Pohls & Associates is a full-service law firm for the life, health and disability insurance industry. Although we are known best as skilled litigators who consistently achieve favorable outcomes in state and federal courts throughout California, the breadth and depth of our attorneys’ experience in the field makes us uniquely qualified to develop and implement effective strategies for avoiding litigation altogether. At the same time, we have both the mettle to try cases that cannot be resolved and the uncommon ability to present complicated facts and address novel questions of law in ways that persons less familiar with life, health and disability insurance can readily understand.
Our rare blend of experience and skills allows us to seamlessly tailor our services to the needs of each situation, regardless of whether it calls for us to act as legal advisors, litigators or trial attorneys.
ERISA/Life, Health & Disability Insurance
Over the past 25 years, Rob Pohls has represented more than 50 life, health and disability insurers in various forms of litigation. He therefore is a veteran at litigating first party coverage disputes, bad faith claims and numerous other issues involving individual and group life, health and disability insurance products.
The firm's experience in this area is as diverse as the products our life, health and disability insurance clients offer. For example, we have litigated cases involving life insurance and annuities, accident and health insurance, disability income insurance and long term care insurance. The firm also has litigated cases involving pensions, retirement plans and similar types of sophisticated financial products.
That work includes handling all types of benefit disputes and bad faith litigation, as well as claims of fiduciary and co-fiduciary liability under ERISA. It also has involved prosecuting claims for rescission and declaratory relief, defending against claims of unfair competition and agent misconduct, litigating disputes with agents, and handling a variety of regulatory issues.
In addition, the firm works closely with its clients' claims personnel, underwriters and key executives to anticipate legal issues and fashion effective strategies to minimize any related risks.
Long Term Care Insurance
Rob Pohls is a pioneer in the California long term care insurance industry, having directly participated in litigation that established the California Insurance Commissioner's authority to approve of tax-qualified long term care insurance policies and having helped develop a number of related statutory amendments.
The firm's role in shaping California law with respect to long term care insurance makes it uniquely qualified to assist clients in the investigation and/or litigation of questioned claims for long term care insurance benefits. However, our experience as bad faith litigators also gives us a valuable perspective that can help insurers in this field avoid litigation altogether.
Since 2003, one leader in the long term care insurance industry has taken advantage of those qualities by calling upon our firm to review and comment on a substantial portion of its adverse claim decisions before they are finalized and/or communicated to the insured. Unlike any other private law firm, then, we have reviewed, evaluated and substantively commented on more than 1,000 long term care insurance files.
Bad Faith Litigation
Since 1958, California law has implied a covenant of good faith and fair dealing to exist as part of every contract. For insurers, a breach of the implied covenant opens the door to a set of extra-contractual remedies – including damages for emotional distress, attorneys’ fees, and punitive damages – that are not available in any other context. Because those remedies are appealing to plaintiffs (and their attorneys), the defense of bad faith claims has been part of virtually every piece of non-ERISA litigation the firm has handled.
To be sure, a mere incorrect refusal to pay benefits does not constitute bad faith. Rather, a bad faith claim requires proof that a benefit is payable and further proof that the insurer's refusal to pay benefits was both unreasonable and without proper cause. At a minimum, then, the successful defense of a bad faith claim must begin with an evidentiary showing that the insurer's claim decision was reasonable.
As a practical matter, making that proof may not be enough. Instead, the successful defense of bad faith litigation requires both a firm belief that the insurer's claim decision was correct and a genuine understanding of the insurance claim processes that yielded the evidence which compels that conclusion.
Agents and Producers
Because an agent's actions sometimes can be imputed to the insurer, most companies expect the agent to faithfully represent the insurer in all dealings with a policyholder. however, agents sometimes view policyholders as customers whose business has been won and whose interests must be served. Success in any dispute involving allegations of agent misconduct therefore requires a solid understanding of when an agent is acting on behalf of the insurer and when an agent is action on behalf of the policyholder.
We carefully examine those issues in every case to ensure that the agent's and insurer's interests are aligned. When they are not, we are prepared to both establish the limits of an agent's authority and enforce the terms of the contracts which govern the agent's relationship with the insurer.
In other contexts, we assist agents and producers with licensing issues and regulatory problems. Because we recognize that agents are not immune to the legal problems of other small businesses, we also provide them with a basic set of legal services which include business formation, employment practices, licensing and regulatory assistance and help with a range of other issues.