Insurance Litigation, Claims, & Consulting

• Using ERISA To Obtain Victory for An Employer Against A Major Group Health Insurer

  A major group health insurer denied all of the health insurance claims of the employees in a large group. The employees were covered under a group health insurance policy. The reason for the claim denials,…
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  Using ERISA To Obtain Victory for An Employer Against A Major Group Health Insurer
  A major group health insurer denied all of the health insurance claims of the employees in a large group. The employees were covered under a group health insurance policy. The reason for the claim denials, according to the health insurer, was that the group insurance policy had lapsed for non-payment of premium. After a few rounds of argument with their prior lawyers, the employer turned to Quadrino Schwartz for help.

  We determined that the group plan was governed by ERISA. We designed an approach that was vastly different from the efforts of the prior counsel. Using ERISA's tools that allow us to investigate a health insurer without filing a lawsuit, we were able to obtain a quick victory.

  The investigation we conducted demonstrated that the insurer was incorrect in its position and it agreed to deem the group policy in force for the disputed time period. All of the employees' claims will now be re-processed for payment.

  For any questions as to how we can use ERISA to help you, please call us at 1-800-745-1755 and ask for Richard Quadrino or Evan Schwartz.

• Commercial General Liability:  National Restaurant Chain

  Quadrino Schwartz successfully consulted for a joint venture between a national restaurant chain and a group of regional steakhouses.  The client was faced with an unfair competition lawsuit, and…
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  Commercial General Liability:  National Restaurant Chain
  Quadrino Schwartz successfully consulted for a joint venture between a national restaurant chain and a group of regional steakhouses.  The client was faced with an unfair competition lawsuit, and Quadrino Schwartz was hired to analyze the insurance coverage afforded under the advertising injury portion of the client's commercial general liability policy.  Coverage was secured, and the insurer assigned counsel to defend the client in the trade secrets and unfair competition litigation.

• Property & Casualty Insurance:  Third Party Bad Faith

  Our firm obtained $2 million from an insurance company for its bad faith refusal to settle a personal injury case against our client, the owner of a large apartment complex in New York City. When a business…
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  Property & Casualty Insurance:  Third Party Bad Faith
  

  Our firm obtained $2 million from an insurance company for its bad faith refusal to settle a personal injury case against our client, the owner of a large apartment complex in New York City.

  When a business or individual gets sued but they carry liability insurance, it is expected that the liability insurance company will provide a defense and pay any appropriate settlement. If the insurance company leaves its customer "hanging out to dry", there can be a "bad faith" problem.  That's where Quadrino Schwartz steps in.

  If you have, for example, $1 million in coverage and the lawyer suing you says he will accept the $1million, your insurance company should pay if the case is large and serious and you could be held liable for more than the $ 1 million.  In this case, the insurance company refused to settle the case against our client and a jury rendered a verdict against our client for much more than the limits of his insurance coverage.

  We sued the insurance company for its bad faith refusal to settle the case within the available coverage, and won a settlement of nearly $2 million to compensate our client and make the client whole.

• Health Insurance: Large Settlement for Chiropractor

  When a chiropractor's claims all started to get denied from one health insurance plan, he knew he had a significant problem. Not only was he getting the classic "run around", his patient pool of referrals…
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  Health Insurance: Large Settlement for Chiropractor
  When a chiropractor's claims all started to get denied from one health insurance plan, he knew he had a significant problem. Not only was he getting the classic "run around", his patient pool of referrals were almost all covered under that same plan. After engaging in a paper war with the health insurer, he hired an attorney and sued the health insurer.

  The health insurer and the self-insured employer made a motion to dismiss the case and mounted various arguments under ERISA alleging that the chiropractor could not recover any money and that he allegedly blew various deadlines under the ERISA regulations. The prior attorney recommended that the client accept a very small, nuisance value, amount in full settlement of the case. The chiropractor interviewed and then hired partner Richard Quadrino of Quadrino Schwartz and discharged prior counsel.

