By JJ?Conway
Conway Law
Conway Law
Years of writing and grammar classes taught me to never begin a paragraph with the word, “I.” That lesson has stuck with me not only in writing, but also as a subtle reminder to go about life with an abiding sense of humility.
So, in marking the 25th anniversary of J.J. Conway Law, I have been a little sheepish about how to properly celebrate this milestone. Consistent with what those great schoolteachers taught me, we will mark our 25th anniversary this year by celebrating the contributions of a few of our clients who have had a transformative effect on employee benefits law. The clients that are highlighted reflect true altruism in that they always saw their own case in the context of a larger need. Unequivocally, their cases helped others and, in some cases, sparked real change.
Employee benefits is an interesting legal specialty area. Our clients range in age from newborns to 80-year-olds and everyone in between. That is principally because employee benefits play a real role in people’s lives. From healthcare to retirement to insurances covering life’s unexpected events – employee benefits can make the difference in someone surviving financially. So, within this context, here are a few of the cases that have made an impact in the lives of others:
Mayfield v. ASC Corporation.
A father and sales executive began a quest to challenge the routine denials of healthcare benefits for children with autism. Previously, parents were reluctant to have an autism diagnosis appear in a child’s medical file because of the problems they faced with insurance. Mayfield was the first in the nation to secure a federal court ruling that the denial of benefits for his child was “arbitrary and capricious” under ERISA. Mayfield himself used his persuasive salesmanship skills to overcome nearly every obstacle in the case, and he then came back to pull others along with him in the fight for better coverage.
Johns v. Blue Cross Blue Shield of Michigan.
Building on Mayfield, a couple with a young son with Autism Spectrum Disorder (ASD) served as the first lead class action plaintiff and ultimately made the settlement decision allowing hundreds of families to recover their out-of-pocket charges for specialized therapy. The groundbreaking suit led to class action litigation across the United States. Each case built upon the one before it and brought about considerable change in this area. When it was over, nearly every child born in the U.S. with autism who is covered under a private plan of insurance has coverage for specialized and medically necessary care.
Estes v. Anderson.
A union worker and later plant manager with a decades-long career of service to the City of Detroit took on her pension’s trustees and advisors. She brought about real change after years of corruption that contributed to the city’s bankruptcy. Her efforts, which were profiled in the New York Times, sought to reform the way her pension plan’s money was invested – and she succeeded. The plan’s finances were put on a more stable footing for the future and the pensions of more than 15,000 retirees were in a better place as a result.
DeLisle v. Sun Life Assurance Company of Canada.
Sherry DeLisle’s seven-year legal battle led to the Sixth Circuit adopting an “evaluation of factors” approach to resolving ERISA benefits disputes. Prior to DeLisle, courts struggled in deciding how to properly consider the impact of a financial conflict of interest when an insurance company decides whether to pay benefits. Eventually, state insurance laws would remove some of these unfair practices, but until DeLisle, the proper method of evaluating this issue was largely inconsistent throughout the Circuit.
Wallace v. Oakwood Hospital.
A nurse who contracted an infectious disease overseas later challenged an insurer’s requirement that she formally exhaust her pre-suit administrative remedies – even though her contract never included such a requirement. For years, the “exhaustion doctrine” was used regularly to dismiss valid ERISA claims on what amounted to a technicality.
Wallace’s case challenged whether benefit plans could enforce such a requirement when a plan document contained no such requirement. Prior to her case, an exhaustion requirement was presumed to apply. This ruling allowed many claimants another chance to seek benefits where they previously may have been shut out.
Bryant M.
A family turned their own case into a larger quest for appropriate mental health coverage through a movement that sought to change Michigan’s law on mental health parity.
They established an online clearing house that provides information about benefits to families in need. The efforts of this one family have helped hundreds of families struggling to secure intensive mental healthcare treatments for adolescents and teens who are in crisis, especially following the isolation of the pandemic. The work this family does could easily be a full-time job, but they forge on, undeterred.
When reflecting on these cases you realize they were impactful because they were mission-led. The clients thought beyond themselves. They wanted a win for everyone struggling with the same challenges and injustices. In the end, they succeeded, because although their cases have ended, the positive impact remains to benefit others.
