Podcasts about erisa

What can plan sponsors (and advisors) learn from litigation?  As it turns out, a lot – even if you aren't responsible for a billion-dollar plan.There are, of course, things to be learned from litigation.  We've learned that the plaintiffs' bar doesn't (always) knowhow to calculate fees (they rely on Form 5500), doesn't know how to calculate performance, and doesn't appreciate important distinctions in target-date fund glidepaths.  Though some do, of course. But the lessons drawn from litigation can serve as a reminder that fiduciaries should never assume, and never take anything for granted.  Particularly not only what the law allows, but what the plandocument permits.In a special edition of the Nevin & Fred podcast (or, if you prefer, a special edition of Prime Capital's The Reish Brief), Nevin (Adams) and Fred (Reish) cover a wide range of topics with plenty of lessons to learn.  We're talking about things like:1. Annual Beneficiary Checkups: Treat beneficiary designations like milk in the fridge—check them at least annually (and after marriage/divorce), because tiny “paperwork sins” like using 33⅓% instead of whole numbers can void the change and send everyone to court.2. Zombie Beneficiary Cleanup: Don't let auto-enrollment create “beneficiary-less zombies” in your plan; track thepercentage of participants missing designations and run a recurring campaign to get them completed before a claim turns into a family feud.3. Documented Prudence Wins: Win lawsuits the boring way: hold regular (often quarterly) committee meetings, usean IPS that guides without handcuffing you, hire qualified advisors, keep written reports, and document why you kept or replaced investments—because ERISA wants prudence, not psychic powers.4. Defensible Glidepath Choices: Target-date funds can be sued for being too conservative when markets soar and too aggressive when markets tank, so pick a glidepath based onworkforce demographics/industry realities and communicate the “why” to participants like Intel did.5. Forfeiture Compliance Trap: Forfeitures are the new litigation piñata: confirm your plan is using forfeitures exactlyas the document says today, and prepare for upcoming restatements that may force you to hardwire a specific forfeiture-use method instead of “we'll decide later.”That's right – all that – and more!Episode Resources:Court Says Call Center Communication Didn't Change Beneficiary Designation.Appellate Court Backs Beneficiary DesignationBeneficiary Disclosures Trigger Fiduciary Breach Suit, AppealSeason 4 Episode 2 "Glidepaths and 'Guide' Paths” | Nevin & Fred % %Season 5 Episode 7: Nevin & Fred – Has the Forfeiture Tide Turned? | Nevin & Fred % %  

Got questions? Send Ericka a Text!Less than 1% of denied dental claims ever get appealed and insurance companies are counting on you to be in the other 99%. I walk you through the denial management mindset shift that changes everything: stop treating the third appeal like the edge of the map and start using the tools that actually hold payers accountable, including your state insurance commissioner for fully insured plans. We get practical and specific about what makes a denial “unreasonable” or “bad faith” and how to spot the pattern: benefits are active, eligibility is confirmed, documentation supports dental necessity, and the claim still comes back denied. I also explain why we start with state and federal laws before we obsess over codes, because language like prompt pay, network leasing, and silent PPO issues gives your conversations more weight. Then we clean up common risk areas by separating an honest mistake, a contract violation, and fraud, because mixing those up can put a practice in real trouble. From there, we talk tactics: why copy-and-paste appeal templates can work against you in a world where insurers use AI to review claims, and what to use instead. Think ICD-10 diagnosis codes, strong narratives, and patient-specific clinical details that make your claim defensible. Finally, I share documented enforcement examples, including a major fine tied to undisclosed “phantom” frequency limits, and why complaints to regulators compound over time. If you want a denial process that protects patients and stops leaving money on the table, listen all the way through, then subscribe, share this with your office team, and leave a review so more billers learn how to escalate the right way.Sources referenced in this episode:Appeal rate / upheld rate: KFF analysis of CMS data — fewer than 1% of denied ACA marketplace claims are appealed; insurers uphold ~56% of appeals (2023 data), 66% (2024 data). Medicare Advantage: ~57% of appealed denials overturned. (On air we used these instead of the "59% upheld because nobody appealed" framing, which conflated the appeal rate with the uphold-on-appeal rate.)Delta Dental of Washington: Washington State Office of the Insurance Commissioner fined Delta Dental + its health care benefits manager (Wyssta) $130,000 (Oct/Nov 2024) for, among other things, denying claims based on time/frequency limits not filed with or approved by the state; 7 service types and 50 billing codes