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Sean P. Nalty

Shareholder || San Francisco

Employee Benefits and Executive Compensation, ERISA Litigation, eDiscovery and Records Retention
Healthcare

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.”

Employee Benefits and Executive Compensation, ERISA Litigation, eDiscovery and Records Retention
Healthcare
Learn more about Sean P. Nalty

Recent Results

  • Walters v. CUMIS, N.D. Fla. (2014) (court dismissed Fla. R.I.C.O., disgorgement, unauthorized sale of insurance, and breach of fiduciary duties claims with prejudice).
  • Lashbrook v. Lane, District Court Alaska (2013) (The court dismissed with prejudice Lashbrook’s 42 U.S. C. 1983 lawsuit at time-barred.)
  • Nicoletta v. Berkshire, New York County Supreme Court (Summary judgment on the application of the definition of disability in an individual disability policy); affirmed by the Appellate Division, Oct. 12, 2012
  • Sweet v. Transamerica, District Court Nevada (2012) (Summary judgment to Transamerica on breach of contract and bad faith claims.)
  • H.W. v. Xirrus Inc. Pro Plan, CV. 11-01484-RGK, Central District California (2012) (Court held that medical treatment was not medically necessary under provisions of an ERISA governed health insurance plan.)
  • Walker v. CUNA Mutual Ins. Group, Civil No. 1015146, Eastern District of Michigan (2012) (Court granted summary judgment on claim for disability benefits.)
  • Michael Sadel v. Berkshire Life Insurance Company of America, 2012 U.S. App. LEXIS 6455 (3rd Cir. 2012) (The court upheld the district court’s order granting summary judgment on a fraud rescission action.)
  • Donaldson v. CUNA Mutual, Civil No. 100700364 7th District Court, Carbon County Utah (2012) (The Court granted CUNA Mutual’s summary judgment on the bad faith claim applying the fairly debatable doctrine.)
  • Guardian Life v. Gabrielian & Associates (Central District L.A. Dec. 2012) (The District Court rescinded the ERISA Policy issued to Gabrielian for a material misrepresentation on the application.)

Education

  • J.D., Santa Clara University School of Law, 1985
  • B.A., Santa Clara University, 1982

Admittance to Practice

  • California
  • U.S. District Court, Central, Eastern, Northern and Southern Districts of California
  • U.S. District Court, Southern District of New York
  • U.S. District Court, District of Colorado
  • U.S. District Court, Western District of Washington
  • U.S. District Court, District of Arizona
  • U.S. Court of Appeals, Third and Ninth Circuits
  • April 1, 2019 - Law360 - "10 Key Aspects Of Calif.'s CalSavers Retirement Program"
  • Spring 2016 - In-House Defense Quarterly - "Proposed Amendments to Disability Regulations Promise to Increase Costs as Well as Litigation"
  • June 5, 2015 - Lexology - "Ninth Circuit Extends ERISA Deadline, Revives Untimely Appeal"
  • Winter 2014 - The Tort Trial & Insurance Practice Law Journal - "A Comprehensive Analysis of the Ninth Circuit's Application of the Standards of Review Under ERISA (2012)"
  • March 21, 2013 - Insurance Coverage Law Report - "The Application of the 'Fairly Debatable' Doctrine in Utah under Chad Jones v. Farmers Insurance Exchange"
  • September 2012 - Financial Fraud Law Report - "Fraud Rescission in Pennsylvania - No More Excuses"
  • 2012 - Tort Trial & Insurance Practice Law Journal, Vol. 42-2 - "A Comprehensive Analysis of the Ninth Circuit's Application of the Standards of Review Under ERISA"
  • October 2005 - Mealey's Litigation Report: California Insurance, Vol. 5, No. 4 - "California Law on Insurance Bad Faith: How to Use the Genuine Dispute Doctrine to Avoid Bad Faith Exposure"
  • March 2003 - California Insurance Law & Regulation Reporter, Vol. 15 - "Does a Disability Insurance Policy Really Mean What It Says? Understanding and Applying the Terms Total and Residual Disability"
  • April 2001 - California Insurance Law & Regulation Reporter, West Group, Vol. 13 - "Guebara v. Allstate - The Genuine Issue Doctrine Is Expanded to Factual and Legal Disputes"
  • February 1998 - California Insurance Law & Regulation Reporter, Vol. 10 - "The Trials and Tribulations of the Mandated Incontestability Clauses in Life and Disability Insurance Policies"
  • Summer 1997 - Defense Research Institute Life and Health News - "The Health Insurance Portability and Accountability Act of 1996"
  • Winter 1996 - Defense Research Institute Life and Health News - "The Application of Mental and Nervous Disorder Limitations in Health and Disability Policies"
  • September 1996 - Best Review (Life/Health) - "Prepare a Strong Defense Against Liability Risk"
  • AV Rated by Martindale-Hubbell
  • 2014 Client Choice award by International Law Office (exclusive winner of the Healthcare/Life Sciences category in California)

Insights by Sean P. Nalty

Benefits document surrounded by orange pill bottles and stethoscope.

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.

Stethoscope on desk with notepad.

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.

Stethoscope on desk with notepad.

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.

Yellow street sign that says "Open Enrollment Ahead" on autumn road.

Key Arguments in Defending a Disability Claim Based on Subjective Complaints

Courts often do not clearly articulate what are key arguments in defending an action under the Employee Retirement Income Security Act of 1974 (ERISA) involving a claim for benefits based on subjective complaints. However, the stars recently aligned and U.S. District Judge Michael W. Fitzgerald of the Central District of California did just that in Haber v. Reliance Standard Life Insurance Company, No. 14-9566, 2016 WL 4154917 (August 4, 2016). He concluded that the plaintiff Orly Haber did not prove that her upper extremity pain complaints were severe enough to preclude her from performing an occupation normally performed in the national economy for which she was reasonably suited based upon her education, training, or experience (the “any occupation” standard).

State flag of California

Ninth Circuit Extends ERISA Deadline, Revives Untimely Appeal

Last week, the Ninth Circuit Court of Appeals issued its opinion in LeGras v. AETNA Life Insurance Company, No. 12-56541 (May 28, 2015), holding that the 180-day period to appeal a denial of a long-term disability claim was extended to the following Monday because the last day to submit the appeal fell on a Saturday.

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