Experience

• National Fire & Marine Insurance Co v. [Redacted]. A nationwide operator of senior residential facilities was named as a defendant in a declaratory judgment action filed by National Fire & Marine Insurance Co. The dispute regards coverage under professional liability policies for claims arising from bodily injury from COVID-19 in more than 1,700 assisted care facilities owned and/or operated by the policyholder. A matter of first impression, the case was fast-tracked for litigation and trial. The District Court ruled in favor of plaintiffs. We appealed to the U.S. Court of Appeals for the Third Circuit, which overturned the lower court’s ruling.
• NYU Langone Hospitals v. Aetna Health, Inc. et. al (N.Y. Supr. Ct, NY Cty). Lead counsel to NYU Langone Hospitals in a breach of contract and bad faith claim against Aetna for systemic underpayments and non-payments for services rendered. Recovery was sought in excess of $25 million, including 12% interest for violations of NYS Prompt Pay Law (NY Ins. Law §3224-a). Following denial of dueling motions for summary judgment, NYU Langone filed a renewed motion for partial summary judgment in August 2021 in accordance with directions from the Court. While judgment on that motion was pending, the case settled in November 2021, with full resolution in 2022.
• Aetna Ins. Co. et. al. v. Esselte Corporation (U.S. District Court, S.D.N.Y.). Lead trial counsel to office products manufacturer with regard to self-funded employee benefit plan; obtained jury verdict in favor of the plan in April 2005, along with reimbursement of legal fees it incurred in defending against the lawsuit filed by Aetna in its dual capacities as third-party administrator and stop-loss insurance company.
• Niesenbaum v. AXA/Equitable Life Insurance Co. (N.Y. Supr. Ct., Nassau Cty). Lead counsel to plaintiff physician in coverage action against disability insurance company; achieved confidential settlement after defeating summary judgment motion filed by insurance company seeking dismissal of bad faith count under Bi-Economy. See Niesenbaum v. AXA/Equitable Life Insurance Co., 2015 NY Slip Op. 32538 (N.Y. Supr. Ct., Nassau Cty 2015).
• Cohen v. Standard Ins. Co. (U.S. District Court, E.D. Pa.). Lead counsel to plaintiff law partner; obtained summary judgment for policyholder, including attorney’s fees, in ruling that insurance company’s refusal to pay disability claim was arbitrary and capricious. See Cohen v. Standard Ins. Co., 155 F. Supp. 2d 346 (E.D. Pa. 2001).
• Kodsi v. Empire Blue Cross (N.Y. Supreme Ct., N.Y. County). Lead counsel to plaintiff physician arising for suit alleging wrongful termination by insurance company in retaliation for physician challenge to non-payments by insurance company; obtained ruling from NY State Supreme Court that it violates NY law for PPOs to terminate providers without cause.
• Lead counsel to Colt’s Manufacturing Company LLC in confidential mediation against hospital, stop-loss insurance company and third-party administrator, arising from long-overdue hospital bill for services rendered under a self-insured health plan. The complex multi-party dispute was resolved.
• Counsel to numerous corporations and foreign embassies regarding self-funded benefits plans, self-administered insurance policies and self-insurance arrangements, including securing recovery of unpaid sums without resort to litigation, avoiding payment of sums not owed by the corporations or their plans, and analyzing SPDs, administration agreements, stop-loss insurance policies and related documents.