had undisclosed limits. Triggered by consumer complaints. This is an actual regulatory fine.Self-funded vs. fully insured (the "federal path" mention): The commissioner regulates fully insured plans. Self-funded employer plans fall under federal ERISA law and route to the U.S. Department of Labor (EBSA) instead, not the state commissioner. This is covered in depth in the full denial management talk, not this episode. (Government and church plans are a further exception.)Cigna PxDx: 2023 class action (E.D. Cal.), citing ProPublica reporting — ~300,000 denials in two months, avg. 1.2 seconds per claim, "we literally click and submit." Court allowed the case to proceed March 2025 (abuse of discretion). This is litigation, not a fine — described on air as a lawsuit/court ruling.UnitedHealth nH Predict: Class action (D. Minn.) alleging a 90% error rate on the AI tool and that ~0.2% of policyholders appeal. Court ordered algorithm disclosure in 2026. Allegations in active litigation — stated as such on air.The "0.2% will appeal" motive appears in both the Cigna and UnitedHealth complaints as an allegation of intent. Interested in a Demo of Dentiq - The Billing Command Center? Get on the interest list here:https://4063-dentiq.systeme.io/waitlistGet your Dental Billing Toolkit Here:https://www.dentalbillingdoneright.com/the-dental-billing-toolkitDownload "The Most Underused Codes in Dentistry - And How to Get Them Paid" checklist here:https://docs.google.com/forms/d/e/1FAIpQLSfxnnfSlNd0NPhMoBWq-1D_xU5R8LS4xPhHNKIjfLQwStOUag/viewform?usp=headerSchedule a billing chat with Ericka:https://calendly.com/ericka-dentalbillingdoneright/30minEmail Ericka:ericka@dentalbillingdoneright.comEmail Jen:jen@dentalbillingdoneright.com

Have a comment or question? Click this sentence to send us a message, and we might answer it in a future episode.Welcome to Season 6, Episode 25 of Winning Isn't Easy: Long-Term Disability ®. In this episode, we'll dive into Unum Exposed: The Tactics Behind Disability Claim Denials.Claimants pursuing Long-Term Disability benefits face more than the burden of proving they cannot work, as they must also contend with insurers that aggressively scrutinize medical evidence, reinterpret policy provisions, and use procedural tactics to justify claim denials. In this episode, attorney Nancy Cavey examines how Unum evaluates disability claims by analyzing three recent federal court decisions that reveal common strategies used to challenge claims. By exploring these cases, she explains how claimants can anticipate insurer tactics, strengthen their evidence, prepare themselves, and protect their rights throughout the disability claims process.In this episode, we'll cover the following topics:One - Introduction to 29 CFR and Why It Is Important in ERISA CasesTwo - A Summary of Three Cases, the Games That Unum Tried to Play, and What the Courts RuledThree - What ERISA Policyholders Can Learn From These Three CasesWhether you're a claimant, or simply seeking valuable insights into the disability claims landscape, this episode provides essential guidance to help you succeed in your journey. Don't miss it.Listen to Our Sister Podcast:We have a sister podcast - Winning Isn't Easy: Social Security ®. Give it a listen: https://wiessdpodcast.buzzsprout.com/Resources Mentioned in This Episode:LINK TO ROBBED OF YOUR PEACE OF MIND: https://mailchi.mp/caveylaw/ltd-robbed-of-your-piece-of-mindLINK TO THE DISABILITY INSURANCE CLAIM SURVIVAL GUIDE FOR PROFESSIONALS: https://mailchi.mp/caveylaw/professionals-guide-to-ltd-benefitsFREE CONSULT LINK: https://caveylaw.com/contact-us/Need Help Today?:Need help with your Long-Term Disability or ERISA claim? Have questions? Please feel welcome to reach out to use for a FREE consultation. Just mention you listened to our podcast.Review, like, and give us a thumbs up wherever you are listening to Winning Isn't Easy. We love to see your feedback about our podcast, and it helps us grow and improve.Please remember that the content shared is for informational purposes only, and should not replace personalized legal advice or guidance from qualified professionals.

DOL ERISA Regulations 2026: What Every Fiduciary, Investor & Plan Sponsor Needs to Know Major new proposed regulations from the Department of Labor are currently under review, and they could significantly impact how retirement plans are managed and how private assets are utilized. In this informative interview, administrative law expert and former DOL senior staffer Andrew joins the program to break down the massive 40,000+ public comment docket. He explains the new asset-neutral framework, the potential inclusion of private market assets in target-date funds, how these rules serve as a legal safe harbor against rising ERISA litigation risk, and what this means for the future of 401(k) plans. Whether you're a financial advisor navigating fiduciary duties, a sophisticated investment consultant, a plan sponsor, or anyone focused on institutional retirement planning, this conversation provides practical guidance to help you maximize portfolio diversification while avoiding regulatory pitfalls.

