ERISA - The Employee Retirement Income Security Act regulates claims and relationships in employer or labor union sponsored fringe benefits. This includes retirement plans, severance plans and insurance programs provided employees by the employer (group health insurance, group life insurance and group disability insurance). We represent individuals in their claims for employee benefits, in administrative (insurance company) appeals of the denials of claims, and in court litigation over the denial of a claim. We also represent or counsel businesses concerning the benefit plans, eligibility or coverage issues.
Our work in ERISA cases began with Eddy v. Colonial Life Insurance Company. Mr. Eddy was HIV+. He had his health insurance through his employer. The employer went out of business, giving its employees very short notice of termination of its health insurance plan. Mr. Eddy had a medical procedure scheduled, contacted the insurance company and asked to convert or continue his policy. Despite plain language in the plan permitting conversion of the group insurance to an individual policy under these circumstances, the insurer said no. We sued the insurer for the benefits. In a decision that has been widely cited nationwide, the D.C. Circuit set the standard for the conduct of fiduciaries in ERISA plans in the first Eddy decision, Eddy v. Colonial Life Insurance Co., 287 U.S. App. D.C. 78, 919 F.2d 747 (1990). In the second Eddy decision, the D.C. Circuit set the standard for the award of attorneys fees in ERISA cases in the District of Columbia. Eddy v. Colonial Life Insurance Co., 313 U.S. App. D.C. 205, 59 F.3d 201 (1995).
COBRA - We advise clients on policies concerning continuation of health insurance under COBRA, coverage denials or issues, notice requirements and benefit denials.
We have obtained retroactive reinstatement to employer medical insurance policies for numerous clients, frequently without having to take the matter to court. The statutory requirements for COBRA continuation of employer provided medical insurance are very straight forward and penalties apply if the employer violates them. The federal law applies to employers with 20 or more employees, but the states have mini–COBRA laws that may provide an individual with protection. Prior to the effective date of the Affordable Care Act (Obamacare), COBRA continuation was the only viable option for continuing insurance for persons with serious medical conditions such as cancer, AIDS, fibromyalgia, severe degenerative disc disease, and numerous others.
HIPAA (Health Insurance Portability and Accountability Act) - We counsel clients concerning rights and obligations under this Federal law, including issues pertaining to pre-existing condition clauses and creditable coverage.
HIPAA also governs confidentiality of medical records. To obtain damages for a breach of the confidentiality of medical records, we use tort law for invasion of privacy. For example in John Doe v. Shady Grove Adventist Hospital, 598 A.2nd 507 (Md. App. 1991), we sued in Montgomery County Circuit Court for relief for our client after an employee of the hospital revealed to John Doe’s friends that he was HIV+, a diagnosis that John Doe had not revealed to anyone. Similar facts were involved in Doe v. Medlantic-Health Care Group, Inc., 814 A.2d 939 (D.C. 2003).
Insurance - Disability Insurance, Health Insurance, Life Insurance, Long Term Care Insurance. We represent individuals with problems under their insurance policies, whether the policies were obtained individually or as part of a group plan. Among other matters, we address coverage issues, denial of policies, attempted rescission of policies, allegations of material misrepresentation, pre-existing condition clauses, and denials of benefits.
Employment - This is a broad category that includes employment contracts, medical or maternity leave under the Federal or D.C. Family and Medical Leave Act, compensation issues under the Fair Labor Standards Act, issues of negligent hire or supervision, severance issues, wrongful discharge and defamation.
Discrimination in employment, education, public accommodations and government programs and services - This firm represents and advises clients in matters involving all of the protected classes, e.g., disability law, sex discrimination, race discrimination, age discrimination, sex harassment, or harassment based on race, religion, or another protected class, hostile environment and retaliation for complaining of discrimination or harassment..
Other civil and appellate litigation - Aside from the practice areas already mentioned, the firm represents individuals in legal malpractice actions, various personal injury tort cases, and litigation involving breaches of the confidentiality of medical records.
For example, our clients had taken their baby to Bethesda Naval Hospital for a well baby check-up, in the process of which the doctor found bumps on the baby’s chest and fractures of rib bones. Without any other evidence or investigation, the hospital wrongly assumed that the child’s Hispanic father (who was the primary care-giver) had abused the child, notified Child Protected Services and caused the baby to be removed from her parents. The child actually had a genetic bone disease that caused bones to be fractured very easily – walking across a floor, being placed in a car seat in a vehicle. Despite the testing conducted by and testimony of experts used in the CPS proceedings and the criminal case against the father, the doctor at the hospital continued to insist that the Hispanic father had abused the child. It took a couple of years for the attorney in the CPS case to obtain return of the child to the parents. We then sued in federal court in Maryland for the damages caused to the family. Velasquez v. United States, Docket No. DKC 03cv2142, United States District Court for the District of Maryland.