  Mr. Quadrino determined that it was the health insurer -- and not the chiropractor -- who was in violation of the ERISA regulations. He sought and obtained a court order allowing the Complaint to be amended and he filed a brand new lawsuit, making new and different legal arguments and pointing out various aspects of the health insurer's unlawful conduct.

  Mr. Quadrino obtained agreement that the prior motion to dismiss be withdrawn and he engaged in vigorous and comprehensive settlement negotiations with the health insurer. Agreement was reached whereby the chiropractor received a very substantial settlement from the insurer and there was also a resolution as to the ongoing business relationship between the chiropractor and the health insurance company.

  For more information on the ways that Quadrino Schwartz is making a difference in the health insurance arena, visit our health insurance web page or call Mr. Quadrino at 516-745-1122.

• Insurance Class Action: Groundbreaking ERISA Case

  Quadrino Schwartz was the first law firm in the United States to bring a class action lawsuit against UnumProvident Corporation and its subsidiaries to stop and correct their illegal claims…
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  Insurance Class Action: Groundbreaking ERISA Case
  

  Quadrino Schwartz was the first law firm in the United States to bring a class action lawsuit against UnumProvident Corporation and its subsidiaries to stop and correct their illegal claims practices.  Quadrino Schwartz completely defeated the insurance company's motion to dismiss the Complaint, which was fully sustained by the U.S. District Court.  To date, Quadrino Schwartz is actively pursuing three class actions against UnumProvident and its subsidiaries.

  The class action lawsuit seeks recovery for people who obtained their disability coverage through their employers. Many of those group insurance policies are governed by a federal law called "ERISA".

  Before starting the first case, we conducted many years of investigation and research into the practices of UnumProvident and its subsidiaries. Armed with our extensive knowledge of ERISA law and our many years of experience in conducting litigation on a large-scale basis, Quadrino & Schwartz commenced and pursued the largest ERISA disability class action lawsuit ever attempted.

  Our legal Complaint, filed in the federal court in New York, was vigorously attacked by UNUMProvident's lawyers, who attempted to get the case dismissed. We were successful in defeating UNUMProvident on each and every legal issue raised by them, with the court ordering that the class action proceed against the insurance company on all fronts.

• Fidelity Bond Insurance:  Ponzi Scheme Losses From Lawyer Theft Recouped for Client

  After a high profile murder-suicide by a lawyer who killed himself and his family, it was revealed that the lawyer had been involved in a Ponzi scheme that victimized many of his clients. One of the lawyer's…
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  Fidelity Bond Insurance:  Ponzi Scheme Losses From Lawyer Theft Recouped for Client
  After a high profile murder-suicide by a lawyer who killed himself and his family, it was revealed that the lawyer had been involved in a Ponzi scheme that victimized many of his clients. One of the lawyer's longtime friends, who was also a client, owned a professional practice that "invested" with the lawyer. All of the invested funds, in a Keogh retirement plan, had been lost in the scheme.

  The professional practice had obtained a fidelity bond to cover mishandling of funds under the Keogh retirement plan. A claim was filed under the bond, but the fidelity bond insurer denied the claim, alleging that there was no coverage under the terms of the bond.

  Quadrino Schwartz was hired to pursue the substantial proceeds from the insurer. Through tenacious research, the development of creative arguments, and pursuit of litigation, we were able to obtain a favorable settlement for the client.

• Professional Liability:  Law Firm Coverage

  When a professional liability insurer stopped defending a lawyer's malpractice case right before trial, Quadrino Schwartz stepped in and forced the insurance company to meet its obligation to provide and…
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  Professional Liability:  Law Firm Coverage
  When a professional liability insurer stopped defending a lawyer's malpractice case right before trial, Quadrino Schwartz stepped in and forced the insurance company to meet its obligation to provide and pay for attorneys to defend the lawsuit.

  Sometimes insurance companies pull the plug on defending a case right in the middle of a lawsuit.  Our client, a successful law firm, was sued for malpractice by one of its former clients.  The law firm's professional liability insurer defended the malpractice case but abruptly pulled out on the eve of trial, claiming a failure of "cooperation" by our client.