Scott Galloway doesn't do soft-pedal advice. In this Greatest Hits conversation, the NYU professor, entrepreneur, investor, and author of The Algebra of Wealth joins Joe to talk about why building wealth is less about chasing passion, picking the perfect stock, or waiting for retirement -- and more about focus, discipline, diversification, time, and relationships. Before that, Joe and OG dig into a 401(k) lawsuit involving AllianceBernstein and why comparing your portfolio to the wrong benchmark can send your plan sideways. Later, Alex calls in with a big early-retirement question: how do you access retirement money before age 59 and a half without triggering penalties?What You'll Walk Away WithWhy Scott Galloway says money is not the story -- it's the ink in the pen that can help you build deeper relationships with less anxietyThe "follow your passion" problem: why Scott believes young people should look first for talent, certification, and industries where they can become excellentWhy boring careers can create extraordinary lives -- especially when they offer income, stability, and room to build optionsScott's wealth equation: focus, stoicism, diversification, and time -- and why each piece matters more than trying to look brilliant for one lucky momentThe savings muscle: why measuring spending, gamifying saving, and surrounding yourself with the right people can change behavior faster than good intentions aloneWhy diversification is financial Kevlar -- it may not make you look like a hero, but it can keep one bad investment from becoming a fatal woundThe retirement myth Scott wants to burn down: why the goal isn't necessarily to stop working, but to make work a choice instead of a trapThe 401(k) benchmarking lesson: why Joe and OG say your benchmark should be your goal, not whichever index happened to win over the last decadeWhy chasing the S&P 500 because it recently crushed everything else can become dangerous when you forget that market leadership rotatesWhat the AllianceBernstein lawsuit teaches participants: ERISA protects against imprudence, not against every disappointing stretch of market performanceAlex's early-retirement question: the difference between accessing 401(k) money after separation from service at age 55 and using SEPP rules before thenWhy substantially equal periodic payments can work -- but also why OG says you want experienced help before touching those rulesWhy splitting IRA assets into separate buckets may create more flexibility for early-retirement income planningWhy This Matters NowA lot of people want the shortcut: the best stock, the best index, the perfect retirement number, the magic career move. Scott Galloway's message is more durable than that. Build skills. Save consistently. Avoid lifestyle traps. Diversify. Give time room to work. Keep the people around you strong. That's not flashy, but it is the kind of advice that still works when the market, the economy, and your life refuse to cooperate.From the BasementJoe and OG start with a retirement-plan lawsuit that turns into a bigger conversation about how Stackers should judge their own portfolios. Then Scott Galloway pulls up a chair at the card table to talk about wealth, work, saving, relationships, his mom, Sizzler, bourbon, Tom Petty, and why you don't need to be a hero to build real financial security. Doug brings trivia about the first camera phone, plus a few modeling notes of his own. Later, Alex asks how early retirees can tap retirement accounts before 59 and a half, and the basement joke-off marches toward its dramatic, deeply mathematical conclusion.Resources MentionedScott Galloway -- The Algebra of WealthStacking Benjamins Newsletter, The 201 -- stackingbenjamins.com/201OG financial planning calendar -- stackingbenjamins.com/ogStacking Benjamins voicemail line -- stackingbenjamins.com/voicemailStacking Benjamins Community, The Basement -- stackingbenjamins.com/basementStacking Benjamins YouTube channel -- youtube.com/stackingbenjaminsInvestmentNews article by Emil Halasz on the AllianceBernstein 401(k) lawsuitJL Collins -- The Simple Path to WealthPaul Merriman and Peter Mallouk -- referenced during the benchmarking and diversification discussionIRS Rule 72(t) / SEPP rules -- referenced for early retirement account withdrawalsSee Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

DR1THINGS WE MISSEDThe meritocracy is still a lie: ‘Don't look at the résumé': Elon Musk admits he's ‘fallen prey' to flashy credentials and says conversation matters most when hiring“Generally, what I tell people—I tell myself, I guess, aspirationally—is, don't look at the résumé,” he said. “Just believe your interaction. The résumé may seem very impressive…but if the conversation after 20 minutes is not ‘Wow,' you should believe the conversation, not the paper.”