John T. Seybert Partner, New York, New York

Transcription

1 John T. Seybert Partner, New York, New York Insurance Litigation Healthcare Life, Health & Disability Managed Care JOHN T. SEYBERT tel fax Current Scope of Practice John T. Seybert provides litigation defense on behalf of insurance and healthcare clients. He has represented insurers in over 200 state and federal court actions arising out of benefits claims under group and individual plans involving ERISA, COBRA, Medicare and Medicaid. Mr. Seybert has successfully defended insurance clients against claims for disability income, life insurance, medical services and pharmaceutical benefits. Mr. Seybert also prosecutes fraud actions against healthcare providers for false claims under ERISA, individual and Medicaid plans. His litigation experience includes extensive motion practice, depositions, trials and appeals. Mr. Seybert is also a contributing author to a number of publications, including the American Bar Association, Defense Research Institute and the American Health Lawyers Association. Litigation Matters Obtained a groundbreaking defense verdict in a federal case upholding the explicit terms of a benefits plan s limitations period. Plaintiff filed an ERISA suit in the U.S. District Court (SDNY) to challenge denial of longterm disability benefits by our clients, an insurance carrier and a long-term disability plan. The judge held that judicial deference to written contractual obligations and to New York State law proscriptions on trigger dates for commencement of policy limitations periods justified ruling for our clients. The Second Circuit affirmed the district court s ruling, which set the stage for the U.S. Supreme Court to review the issue in a later decided case. On December 16, 2013, the U.S. Supreme Court cited the Second Circuit opinion with approval in Heimeshoff v. Hartford Life & Acc. Insurance Co., No , unanimously upholding the plan limitation of actions provisions and enforcing them as written.

2 Successfully defeated plaintiff's motion for leave to amend her complaint to allege a class action on behalf of a putative national class of ERISA welfare benefit plan participants who allegedly had not been properly paid long-term disability (LTD) benefits by our client, the insurer. Sedgwick argued and proved that the benefit plan at issue unambiguously permitted offsets in the amount of Social Security Disability Income payments made to participants dependent children to be deducted from plaintiff's monthly LTD benefit award, explained the need for such offsets and how the insurer fulfilled its fiduciary duty to preserve plan assets by deducting them. The District Court agreed and denied plaintiff's motion to amend as futile. Successfully defended against a doctor seeking to void the termination of his in-network agreement when it was terminated due to evidence of fraudulent billing practices. The doctor had sought arbitration to avoid the termination of his agreement. Sedgwick, representing the Managed Care Organization, was able to demonstrate that the doctor was not entitled to arbitration and obtained a stay of an arbitration proceeding and the termination was able to take effect. Obtained a trial victory and an affirmance by the Second Circuit. Plaintiff was a pharmaceutical distributor who had been waiving deductible and coinsurance payments owed by its patient. Sedgwick's client, a health insurance company, asserted that the out-of-pocket limits had not been exhausted and therefore, it was not required to pay a greater percentage of coverage that would apply under the terms of the health beenfit plan when the deductible and coinsurance is paid by the enrollee. After a bench trial, the district court dismissed plaintiffs claims for payment of the additional amounts it claimed were due. On appeal, Plaintiff argued that it had validly waived these out-of-pocket costs based on a good faith review of the enrollee's financial condition. But Sedgwick was able to point to proof in the trial court record which led the Court of Appeals to conclude that the plaintiff's waivers were not based on a good faith inquiry in to the enrollee's financial condition. Affiliations, Activities and Accomplishments Mr. Seybert is admitted to practice in New York and Massachusetts. He is admitted to appear before the U.S. District Court for the Eastern, Southern, Northern and Western Districts of New York, District of Connecticut, District of Massachusetts and the U.S. Court of Appeals for the Second Circuit. Mr. Seybert received Touro Law School s 2005 pro bono award for his representation of indigent tenants in landlord-tenant court through the Volunteer Lawyers Project. Publications and Presentations Mr. Seybert has written numerous articles on Healthcare matters. His published works include: Will NY Set a Trend for Mental Health Parity Enforcement? Law360.com (May 2014). New York State Attorney Gives Insight into Potential Federal Government Enforcement of New Mental Health Parity Regulations, Sedgwick s Healthcare Law Newsletter (May 2014).