  We brought an immediate lawsuit against the insurance company, successfully delayed the malpractice trial, and then forced the insurance company into direct talks with the plaintiff's lawyer representing the firm's former client.  We mediated a successful resolution, avoided two trials, and brought both cases to a quick and amicable resolution.

• Health Insurance: Success In Defending Audit Litigation

  A doctor who had been audited by a health insurer decided, with his prior counsel, to engage in an arbitration proceeding regarding alleged "overpayments" to the health insurer. The doctor lost the proceeding…
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  Health Insurance: Success In Defending Audit Litigation
  A doctor who had been audited by a health insurer decided, with his prior counsel, to engage in an arbitration proceeding regarding alleged "overpayments" to the health insurer. The doctor lost the proceeding and was ordered to pay a very substantial refund to the health insurer. The doctor subsequently discovered, from speaking with counsel at Quadrino Schwartz, that he was never obligated to pay a refund to the health insurer, should have resisted the audit, and not agreed to arbitrate.

  The doctor hired Quadrino Schwartz to attempt to reverse the effects of the adverse ruling in the arbitration and to defend proceedings in Supreme Court to enforce the arbitration award. Partner Richard Quadrino marshalled the facts, the law, and various principles regarding health insurer audits and scheduled a high-level meeting with the health insurer's counsel and director of special investigations.

  After making various arguments to the insurer, Quadrino negotiated both the go-forward billing and payment arrangements between the doctor and the health insurer, resolved a group of unpaid claims that represented significant money due to the doctor, and successfully resolved all issues regarding the prior audit.

  Mr. Quadrino has successfully avoided audits of his physician clients, taking a unique and effective approach to these matters that differs from how other law firms approach these issues. For more information, contact Richard Quadrino at 516-745-1122 or by email at

• Commercial General Liability: Coverage Success For Church in the Bronx

  A parish in the Bronx was facing a lead paint lawsuit involving an injury to a child. We were hired by the church to handle the insurance company's declaratory judgment action and all other liability issues…
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  Commercial General Liability: Coverage Success For Church in the Bronx
  A parish in the Bronx was facing a lead paint lawsuit involving an injury to a child. We were hired by the church to handle the insurance company's declaratory judgment action and all other liability issues in the case.

  We obtained success by getting the insurer to resolve the declaratory judgment action against the church, pay money to the plaintiffs in the liability case, and to have all other parties resolve the rest of case to the great satisfaction of the church and its parishioners.

• Insurance Class Action: Quick Settlement

  When Quadrino Schwartz saw an illegal practice being committed by a major insurance company, the firm commenced a class action to obtain an injunction to stop the practice.  Within days, the insurance…
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  Insurance Class Action: Quick Settlement
  When Quadrino Schwartz saw an illegal practice being committed by a major insurance company, the firm commenced a class action to obtain an injunction to stop the practice.  Within days, the insurance company agreed to stop its illegal practice and Quadrino Schwartz promptly obtained a benefit for thousands of individuals across the United States.

• Health Insurance:  Audit & Overpayment Litigation Successfully Resolved for Neurology Practice

  When health insurers or HMOs come knocking on the door seeking a refund from a doctor for money already paid, it's time to get Quadrino Schwartz involved. In one recent case, a major health insurer…
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  Health Insurance:  Audit & Overpayment Litigation Successfully Resolved for Neurology Practice
  When health insurers or HMOs come knocking on the door seeking a refund from a doctor for money already paid, it's time to get Quadrino Schwartz involved. In one recent case, a major health insurer sought a $450,000 refund from our client, a neurologist.  The insurer sued, claiming that it "overpaid" the doctor. We fought back hard and demonstrated that our client's billing practices and services were proper.  The insurer was convinced to essentially drop its case by accepting a pennies on the dollar settlement.