“I think goodness of heart is important.”Four Black women. Nine degrees. Not one steady paycheck.The president promised to save “Black jobs,” but his policies have resulted in fresh pain for the Black middle class as the employment gap widens.Study: Women are more likely to get hired after taking GLP-1sZuck still sucks: Mark Zuckerberg Sure Sounds Eager to Get Young People Hooked on Online GamblingThe Meta CEO is developing a social network betting market app—and wants help from Polymarket and Kalshi.Starbucks “Actively Reassessing” 2030 Climate GoalStarbucks initially unveiled its climate goal in 2020, targeting a 50% reduction in Scope 1, 2 and 3 emissions by 2030, on a 2019 basis.While the company's impact report indicates that it has succeeded in cutting operational emissions, with Scope 1 and 2 falling 17% since 2019, wider value chain emissions have continued to climb, with Scope 3 rising by 8% since 2019. With Scope 3 accounting for over 90% of overall emissions, Starbucks has seen its GHG footprint grow by 7% overall since 2019.The reassessment of the goal comes as the company takes “a fresh, comprehensive look at our sustainability goals,” according to a blog post by Starbucks' Chief Sustainability and Social Impact Officer Kelly Goodejohn, as part of the company's ‘Back to Starbucks' strategy initiated by CEO Brain Niccol. From the Impact Report:Overall Grants from the Starbucks FoundationFY25 $13.6M ($31M)FY24 $21.4M ($96M)Delaware Court of Chancery Interprets New Section 144 and Applies Heightened Presumption of Director IndependenceThe Opinion arose in a common context in Delaware stockholder litigation: claims over director and management compensation. In the decision, Vice Chancellor Lori W. Will applied, for the first time, the statute's heightened presumption of independence for directors of public companies determined by the board to be independent under the relevant NYSE or Nasdaq listing standards to dismiss derivative claims on demand futility grounds.In conducting the demand futility analysis, which looks to whether a majority of the board can independently consider a stockholder demand to bring derivative litigation, the Court reasoned that the new statutory language requiring a plaintiff to plead “substantial and particularized facts” to rebut the “heightened” presumption of independence sets a higher bar than under pre-existing law. Specifically, the Court held that the addition of “substantial” to the existing standard that already required particularized facts meant that “a plaintiff must plead specific, non-conclusory facts of sufficient qualitative significance to support a reasonable inference of a material interest or relationship that would impair the director's objective judgment.” The Court was clear that it is not a matter of quantity but rather quality, observing that “a collection of trivial facts” will not rise to the level of materiality required to satisfy this “heightened” standard. Applying that standard to the facts in the case, the Court concluded that the plaintiff's allegations of various overlapping board positions, overlapping investments, and other “business ties” with the company's founder and non-executive chairman were not sufficiently material.DR2The Boardroom Buy-InThe Taser CEO Who Says AI Is the Future of PolicingTaser and body-cam king Rick Smith is betting Axon's dominance—and his own pay package—on his tech-driven vision66% influenceRick Smith: Every 30 seconds one of his Tasers is fired by somebody in the U.S., usually a police officer.The pay package he and his board put together catapulted him to the top of last year's list of the highest-paid CEOs, with a compensation package valued at $164.4 million.33% no 2025; 10% no 2026Smith has already hit three of seven goals. At the end of 2025, Axon estimated the shares underlying the full award could be worth nearly $386 million.IN: Not a dictatorshipOne share one voteBlackRock 9.3%The Vanguard Group 11.6%Patrick Smith 3.5 %OUT: Patrick Smith 66% influence MMWith Chair Michael Garnreiter (2006-); sits on Audit, Compensation Committee, and Nominating committeesCompensation Committee chair Hadi Partovi (2010-): Smith (‘91) and Partovi (‘94) both members of the Theta Eta chapter of Sigma Chi at HarvardOUT: Patrick Smith ignores his board: In the wake of the tragic 2022 school shooting in Uvalde, Texas, Smith announced that Axon would begin developing Taser-equipped drones that could fly into classrooms to incapacitate active shooters.This decision was made unilaterally, bypassing Axon's own independent AI Ethics Board.The board issued a rare, public rebuke of Smith, accusing him of "trading on the tragedy" of school shootings to push a dangerous idea.Consequently, 9 of the 12 ethics board members resigned in protest, citing a total loss of faith in Axon's ability to act responsibly.Smith was forced to publicly back down and pause the project. IN: The CEO Performance award was specifically voted on in 2024 and passed, barely, but it passed: 50.1% yesNintendo Boss to Give Sweeping 10% Salary Raise to Retain EmployeesWhile most of the players in the gaming industry continue to hemorrhage jobs, Nintendo is opting to take a different path. The Kyoto-based gaming giant has recently announced a 10% increase to base salaries for its employees, a move that highlights its commitment to talent retention while everyone else is laying off employees.Nintendo