3 NY Bill Seeking to Strip Insurers of Discretion When Substance Abuse Services Should be ERISA Preempted, Sedgwick s Healthcare Law Newsletter (May 2014). Arguing for and Against ERISA Preemption and Understanding the Subsequent Impact on Providers, American Conference Institute s Advanced Forum on Healthcare Provider Disputes (March 2014) The U.S. Supreme Court Unanimously Holds that ERISA Plans Limitation of Actions Provisions Must be Enforced as Written Heimeshoff v. Hartford Life Insurance Company, Sedgwick's Insurance Law Blog (coauthored with Sedgwick attorney Michael H. Bernstein) (December 2013). U.S. District Court Denies Motion to Dismiss Insurer s Claims of Overpayment Resulting From Provider s Waiver of Out-of-Pocket Expenses, Sedgwick s Insurance Law Blog (October 2013). Recent Trends in Health Care Enforcement and Compliance: Will Medical Loss Ratio Spur ERISA Litigation? Chapter in Health Care Law Enforcement and Compliance, 2013 ed., published by Aspatore Books (July 2013). Seventh Circuit: Insurer Was Proper Defendant to an ERISA Benefits Claim, but Setting High Co-Payment Not a Fiduciary Act or De Facto Denial of Coverage, Sedgwick s Insurance Law Blog (July 2013). The Sixth Circuit Reminds Claim Administrators of the Dangers of a Breach of Fiduciary Duty When Handling Plan Assets, Sedgwick s Insurance Law Blog (July 2013). Seventh Circuit Demonstrates The Dangers Of Not Having Sufficient Written Procedures In Place To Confirm Coverage Money Damages Are Available For a Breach of ERISA Fiduciary Duty, Sedgwick s Insurance Law Blog (July 2013). Disability Policy s Mental Illness Limitation Upheld by Ninth Circuit in Fibromyalgia Case, Sedgwick s Insurance Law Blog (January 2013) (coauthored with Sedgwick attorney Julie Y. Kim). Effective Use of Analogies in Legal Practice, published by For the Defense magazine (September 2012) (coauthored with Sedgwick attorney Michael H. Bernstein). Recent Circuit Court Decisions May Limit Discovery in ERISA Health Benefit Litigation, ABA s Health esource (February 2011). Eighth Circuit Holds That Discretionary Clauses Must Appear in Both Policy and Summary Plan Description for Deferential Standard of Review, Sedgwick Healthcare Law Newsletter (Fall 2010) (coauthored with Sedgwick attorney Michael H. Bernstein). Supreme Court Rules that Litigant Need Not Be Prevailing Party to Recover Attorney's Fees Under ERISA, Sedgwick Healthcare Law Alert (May 2010) (coauthored with Sedgwick attorney Michael H. Bernstein). Will the Mental Health Parity and Addiction Equity Act of 2008 Successfully Encourage Employers to Provide Benefits for Inpatient Mental Health Treatment? ABA s Health esource (March 2010) (coauthor).