• Auto No Fault Insurance:  Professional Medical Corporations

  When a nationally known insurance company made a second attempt at victimizing medical providers, Quadrino Schwartz led a team of law firms in obtaining a dismissal of the insurance company's…
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  Auto No Fault Insurance:  Professional Medical Corporations
  When a nationally known insurance company made a second attempt at victimizing medical providers, Quadrino Schwartz led a team of law firms in obtaining a dismissal of the insurance company's lawsuit.  The insurance company, in an effort to intimidate medical multi-specialty clinics, sued the clinics for refunds of millions of dollars paid by the insurer for medical services provided by the clinics and billed to the insurance company.  The insurer claimed that even though the services were rendered by licensed professionals, the billing was "illegal" because management companies associated with the clinics were not owned by doctors.  Quadrino Schwartz fought hard against this faulty tactic, arguing that the billing was appropriate and that the insurance company's position was not supported by any rational view of the law.  The federal court agreed, dismissing the insurance company's case.

• Legal Malpractice Coverage:  Reversal of Coverage Denial on the Eve of Trial

  A professional liability insurer withdrew from defending a lawyer in a malpractice suit, claiming that his failure to cooperate invalidated his insurance coverage. We were hired by the lawyer, on the eve…
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  Legal Malpractice Coverage:  Reversal of Coverage Denial on the Eve of Trial
  A professional liability insurer withdrew from defending a lawyer in a malpractice suit, claiming that his failure to cooperate invalidated his insurance coverage.

  We were hired by the lawyer, on the eve of trial. We successfully convinced the insurer to reverse its position and the entire case was promptly settled in a favorable manner for the client.

• Premises Liability Insurance: Coverage Won for Real Estate Management Company in the Hamptons

  We were retained by an East End property management company facing lawsuits over an incident on its premises. Among the many issues presented were insurance coverage disputes regarding multiple parties.…
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  Premises Liability Insurance: Coverage Won for Real Estate Management Company in the Hamptons
  We were retained by an East End property management company facing lawsuits over an incident on its premises.

  Among the many issues presented were insurance coverage disputes regarding multiple parties. We obtained coverage for one key player that assisted in a resolution of the entire dispute in a manner favorable to our client.

• Health Insurance: Full Recovery of Benefits

  After insurer Empire Blue Cross/Blue Shield stopped paying all of our client's healthcare benefits due to an administrative hold placed on the client's claims, we sued seeking benefits and damages.…
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  Health Insurance: Full Recovery of Benefits
  After insurer Empire Blue Cross/Blue Shield stopped paying all of our client's healthcare benefits due to an administrative hold placed on the client's claims, we sued seeking benefits and damages. Despite numerous attempts by our client to communicate with his insurer to resolve the matter, he only met with frustration. In response to our lawsuit, the insurer released about half of the claims for payment. We then negotiated a settlement with the insurer, obtaining payment for the remainder of the outstanding claims.

• Life Insurance:  Widow’s Denied Claim Reversed Without the Need for a Lawsuit

  We obtained a large settlement from a life insurance company for a widow who had received a series of conflicting letters and invoices from her husband's life insurer while he was ill and dying. She made…
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  Life Insurance:  Widow’s Denied Claim Reversed Without the Need for a Lawsuit
  

  We obtained a large settlement from a life insurance company for a widow who had received a series of conflicting letters and invoices from her husband's life insurer while he was ill and dying. She made one payment, as the insurer requested, but was then told that more was owed and that the policy would lapse if she could not make more payments. Exasperated, in crisis, and completely out of money, she could not pay what the insurer demanded. Shortly thereafter, her husband died and the insurer alleged that policy lapsed because of her failure to pay the amount of premiums by the deadline indicated in the letters and invoices.

  After speaking with a number of attorneys who told her that they could not help, she found Quadrino Schwartz. We immediately identified a number of technical -- but legally important -- defects in the insurance company's letters and invoices. After our investigation, we also determined that the insurer's demanded premium amounts were incorrect.

