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If ERISA Is So Unfair, How Can You Ever Win A Case?

We stop insurance companies from taking advantage of the rules under ERISA by developing a strong medical file and successfully engage in protracted conflict of interest discovery litigation in federal court to force the insurance companies to turn over documents which expose their bad behavior. This means during the discovery phase of litigation we request information regarding claims management (including specific electronic databases and applications and particular terms used therein), information regarding pay, bonus, and other financial information, as well as performance evaluation information related to the employees of the insurance company who worked on our client's claim. We specifically seek this information to determine what standards the insurance company uses to evaluate the case and whether there was an overriding conflict of interest overshadowing the impartiality of the decision-making process in this case. We want to know whether or not there was any financial incentive for the insurance company's employees to mishandle this case. We also explain to the court that under ERISA an insurance company acts as a fiduciary, which is supposed to mean that it is required to carry out its duties with respect to the plan “solely in the interest of the participants and beneficiaries and—(A) for the exclusive purpose of: (i) providing benefits to participants and their beneficiaries;…[and] (B) with the care, skill, prudence, and diligence under the circumstances then prevailing that a prudent man acting in a like capacity and familiar with such matters would use in the conduct of an enterprise of a like character and with like aims…” 29 U.S.C. § 1104(a)(1). Under the law of ERISA an insurance company owes the participants in its plan and their beneficiaries a duty of loyalty like that borne by a trustee under common law, § 1104(a)(1)(A), and it has to exercise reasonable care in executing that duty, 1104(a)(1)(B). Mondry v. Am. Fam. Mut. Ins. Co., 557 F.3d 781, 807 (7th Cir.), cert. denied, 130 S. Ct. 200 (2009). We take great pleasure in forcing insurance companies to stop their mistreatment of people.


Seth has always been compelled to excel, whether it meant earning his Eagle Scout as a teenager, participating in theater, debate and varsity football in high school, his Rhodes Scholar candidacy in college, or opening his own law firm. He also perseveres in situations others might shy away from, whether it involves sky-diving, rappelling down a mountain, white-water rafting, participating in marathons and triathlons, writing a novel, or lecturing nationally to large audiences about the vagaries of ERISA.


Seth is committed to serving disabled individuals. He is proud of his work in prominent organizations such as the American Association for Justice (AAJ), the Tennessee Bar Association (TBA) and Hospice. Seth is past-Chair of both AAJ's & TBA's Disability Law Sections, past-President of the Chattanooga Trial Lawyers Association, a 2-time recipient of the Pro Bono Excellence Award, and a 7 year member of the Board of Directors for Hospice of Chattanooga.