claim falls under the Employee Retirement Income Security Act (ERISA), or you have a claim under an individual insurance policy, my goal has, and is the same as yours – getting you paid or making the insurance company pay for your medical care. In reaching your objective, I want to understand you, work collaboratively with you and listen to you, rather than talk at you.
(If you are more interested in my legal pedigree, leadership roles as a lawyer and case accomplishments, skip ahead)
Regardless of the size your problem, whether it’s $50 per month, or $80,000 per month long-term disability claim, I am ready to assist. I have represented hundreds of clients, reviewed thousands of claims and I have recovered tens of millions of dollars for clients.
Recognizing that litigation is expensive, I handle most cases on a contingency fee basis. Usually I advance the costs of litigation too. If you don’t get paid, I don’t get paid.
My practice is national. I litigate insurance denials in the state trial courts, the United States District Courts, the United States Circuit Courts of Appeals and state Supreme Courts. I have filed briefing in the US Supreme Court on behalf of a charitable organization too. In many locations outside my base in Boston, I collaborate with the small pool of other knowledgeable policyholder and ERISA lawyers.
Fewer ERISA disability, health and life insurance cases settle before judgment. The reason is the deck is stacked against you. For starters, no jury trial; limited damages; and the suit are filed only after extensive administrative review by the benefit denier, the same insurance company. This makes for a challenging paradigm. An ERISA fiduciary, who is often a profit-making insurance company, may control the flow of information, act as a judge and defendant all to the detriment of the plan beneficiary. There is only a small financial downside for insurance companies in proceeding to judgment. The economics are that it is cost efficient for insurers to take most cases to judgment. The worst case for an insurer is that the insurance company pays past due benefits, interest, some amount of attorneys’ fees and costs and its own attorneys’ fees. An insurer faces relatively little excess exposure and does not risk bad-faith or punitive damage awards.
Over the years, insurers have become more sophisticated in their arguments, involving plan interpretation, standards of review, evidentiary issues, application of the United States Department of Labor Regulations, medical issues and vocational issues. While disability cases, for example, may seem straightforward, the complexities of preemption, lack of jury trial, lack of compensatory and punitive damages and the unique standard of proof issues, make even the most garden-variety ERISA claims into complex and generally undesirable ones. However, this has not dampened my efforts to advocate for you.
Boston has been my adopted home for over 30 years. During my childhood, we moved around because my father was an academic. This provided great opportunities for our family. When I was in the 6th grade we lived Dublin, Ireland and in the 11th grade, we lived in Ankara, Turkey. To this day I travel a great deal; I have circumnavigated the globe many times.
Since 3rd grade, I consider a small-town bordering Washington, D.C. the place where I grew-up. I am still the proud owner of an authentic Washington Senators baseball T-shirt I received in 4th grade. Although it has holes, it’s an original to the time of the great Frank “Hondo” Howard. The “Gentle Giant” had a well-deserved reputation as the face of baseball and all-around nice guy except to the pitchers he faced. That is the role model I emulate.
As my father says, “Everyone needs a hobby or two or more.” I have a few beside traveling, including playing racquet sports and doing anything and everything in the ocean. I like movies, so I made one with some other friends. Take a look, www.bluffthemovie.com.
NOW THE LEGAL STUFF ABOUT ME
- MacNaughton v. Paul Revere Life Insurance Company, 405 F.Supp.3d 203 (D. Mass. 2019) (Massachusetts federal court refused insurance company’s motion to transfer case to Kansas ERISA action for long-term disability benefits brought against insurer and its parent company with significant operation in Massachusetts even when doctor lived in Kansas)
- Tyll v. Stanley Black & Decker Life Insurance Program, 403 F.Supp.3d 27, 41 (D. Conn. 2019) (judgment entered for widow Mrs. Tyll awarding life insurance benefits for $4 million plus interest of $1,891,442.73)
- Kamerer v. Unum Life Insurance Company of America, 334 F.Supp.3d 411 (D. Mass. 2018) (as a matter of first impression in First Circuit, insurance company rather than ERISA plan participant, had burden to prove that physical disability from fibromyalgia was due to mental illness to justify terminating benefits after 24 months under the “mental and nervous” litigation)
- Gross v. Sun Life Assurance Company of Canada, 320 F.Supp.3d 240 (D. Mass. 2018) (court awarded prejudgment interest at 12 percent, based on Massachusetts statutory rate, compounded annually for each monthly benefit and accruing through date of ERISA plan insurer’s final payment to participant for approximately 10 years of past due payments)
- Gross v. Sun Life Assur. Co. of Canada, 880 F.3d 1 (1st Cir. 2018) (judgment awarding over 10 years of past due benefits through the date of judgment, and reversing the District Court for discounting attorney’s fees and failing to explain low rate for prejudgment interest)
- Stephanie C. v. Blue Cross Blue Shield of Massachusetts HMO Blue, Inc., 813 F.3d 420 (1st Cir. 2016) (compelling First Circuit case holding a grant of discretionary decision-making authority in an ERISA plan must be couched in terms that unambiguously indicate that the claims administrator may construe the plan and determine whether benefits are due in particular instance).