4 Full-Blown Discovery and Trial Ordered in Seventh Circuit on De Novo Review, Sedgwick s Healthcare Law Newsletter (Winter 2009/2010). Eighth's Circuit's ERISA Holding Could Give Supreme Court Another Opportunity to Consider Scope of Equitable Relief, Sedgwick s Healthcare Law Newsletter (Spring 2009). Second Circuit, a chapter in Misrepresentation in the Life, Health and Disability Insurance Application Process: A National Survey, published by ABA s Tort Trial & Insurance Practice Section (June 2009) (coauthored with Sedgwick attorney Michael H. Bernstein). ERISA Discretionary Review in the Wake of MetLife v. Glenn, AHLA s Payors Plans & Managed Care (January 2009) (coauthored with Sedgwick attorney Michael H. Bernstein). Everyone Pays The Price When Healthcare Providers Waive Patients Co-Insurance Obligations, ABA s The Health Lawyer (co-authored), (December 2008). Two Circuit Courts Pause to Determine Language Sufficient to Confer Discretion for Arbitrary and Capricious Review, Sedgwick s Healthcare Law Newsletter (co-authored), (Summer 2008). New York s Bill Requiring Public Disclosure of Physician Misconduct Charges Will Impact Medical Malpractice Litigation and Physicians Reputations, (co-authored), ABA Health esource Newsletter (August 2008). Supreme Court Denies Certiorari on Scope of Damages Available Under ERISA 502(a)(3) for Welfare Benefit Plans (co-authored), Sedgwick s Healthcare Law Alert (June 2008). ERISA: Michigan and Montana Don t Like Discretionary Clauses, Sedgwick s Healthcare Law Newsletter (Spring 2008). Is There Any Uniformity? ERISA s Standard of Review for Structurally Conflicted Administrators (coauthored), DRI s In-House Defense Quarterly (April 2008). State and Local Employer Healthcare Mandates: Preempted by ERISA? (co-authored), DRI Life, Health and Disability News (Winter 2008). Ninth Circuit Telegraphs Potential Circuit Split on Whether ERISA Preempts Employer Health Benefits Funding Mandates (co-authored) Sedgwick Healthcare Law Flash (January 2008). Will the U.S. Supreme Court Open The Door to Make Whole Relief For Litigants Under ERISA? Sedgwick s Healthcare Law Newsletter (Winter 2007). Tenth Circuit Holds Claimant Not Entitled to Comment on Medical Report Prepared at Appeal Level, Sedgwick s Healthcare Law Newsletter (Spring 2007). You Can't Get There From Here ERISA Preemption of State Laws Mandating Employer Healthcare Contributions (co-authored), ABA Health esource (March 2007).

5 Keeping Confidences and Secrets in the Electronic Age, Committee News (Summer 2006). Mr. Seybert s presentations include: Fraud Protection Privilege - Consider What You Write, In-House Presentation to Clients (May 2014). Mental Health Parity: Comparing Apples to Oranges, presented at the 2014 Eastern Claims Conference, New York, N.Y. (February 23, 2014). The Latest on the Enforceability of Contractual Limitations Periods and Accrual Provisions for Benefit Claims, co-presented at the American Conference Institutes 16th National Advanced Forum on Litigation Disability Insurance Claims, New York, N.Y. (January 23, 2014). New Compliance Obligations, Enforcement Risk and Litigation Exposure after the Affordable Care Act, co-presented at the American Bar Association's Health Law Section's 11th Annual Washington Health Law Summit, Washington, D.C. (December 9-10, 2013). Take It to the Limit: A Review of Heimeshoff Case Pending Before the U.S. Supreme Court, presented at Sedgwick's Annual Developments in Healthcare Seminar, Hartford, CT (October 2013). Co-Presenter, Mental Health Parity and Addiction Equality Act of Recent Litigation Trends, Behavioral Health Issues and Coverage of Autism Treatment, Presented at Client Lunch and Learn (September 2013). My Doctor Says I m Not Ready: Assessing Treaty Providers Reliance on Claimants Self Report, presented at the Eastern Claims Conference, New York, NY (February 2011). State Regulation Affecting ERISA-Governed Plans State of Confusion, presented at the Eastern Claims Conference, New York, NY (February 2009). Disability and Life Litigation Update, presented at Sedgwick s Healthcare Seminar, Hartford, CT (September 2007). Education Mr. Seybert received his J.D. (1999) from St. John s University School of Law, where he was articles and notes editor for the American Bankruptcy Institute Law Review. He graduated with a B.S. (1996) from Lehigh University.