—————
John Joseph (J.J.) Conway is an employee benefits and ERISA attorney and litigator and founder of J.J. Conway Law in Royal Oak.
So, in marking the 25th anniversary of J.J. Conway Law, I have been a little sheepish about how to properly celebrate this milestone. Consistent with what those great schoolteachers taught me, we will mark our 25th anniversary this year by celebrating the contributions of a few of our clients who have had a transformative effect on employee benefits law. The clients that are highlighted reflect true altruism in that they always saw their own case in the context of a larger need. Unequivocally, their cases helped others and, in some cases, sparked real change.
Employee benefits is an interesting legal specialty area. Our clients range in age from newborns to 80-year-olds and everyone in between. That is principally because employee benefits play a real role in people’s lives. From healthcare to retirement to insurances covering life’s unexpected events – employee benefits can make the difference in someone surviving financially. So, within this context, here are a few of the cases that have made an impact in the lives of others:
Mayfield v. ASC Corporation.
A father and sales executive began a quest to challenge the routine denials of healthcare benefits for children with autism. Previously, parents were reluctant to have an autism diagnosis appear in a child’s medical file because of the problems they faced with insurance. Mayfield was the first in the nation to secure a federal court ruling that the denial of benefits for his child was “arbitrary and capricious” under ERISA. Mayfield himself used his persuasive salesmanship skills to overcome nearly every obstacle in the case, and he then came back to pull others along with him in the fight for better coverage.
Johns v. Blue Cross Blue Shield of Michigan.
Building on Mayfield, a couple with a young son with Autism Spectrum Disorder (ASD) served as the first lead class action plaintiff and ultimately made the settlement decision allowing hundreds of families to recover their out-of-pocket charges for specialized therapy. The groundbreaking suit led to class action litigation across the United States. Each case built upon the one before it and brought about considerable change in this area. When it was over, nearly every child born in the U.S. with autism who is covered under a private plan of insurance has coverage for specialized and medically necessary care.
Estes v. Anderson.
A union worker and later plant manager with a decades-long career of service to the City of Detroit took on her pension’s trustees and advisors. She brought about real change after years of corruption that contributed to the city’s bankruptcy. Her efforts, which were profiled in the New York Times, sought to reform the way her pension plan’s money was invested – and she succeeded. The plan’s finances were put on a more stable footing for the future and the pensions of more than 15,000 retirees were in a better place as a result.
DeLisle v. Sun Life Assurance Company of Canada.
Sherry DeLisle’s seven-year legal battle led to the Sixth Circuit adopting an “evaluation of factors” approach to resolving ERISA benefits disputes. Prior to DeLisle, courts struggled in deciding how to properly consider the impact of a financial conflict of interest when an insurance company decides whether to pay benefits. Eventually, state insurance laws would remove some of these unfair practices, but until DeLisle, the proper method of evaluating this issue was largely inconsistent throughout the Circuit.
Wallace v. Oakwood Hospital.
A nurse who contracted an infectious disease overseas later challenged an insurer’s requirement that she formally exhaust her pre-suit administrative remedies – even though her contract never included such a requirement. For years, the “exhaustion doctrine” was used regularly to dismiss valid ERISA claims on what amounted to a technicality.
Wallace’s case challenged whether benefit plans could enforce such a requirement when a plan document contained no such requirement. Prior to her case, an exhaustion requirement was presumed to apply. This ruling allowed many claimants another chance to seek benefits where they previously may have been shut out.
Bryant M.
A family turned their own case into a larger quest for appropriate mental health coverage through a movement that sought to change Michigan’s law on mental health parity.
They established an online clearing house that provides information about benefits to families in need. The efforts of this one family have helped hundreds of families struggling to secure intensive mental healthcare treatments for adolescents and teens who are in crisis, especially following the isolation of the pandemic. The work this family does could easily be a full-time job, but they forge on, undeterred.
When reflecting on these cases you realize they were impactful because they were mission-led. The clients thought beyond themselves. They wanted a win for everyone struggling with the same challenges and injustices. In the end, they succeeded, because although their cases have ended, the positive impact remains to benefit others.
—————
John Joseph (J.J.) Conway is an employee benefits and ERISA attorney and litigator and founder of J.J. Conway Law in Royal Oak.