- Tracia v. Liberty Life Assurance Company of Boston, 164 F.Supp.3d 201 (D. Mass. 2016) (ERISA Administrator failed to provide required notice of type of evidence to support participant’s appeal
- Gross v. Sun Life Assur. Co. of Canada, 763 F.3d 73 (1St Cir. 2014) (leading Circuit Court case nationwide holding remand to administrator was sufficient success on merits to establish participant’s eligibility for attorney’s fees even if no benefits awarded)
- Mead v. Reliastar Life Ins. Co., 768 F.3d 102 (2d Cir. 2014) (as matter of first impression in the Second Circuit, district court’s order remanding issues to plan administrator was not final and appealable to the Circuit court)
- Auto Flat Car Crushers, Inc. v. Hanover Ins. Co., 469 Mass. 813 (2014) (filed Amicus Brief for United Policyholders supporting Auto Flat where Supreme Judicial Court held acceptance of a defendant’s tender of payment of insurance policy does not vitiate a claim under consumer protection statute automatically for multiple damages)
- Gross v. Sun Life Assur. Co. of Canada, 734 F.3d 1 (1st Cir. 2013) (reversing 10 year old precedent holding “satisfactory to us” language as used in ERISA plan did not state with sufficient clarity that the plan administrator was to make a judgment largely insulated from judicial review under discretionary authority)
- Petrone v. Long Term Disability Income Plan for Choices Eligible Employees of Johnson & Johnson and Affiliated Companies, 935 F.Supp.2d 278, 293 (D. Mass. 2013) (holding ERISA administrator cannot simply ignore contrary evidence, or engage with only that evidence which supports his conclusion)
- Kaufmann v. Prudential Ins. Co. of America, 840 F.Supp.2d 495 (D.N.H. 2012) (court held administrative appeal deadline included in a summary plan description (SPD) only but not in the written instrument that established the plan was not enforceable against plan beneficiary)
- Denmark v. Liberty Life Assur. Co. of Boston, 566 F.3d 1 (1st Cir. 2009) (leading First Circuit case holding in a review of a denial of ERISA benefits, a structural conflict must be accorded weight, albeit not necessarily dispositive weight, in the standard-of-review equation under ERISA)
- McDonough v. Federal Ins. Co., 2012 WL 4060564, at *5 (D. Mass. 2012) (holding while using drugs and alcohol may cause some incidental bodily injury to the user, to suggest, that, as a per se rule, every drug and alcohol user intends to injure himself with such use, is divorced from reality)
- Pinnacle Service Solutions Group, Inc. v. AXA Equitable Life Ins. Co., 831 F.Supp.2d 523 (D. Mass. 2011) (holding that co-defendant did not consent to removal within 30-day removal period, and thus removing defendants’ petition for removal was defective requiring remanding to state court)
- Mead v. ReliaStar Life Ins. Co., 755 F.Supp.2d 515, 537 (D. VT 2010) (holding explaining the record review of insurance company to discredit retained neurologist is a paradigm of arbitrary and capricious decision-making)
- Jacoby v. Hartford Life and Acc. Ins. Co., 254 F.R.D. 477 (S.D.N.Y. 2009) (Hartford failed to establish that its claims manual and reference manual were confidential)
- Smith v. Jefferson Pilot Financial Ins. Co., 245 F.R.D. 45 (D. Mass. 2007) (as a matter of first impression in the First Circuit holding that fiduciary exception to attorney-client privilege applied to communications between insurance company personnel and in-house attorney)
- Giannone v. Metropolitan Life Ins. Co., 311 F.Supp.2d 168, 178 (D. Mass. 2004) (holding substantial evidence means actual evidence, not third-hand speculation about the possible cause of a claimant’s disability.
- Henry v. National Geographic Society, 147 F.Supp.2d 16 (D. Mass. 2001) (holding material issues of fact, as to whether trip planners which included photographs originally appearing in driving guides were “related” to guides, precluded summary judgment in suit by photographer claiming that publisher breached contract by using copyrighted photographs in unrelated publication)
Significant Published Works
Employee Benefits Law, Bloomberg BNA, Third Edition, Senior Editor. This is the leading treatise on employee benefits.
Tort Trial & Insurance Practices section of the American Bar Association titled, Did The Supreme Court Flunk Constitutional Law When It Permitted Discretionary Review Of Insured ERISA Benefits Cases?