  Instead of filing a lawsuit, we embarked upon an effort to get the insurance company to change its decision and pay the widow the proceeds immediately, which she needed to stay in her home and meet her expenses. Through a series of lengthy letters detailing all of the legal arguments and issues, we convinced the insurer to settle the claim on very favorable terms for our client. By seeking the resolution in this manner, prior to filing a lawsuit, we saved the client a significant amount in legal fees and obtained the money promptly, avoiding a foreclosure on her home and securing her financial future.

• Class Action:  Venue Victory

  In one of the class actions pending against UnumProvident (NYSE:UNM), a Federal Court in Massachusetts rejected a last-minute tactical maneuver by UnumProvident that sought to avoid a class certification…
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  Class Action:  Venue Victory
  

  In one of the class actions pending against UnumProvident (NYSE:UNM), a Federal Court in Massachusetts rejected a last-minute tactical maneuver by UnumProvident that sought to avoid a class certification hearing in the State's Superior Court.  Quadrino Schwartz convinced the federal court to act on an emergency basis.  In an extensive emergency Memorandum Opinion, Judge F. Dennis Saylor agreed with Quadrino Schwartz on the jurisdictional issues and rejected UnumProvident's attempt to transfer the case out of the State's Superior Court and into the federal system just 45 minutes before a critical hearing on class certification. See Jewel v. UnumProvident, No. CV 04-40262. UnumProvident also tried to transfer the class action to Tennessee, where other class actions were previously transferred in September 2003.

  Plaintiffs and the class members in the case are represented by Quadrino Schwartz, Mansfield Tanick & Cohen of Minneapolis, Minnesota, Gilman & Pastor of Saugus, Massachusetts, and Sandals & Associates of Philadelphia.

• Evidence Preservation Order:  Insurance Class Action

  Quadrino Schwartz obtained an important decision in one of the three class actions spearheaded by the firm. In this class action, we pursued a reassessment of all claims denied or terminated by UnumProvident…
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  Evidence Preservation Order:  Insurance Class Action
  

  Quadrino Schwartz obtained an important decision in one of the three class actions spearheaded by the firm. In this class action, we pursued a reassessment of all claims denied or terminated by UnumProvident under insurance policies issued by New York Life, John Hancock Life, The Equitable, National Life of Vermont, General American Life, and others. These other companies hired UnumProvident to administer their entire book of disability claims and, subsequently, make those claims decisions. UnumProvident used the same illegal claims practices in denying and terminating these claims as they did with their own claims as issued by Paul Revere, UnumProvident, and Unum.

  Based upon the insurance company's prior conduct, Quadrino Schwartz fought for the preservation of additional evidence that was not saved in the other pending class actions.  The insurance company fought the effort, but Quadrino Schwartz won the battle.  The decision was recently featured on the front page of The New York Law Journal (3/28/2005), highlighted as a “Decision of Interest” and the full text version of the decision was included. See Quadrino Schwartz Court Decisions for more information.

   

• Auto Insurance and Professional Liability

  Our client was sued by a major auto leasing company that paid nearly a million dollar settlement on his behalf, since it was liable under the law as the owner of the vehicle.  The leasing company…
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  Auto Insurance and Professional Liability
  Our client was sued by a major auto leasing company that paid nearly a million dollar settlement on his behalf, since it was liable under the law as the owner of the vehicle.  The leasing company claimed that the fine print of the auto lease allowed it to get the money back from our client.  We sued the auto insurance company and their lawyers for failing to protect our client, and we forced them to pay for almost all of the liability and got our client out of the case for less than 5% of the liability.

• Email Destruction Trial:  Insurance Class Action

  Quadrino Schwartz successfully conducted an unprecedented trial in a class action regarding email destruction. Quadrino Schwartz established at the trial that the insurance company violated an…
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  Email Destruction Trial:  Insurance Class Action
  

  Quadrino Schwartz successfully conducted an unprecedented trial in a class action regarding email destruction. Quadrino Schwartz established at the trial that the insurance company violated an evidence preservation order that had been sought and obtained by Quadrino Schwartz.  The preservation order was obtained to prevent emails and other materials from routine or other destruction so that they would be available during the discovery process.  The trial was part of Quadrino Schwartz' longstanding fight against the nation's largest disability insurer.  The firm has obtained significant results and gained protections for literally hundreds of thousands of people throughout the United States.