president Shuntaro Furukawa made the announcement during a recent shareholder meeting, emphasising that maintaining competitive compensation is central to the company's strategy. The raise applies to the company's workforce, which has grown to over 8,200 employees, the highest headcount in Nintendo's history.IN: CEO Shuntaro Furukawa's (18%) annual executive compensation at Nintendo generally totals around $2.5MOUT: 63% of shares held by institutional investors. What the hell do these suits know about video games? IN: Of six outside directors, 3 are women (20% average in Japan)IN: Because they literally have questions like this at their annual meeting, in fact it was the first one: “With the release of Splatoon Raiders approaching, how does Nintendo evaluate the previous title, Splatoon 3? Some players experienced communication errors and discrepancies in hit detection in that title. I feel that Nintendo's response to these issues may not have been consistent with “sincerity,” one of the values in the Nintendo DNA.”Copart CEO Jeff Liaw to step down, Jay Adair to returnCEO Jeff Liaw will step down from his position and leave the board of directors effective July 31, 2026.Executive Chairman Jay Adair to resume the CEO role on the same date. Adair previously served as Copart's CEO. Liaw will assist with the transition as Special Advisor to Adair.Liaw has been with the online vehicle auction company for approximately a decade, serving first as CFO, then as President, before becoming the company's third CEO.OUT: Leadership messiness, highlighted by a boomerang CEO and so much more:The board has a Chair (founder Willis Johnson 40%) AND an Executive Chair: Willis' son-in-law and co-founder and boomerang CEO Jay Adair 38%The board also included resigning CEO/former CFO Jeff Liaw and former COO Jim Meeks and former Copart executive Steve CohanIN: a boomerang marks a return to the glory days?former CEO Liaw is actually leaving the boardStock price down 50% over past few yearsOUT: A dumb board for an online car auction company:12 directors5 are former or current executivesOne independent director with an car experience: sort of.Matt Blunt is the president of the American Automobile Policy Council, which represents the public policy interests of Stellantis N.V., Ford Motor Company, and General Motors CompanyServed as the governor of the State of Missouri from 2005 to 2009.Only 2 women.3 directors involved as a private inverter or venture capitalIN: CEO Pay Ratio is 46:1Liaw $2.1MAdair $432k for certain benefits MM1Things We MissedDOL's Replacement ESG Rule Reaches White HouseThe rule isn't interesting in and of itself - it reverts to Trump's prior rule in his first term that basically said ESG (E+S really) is dumb, and that everything must be "pecuniary focused”But the interesting part this time around:Trump also signed an executive order in December 2025 directing the DOL to tighten fiduciary rules governing proxy voting and to increase transparency about plan sponsors' use of proxy advisers. The department issued a technical release in April warning that proxy advisory firms may be subject to ERISA fiduciary standards and that proxy voting is a fiduciary act under the law that must be carried out “for the exclusive purpose of maximizing risk-adjusted return.”From the technical release in April: The Department has long recognized that voting rights and other shareholder rights attributable to shares held by ERISA-governed employee benefit plans are plan assets in their own right. Accordingly, management of those rights is subject to ERISA's fiduciary duties, including the duties of prudence and loyalty. The Department first issued guidance on this topic in the 1980s. For example, a 1988 letter (Avon Letter) noted that “it is the Department's position that the decision as to how proxies should be voted . . . are fiduciary acts of plan asset management.”(2)Proxy advisory firms may also be functional fiduciaries under ERISA section 3(21)(A)(ii) by providing investment advice for a fee to plans with respect to property of that plan.Here's why it's interesting:Defining fiduciaries as those who provide advice for a fee means everyone selling research is a fiduciary if the research is used in an investment decisionThe DOL is squarely defining proxy voting as a fiduciary act - which means that there can be no rational apathy as Mike Levin likes to talk about - if voting your proxies is definitionally your fiduciary duty, you can't defer it or ignore itIf you vote 99% in favor of management, you definitionally are ignoring your fiduciary duty - half of companies will underperform some peer set, meaning they produced fewer returns than peers, in any given year. So you either set the time frame longer (thus forcing the inclusion of long term data like climate and social factors) and say that in any one year it makes sense to vote with management to allow them time to execute strategy, OR you should be voting against nearly half of management proposals for underperformers each year because they are not producing pecuniary returnsGovernance chairs remain under