Notable Speaking Engagements
- Western Trial Lawyers Association “Saving Time And Money Under FRE 902(13) And 902(14) Admitting Electronic Evidence” March 2020
- Western Trial Lawyers Association “Tips For Securing Statutory Attorney’s Fees” February 2019
- American Bar Association, Annual Tort Trial & Insurance Practices Midwinter Symposium on Insurance and Employee Benefits in Coral Gables, FL discussing ERISA 502(a)(3) CLAIMS AROUND THE CIRCUITS – January 2018
- American Association for Justice annual convention in Boston on the new Secretary of Labor claims regulations – July 2017
- Massachusetts Employment Lawyers Association Summary Overview of Short-Term-Disability Benefits, Long-Term-Disability Benefits and Co-ordination with Other Benefits and Settlements Under the Employee Retirement Security Act of 1974 – March 2017
- American Bar Association, Annual Tort Trial & Insurance Practices Midwinter Symposium on Insurance and Employee Benefits in Coral Gables, FL discussing the newly adopted Secretary of Labor Claims regulations – January 2017
- Federal Bar Association (Mass. Chapter) with US District Court Judge Indira Talwani at the Massachusetts chapter of the Federal Bar Association on Changes to the Federal Rules of Civil Procedure since December 1, 2015.- February 2016
- Ogletree Deakins Nash Smoak & Stewart P.C., client seminar in San Antonio, TX where I spoke on ERISA litigation from a plaintiff’s perspective with Mark Schmidtke of Ogletree Deakins who serves as National ERISA Counsel for several large life, health and disability insurers – May 2015.
- Massachusetts Employment Lawyers Association on strategies for seeking attorney’s fees in the Federal Courts – November 2014
- American Bar Association, Joint Committee on Employee Benefits meeting in New Orleans, speaking about drafting plan documents, given AMARA and MCCUTCHEN
- American Association for Justice annual convention Insurance Section speaking on Why Personal Injury Attorneys Must Stop Worrying and Learn to Love ERISA or At Least Understand Reimbursement Provisions in Benefit Plans – July 2013
- American Bar Association, Annual Tort Trial & Insurance Practices Midwinter Symposium on Insurance and Employee Benefits in St. Pete Beach, FL on Practical Approaches to Conflict Discovery in ERISA Cases: A View from Both Sides of the Aisle – January 2012
- American Conference Institute, National Advanced Forum on Litigating Disability Insurance Claims featured speaker years 2003, 2005, 2006, 2007, 2008 and 2013,
- American Association for Justice on litigation strategies after Metropolitan Life Ins. Co. v. Glenn, 128 S.Ct. 2343 (2008) July 2009.
- Worker Injury Law Group in Scottsdale, AZ speaking about reimbursement claims in connection with ERISA health plans and ERISA long term disability plans October 2009.
- International DI Society in Las Vegas, NV in October 2009 and again in Boston in October 2010 speaking on “list bill” tactics of insurance companies
Professional Associations and Memberships
- American College of Employee Benefits Counsel (ACEBC) – Fellow
- American Association for Justice, Past Chairperson Healthcare and Disability Litigation Group
- American Association for Justice
- Past Chair – Insurance Section
- Past Chair – ERISA, Health & Disability Insurance Litigation Group
- Bad Faith Litigation Group
- Insurance Law Section Executive Committee
- American Bar Association
- Vice Chair – Torts Trial and Insurance Practice Section
- Vice Chair – Employee Benefits General Committee
- Former Chair and current Vice Chair – Health and Disability Insurance Law Committee
- Vice Chair – Life Insurance Law Committee
- Vice Chair – ERISA Committee, Vice Chair
- Vice Chair – Insurance Academy Task Force, Member 2016-2017
- Vice Chair – Plaintiffs Practice Standing Committee, 2017-2018
- Vice Chair – Joint Committee on Employee Benefits
- American Bar Association – Lifetime Fellow
- Boston Bar Association – Steering Committee of Solo/Small Firm Section
- California Bar Association
- DC Bar Association
- Director and ERISA Sub-Committee Chair Massachusetts Employment Lawyers Association (MELA)
- Massachusetts Academy of Trial Attorneys
- National Employment Lawyers Association (NELA)
- Patient Advocate Foundation
- Southern Trial Lawyers Association
Honors and Awards
- President’s Award 2014 – Massachusetts Academy of Trial Attorneys
- American Association for Justice 2009 – Outstanding Newsletter of the Year Editor – Insurance Section
- Massachusetts, 1985
- District of Columbia, 1987
- California, 1992
- U.S. District Court District of Massachusetts
- U.S. District Court for the Northern District of California
- U.S. District Court of Vermont
- U.S. District Court for the Western District of Michigan
- U.S. Court of Appeals 1st Circuit
- U.S. Court of Appeals 2nd Circuit
- U.S. Court of Appeals 6th Circuit
- U.S. Court of Veterans Appeals
- Suffolk University Law School, Boston, Massachusetts
- University of Vermont, Burlington, Vermont