  From the outset of the class action, we were very concerned about documents and emails being destroyed before we could review them, so we vigorously pursued and obtained from the court a special court order requiring UnumProvident Corporation to save everything that could be possibly relevant to the case. The order required UnumProvident to preserve thousands of boxes of documents and various emails and other computer based information. When it was revealed that many thousands of the company's emails had been deleted, in violation of the court order, Quadrino & Schwartz vigorously conducted an investigation, engaged in a full-blown trial, and obtained a critical court decision regarding the facts found in our investigation.

  The Court's decision after the trial details all of the facts elicited in the Quadrino & Schwartz investigation, which was comprised of depositions of various witnesses, a review of UnumProvident's corporate email communications, as well an in-court testimony elicited by Quadrino & Schwartz on behalf of the many thousands of potential class members. There will be further activities in the litigation to determine the full extent of the harm caused to the potential class members due to UnumProvident's destruction of its internal company emails.

  Quadrino & Schwartz believes that many of these emails contain the critical evidence needed to fully reveal the unlawful claims practices of the company. All of the email tapes that were not destroyed are preserved for our future review so that we can assess what steps the court may need to take concerning this destruction of evidence.

  Based upon the email destruction and UnumProvident's failure to fully secure other critical documents, we pressed UnumProvident to gather and secure other documents, and they resisted. When we brought this issue to the court, UnumProvident was ordered to promptly seize critical internal company files from the desks and offices of UnumProvident vice presidents and other managers, so that they could be secured for our review. These materials are now being held in a secure off-site warehouse.

   

• No Fault Insurance:  Medical Provider Reimbursement

  When a large-scale medical provider was faced with millions of dollars in denied insurance claims, Quadrino Schwartz was hired to fight back.  Abuses by the automobile insurance company were…
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  No Fault Insurance:  Medical Provider Reimbursement
  When a large-scale medical provider was faced with millions of dollars in denied insurance claims, Quadrino Schwartz was hired to fight back.  Abuses by the automobile insurance company were prevalent, and they were denying many small no-fault insurance claims with apparent impunity.

  Instead of bring hundreds of little suits, Quadrino Schwartz aggregated millions of dollars of claims and brought them in a single case, in federal court.  When the insurance company tried to assert a counterclaim for a refund as a leverage maneuver, Quadrino Schwartz fought back.  The firm obtained a groundbreaking ruling preventing insurance companies from trying to get refunds, either by initiating suits or interposing counterclaims, based upon allegations of improper "corporate structure" of the medical providers. The insurer's arguments were made in an attempt to invalidate proper medical practices and proper billing practices.

  The decision obtained by Quadrino Schwartz has been cited frequently in the no-fault insurance litigation arena and had an impact upon industry tactics.

• Life Insurance:  Policy Lapse Issues

  We successfully fought for a life insurance settlement for an AIDS victim. Life insurance companies often claim that their insurance polices have lapsed due to a failure of the policyholder to pay premiums,…
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  Life Insurance:  Policy Lapse Issues
  We successfully fought for a life insurance settlement for an AIDS victim. Life insurance companies often claim that their insurance polices have lapsed due to a failure of the policyholder to pay premiums, and they deny the insurance claim.  When Quadrino Schwartz gets involved, an investigation often reveals that there have been regulatory violations or other reasons why the insurance policy did not lapse.

  We were hired by the family of an AIDS victim who had died from his affliction.  The life insurance company that held a policy claimed that there was no insurance at the time of death, due to a failure to pay timely premiums.

  Quadrino Schwartz sued the insurance company and established in the litigation that there was no proof that the insurance company sent all of the legal notices that must be sent to the policyholder under New York's statutory scheme.  These notice must be sent by the insurance company in a timely and specific fashion.  Based upon the efforts of Quadrino Schwartz in the lawsuit, the insurance company was forced to compensate the family of the AIDs victim by paying a substantial settlement on the life insurance claim.