pressure as investor scrutiny rises despite rising support for directors, research showsISS found that the MEDIAN support for directors has hit 98%They found that governance/nom chairs (those are specifically governance/nom committee chairs) had median support of 94.1%Pay chairs had 96.9% supportMM2The Boardroom Buy-InJPMorgan built a pipeline of female CEO candidates that was the envy of Wall Street. How did it fall apart? Are you IN or OUT on this board to find a successor to Dimon?IN or OUT: Nom chair: Gini Rometty (2020)Massively connected - highest betweenness, 82% connected to other directors (highest on board)Ex IBM CEO (retired 2020), IBM lifer (since 1981), Council on Foreign Relations, Business RoundtableCEOs replaced: herself? With Arvind Krishna, who was at IBM for more than 30 yearsIN or OUT: Michele Buck (2025)Newly appointed, ex CEO of Hershey, Hershey for 20 years and Kraft/Nabisco for 17 years prior (two companies, all food), board of NY LifeCEOs replaced: zero (dictatorship at Hershey)IN or OUT: Stephen Burke (2004)Lead Director! 16% influence, 22 year tenureComcast since 1998, Disney/ABC 1986, director at Berkshire HathawayCEOs replaced: zero (dictatorship at NBC/Comcast)IN or OUT: Alex Gorsky (2022)Ex CEO of J&J, Boards of Apple, IBM (!), ex Business RoundtableCEOs replaced: Tim Cook, himself, Gini Rometty (!)Jensen Huang's iconic leather jacket is going up for auction. Are you IN or OUT on “iconic” founder clothes?IN or OUT: Steve Jobs' turtleneck INEnabled by Arthur LevinsonIN or OUT: Zuck hoodie INEnabled by Peter Thiel, Marc AndreessenIN or OUT: Bill Gates' glasses OUTIN or OUT: Elizabeth Holmes' turtleneck OUTIN or OUT: Jack Dorsey's “love” hat OUTIN or OUT: Musk's chainsaw INSub question: if a board member has been on the board as long as the founder, are they iconic?Tench Coxe - 32 years on Nvidia board, only board he's on, buddies with JensenHarvey Jones - 32 years on Nvidia board, only board he's on, buddies with JensenBrooke Seawell (28 years) and Mark Stevens (17 years) - both were with Jensen when Nvidia just made dopey video cards for better video games

Have a comment or question? Click this sentence to send us a message, and we might answer it in a future episode.Welcome to Season 6, Episode 24 of Winning Isn't Easy: Long-Term Disability ®. In this episode, we'll dive into When Disability Claims Get Reassessed: Vocational Reviews, DIY Legal Traps, and the Hidden Risks in Building Your Own Case.Disability claims are often complicated not because a claimant's medical condition improves, but because the standard used to evaluate disability shifts over time. As policies transition from "own occupation" to "any occupation" standards, insurers rely on vocational reviews, transferable skills analyses, labor market assessments, and other tools to argue that claimants remain capable of working despite ongoing functional limitations. At the same time, many claimants attempt to strengthen their claims by interpreting policy language, organizing evidence, or using AI-assisted research without recognizing how those efforts can affect the administrative record under ERISA. In this episode, attorney Nancy Cavey examines how disability claims are challenged during vocational reassessments, why the administrative record (not personal narrative) drives claim decisions, and how well-intentioned self-advocacy can unintentionally affect the outcome. Together, these insights demonstrate that ERISA disability claims are often determined less by how disability is experienced than by how it is documented and communicated through the framework insurers use to evaluate eligibility for Long-Term Disability benefits.In this episode, we'll cover the following topics:One - How Vocational Reviews Are Used to Terminate Disability Benefits Two - The Hidden Risks of DIY Legal Strategy in Disability ClaimsThree - Why Using AI for Your Disability Case Can Backfire LegallyWhether you're a claimant, or simply seeking valuable insights into the disability claims landscape, this episode provides essential guidance to help you succeed in your journey. Don't miss it.Listen to Our Sister Podcast:We have a sister podcast - Winning Isn't Easy: Social Security ®. Give it a listen: https://wiessdpodcast.buzzsprout.com/Resources Mentioned in This Episode:LINK TO ROBBED OF YOUR PEACE OF MIND: https://mailchi.mp/caveylaw/ltd-robbed-of-your-piece-of-mindLINK TO THE DISABILITY INSURANCE CLAIM SURVIVAL GUIDE FOR PROFESSIONALS: https://mailchi.mp/caveylaw/professionals-guide-to-ltd-benefitsFREE CONSULT LINK: https://caveylaw.com/contact-us/Need Help Today?:Need help with your Long-Term Disability or ERISA claim? Have questions? Please feel welcome to reach out to use for a FREE consultation. Just mention you listened to our podcast.Review, like, and give us a thumbs up wherever you are listening to Winning Isn't Easy. We love to see your feedback about our podcast, and it helps us grow and improve.Please remember that the content shared is for informational purposes only, and should not replace personalized legal advice or guidance from qualified professionals.

