Sean P. Nalty

Sean Nalty is a member of Ogletree Deakins’ Life, Health, Disability, ERISA and Employee Benefits practice. For 25 years, he has specialized in defending insurance companies and self-insured plans throughout the country in ERISA litigation with emphasis on the Ninth Circuit and the district courts in California. His focus is on healthcare litigation, particularly litigation involving behavioral health issues, as well as life and disability benefit issues. He also specializes in defending insurance companies in bad faith and punitive damage litigation in California involving life, health, and disability insurance.

Sean recently was awarded a 2014 Client Choice award by International Law Office (ILO). He was the exclusive winner of the Healthcare/Life Sciences category in California. Sean was selected based on feedback provided by more than 2,000 in-house counsel subscribers to ILO and Lexology. The recognition focused on his ability to add real value to clients’ business, with specific criteria including the quality of legal advice, value for money, commercial awareness, effective communication, billing transparency, tailored fee structures, response time, sharing of expertise, and use of technology. Clients said (1) “Attorneys often fall into one of two categories: those who are good on their feet, and can be persuasive when talking in court; and those who can build a great argument on paper. Sean is among that rare breed who can articulate clear, strong arguments both orally and in writing,” (2) “He has a tremendous ability to put clients at ease. He does this by listening to their concerns carefully and making sure their voice is heard in the strategic decisions in litigation,” (3) “Sean is not simply a superb litigator; he is a genuinely superb person who is universally admired and respected by senior business leaders, in-house counsel, opposing counsel, mediators and judges,” and (4) “The outcome is high-quality work, and practical legal advice. That is why Sean and Ogletree are my first choice for many issues.”

The Battle Lines of Mental Health Parity Litigation: Utah District Court Grants Motion to Dismiss, Finds Conclusory Allegations Insufficient

On June 5, 2019, in the matter Kerry W. v. Anthem Blue Cross and Shield, No. 2:19cv67, Judge Dee Benson of the U.S. District Court for the District of Utah granted Anthem Blue Cross and Shield’s motion to dismiss the plaintiffs’ cause of action for violation of the Mental Health Parity and Addiction Equality Act (MHPAEA). The district court in Utah continues to determine that a denial of a mental health benefit claim based on medical necessity cannot be transformed into a cause of action for violation of the MHPAEA through conclusory allegations.

District Court in California Denies Motion to Dismiss, Finds an Independent Review Organization to Be a Functional Fiduciary Under ERISA

In Josef K. v. California Physicians’ Service, No. 18-cv-06385-YGR (U.S. District Court for the Northern District of California, June 3, 2019), Judge Yvonne Gonzalez Rogers concluded that an independent medical review (IMR) organization can be subject to a claim under the Employee Retirement Income Security Act of 1974 (ERISA) as amended, 29 U.S.C. 1132(a)(3), for breach of fiduciary duties based on the review of a medical necessity appeal under an ERISA-governed employee welfare benefit plan.

Key Takeaways From an ERISA Fiduciary Breach Ruling on Behavioral Standards of Care After a 10-Day Trial

Behavioral health claims administrators and plan sponsors alike may be looking more closely at their care guidelines—and how they are applied—after a federal court ruled in a California class action that a claims administrator had breached its fiduciary duty under the Employee Retirement Income Security Act of 1974 (ERISA) by applying standards of care that were more restrictive than generally accepted standards and by improperly prioritizing cost savings.

Ninth Circuit Creates Bright-Line Rule, Finds Those Who Cannot Sit for More Than Four Hours Cannot Perform Sedentary Jobs

When applying de novo review to a claim for disability benefits under a group disability policy governed by the Employee Retirement Income Security Act of 1974 (ERISA), district courts must consider all the evidence and determine if a preponderance of that evidence establishes entitlement to benefits.

Northern District Court of California Addresses Residential Treatment for an Eating Disorder in Krysten C. v. Blue Shield of California

Litigation under the Employee Retirement Income Security Act (ERISA) involving the payment of benefits for residential treatment can be challenging—particularly when those claims involve eating disorders. A patient may argue that if treatment is discontinued prematurely, he or she will decompensate, lose the benefit of prior treatment, and risk physical and emotional harm.

California Court Finds That Discretionary Clauses in Health Insurance Policies Are Enforceable

In 2011, the California legislature passed Insurance Code Section 10110.6 which bans the use of discretionary clauses in any policy, contract, certificate, or agreement offered, issued, delivered, or renewed, whether or not in California, that provides or funds life insurance or disability insurance coverage. The district courts in California have enthusiastically enforced this ban, holding that discretionary clauses are unenforceable in group insurance policies and self-funded employee welfare benefit plans that provide disability benefits.

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