https://www.sadis.com/ 212-947-3793 In this episode of The Attorney Post, Ron Geffner offers an inside look at one of the country's most active financial services law practices. As a founding member of Sadis & Goldberg LLP and leader of its Financial Services Group, Geffner shares decades of experience advising hedge funds, investment managers, family offices, and financial professionals navigating an increasingly complex regulatory landscape. Throughout the conversation, Geffner demonstrates that success in financial services law requires much more than technical legal knowledge. It demands strategic thinking, business awareness, and an understanding that every legal decision ultimately affects a client's ability to grow and protect their business. Sadis & Goldberg LLP has established itself as a nationally recognized firm serving investment funds and financial institutions. Each year, the firm helps launch approximately 80 investment funds, placing it among the country's leading law firms in the hedge fund industry. Beyond fund formation, the firm advises clients on SEC compliance, corporate transactions, mergers and acquisitions, tax matters, ERISA issues, securities litigation, and regulatory enforcement. Many attorneys focus exclusively on legal risk. Geffner believes effective counsel must also understand business constraints such as operating expenses, fundraising timelines, market conditions, and available capital. Rather than offering one-size-fits-all advice, he works closely with clients to determine the most practical legal strategy based on their individual goals. Beginning in the SEC's Investment Company Act enforcement division, he developed firsthand experience investigating regulatory compliance and understanding how enforcement agencies evaluate financial firms. Geffner explained that when government regulators become involved, one of the biggest mistakes organizations make is reacting emotionally or providing unnecessary information before understanding the issues. Instead, he recommends remaining calm, gathering the relevant facts, consulting experienced counsel, and developing a thoughtful legal strategy before responding. Many operational disputes arise not because businesses intend to violate regulations, but because communication between founders, investors, and employees becomes inconsistent over time. Rather than resisting technological change, Geffner believes law firms must integrate new tools while continuing to deliver the personalized advice that clients cannot obtain from software alone. This philosophy aligns with Sadis & Goldberg's broader strategy of offering multidisciplinary legal services through attorneys with diverse backgrounds. By combining securities regulation, corporate law, tax planning, litigation, and business counseling under one roof, the firm positions itself as a comprehensive advisor instead of a narrowly focused legal provider. Reflecting on both his professional and personal experiences—including entrepreneurship, parenting, and life's unexpected challenges—Geffner emphasized that influence often comes through consistency rather than grand gestures. For attorneys, entrepreneurs, investment professionals, and business leaders alike, Ron Geffner's conversation offers valuable insight into the intersection of law, finance, regulation, and leadership. His career demonstrates that the most effective legal advisors are those who combine technical expertise with business judgment, empathy, and a long-term commitment to helping clients succeed.

Have a comment or question? Click this sentence to send us a message, and we might answer it in a future episode.Welcome to Season 6, Episode 23 of Winning Isn't Easy: Long-Term Disability ®. In this episode, we'll dive into The Burden of Proof: Inside Neurological Disability Claims.Disability insurance claims involving neurological conditions are frequently misinterpreted as disputes solely over medical evidence, but the outcome often hinges on how symptoms are documented in medical records and how they are interpreted and evaluated under ERISA. Conditions such as migraines, Parkinson's disease, and trigeminal neuralgia can result in profound functional limitations while leaving little objective evidence on imaging or clinical testing, creating opportunities for insurers to challenge the severity of a claimant's disability. In this episode, attorney Nancy Cavey examines three disability cases that illustrate how carriers rely on treatment gaps, reports of improvement, normal diagnostic findings, and perceived inconsistencies in medical records to deny or terminate benefits. She discusses a chronic migraine claim upheld in federal court, strategies for documenting subjective Parkinson's symptoms, and a trigeminal neuralgia case in which a federal judge rejected an insurer's demand for objective proof of debilitating pain. Together, these cases demonstrate that medical records serve as both treatment histories and the foundation of ERISA disability claims, shaping how insurers and courts evaluate eligibility for Long-Term Disability benefits.In this episode, we'll cover the following topics:One - How to Avoid Having Your Chronic Migraine Long-Term Disability Claim DeniedTwo - Tips on How to Document Dizziness, Vertigo, and Balance Problems in Your ERISA Parkinson's CaseThree - Does Trigeminal Neuralgia Qualify as a Sickness or Injury Under a Cigna Disability Insurance Policy?Whether you're a claimant, or simply seeking valuable insights into the disability claims landscape, this episode provides essential guidance to help you succeed in your journey. Don't miss it.Listen to Our Sister Podcast:We have a sister podcast - Winning Isn't Easy: Social Security ®. Give it a listen: https://wiessdpodcast.buzzsprout.com/Resources Mentioned in This Episode:LINK TO ROBBED OF YOUR PEACE OF MIND: https://mailchi.mp/caveylaw/ltd-robbed-of-your-piece-of-mindLINK TO THE DISABILITY INSURANCE CLAIM SURVIVAL GUIDE FOR PROFESSIONALS: https://mailchi.mp/caveylaw/professionals-guide-to-ltd-benefitsFREE CONSULT LINK: https://caveylaw.com/contact-us/Need Help Today?:Need help with your Long-Term Disability or ERISA claim? Have questions? Please feel welcome to reach out to use for a FREE consultation. Just mention you listened to our podcast.Review, like, and give us a thumbs up wherever you are listening to Winning Isn't Easy. We love to see your feedback about our podcast, and it helps us grow and improve.Please remember that the content shared is for informational purposes only, and should not replace personalized legal advice or guidance from qualified professionals.

Have a comment or question? Click this sentence to send us a message, and we might answer it in a future episode.Welcome to Season 6, Episode 22 of Winning Isn't Easy. In this episode, we'll dive into When the Body Breaks but the Policy Doesn't Listen.Disability insurance claims are often presented as questions of medical evidence, but the outcome frequently depends on something else entirely: how a person's limitations are defined, classified, and translated into policy language. The gap between experience and contractual definitions can become especially significant when insurers evaluate complex occupations, subjective symptoms, or functional impairments that do not fit neatly into standardized vocational categories. In this episode, attorney Nancy Cavey examines three disability cases that illustrate how these disputes arise and why occupational definitions often play a central role in claim decisions. She discusses the challenges faced by a river pilot with long COVID symptoms, the importance of "own occupation" language in disability policies, and the difficulties of assessing chronic pain and medication-related cognitive impairments within the framework of vocational analysis. Together, these issues demonstrate that disability claims are rarely determined by medical diagnoses alone. Instead, they reveal how medical evidence, occupational duties, vocational classifications, and legal standards intersect to shape disability determinations, and why understanding that process is critical when pursuing Long-Term Disability benefits.In this episode, we'll cover the following topics:One - Rolling, Rolling Down the River - How the River Pilot With Long COVID Lost His Unum ERISA Disability ClaimTwo - When Definitions Decide Disability - Why “Own Occupation” Is Often the Real BattlegroundThree - Don't Let a Disability Carrier or Plan Ignore How Long-Term Opioid Use and Side Effects Can Prevent You From Performing Your Own OccupationWhether you're a claimant, or simply seeking valuable insights into the disability claims landscape, this episode provides essential guidance to help you succeed in your journey. Don't miss it.Listen to Our Sister Podcast:We have a sister podcast - Winning Isn't Easy: Navigating Your Social Security Disability Claim. Give it a listen: https://wiessdpodcast.buzzsprout.com/Resources Mentioned in This Episode:LINK TO ROBBED OF YOUR PEACE OF MIND: https://mailchi.mp/caveylaw/ltd-robbed-of-your-piece-of-mindLINK TO THE DISABILITY INSURANCE CLAIM SURVIVAL GUIDE FOR PROFESSIONALS: https://mailchi.mp/caveylaw/professionals-guide-to-ltd-benefitsFREE CONSULT LINK: https://caveylaw.com/contact-us/Need Help Today?:Need help with your Long-Term Disability or ERISA claim? Have questions? Please feel welcome to reach out to use for a FREE consultation. Just mention you listened to our podcast.Review, like, and give us a thumbs up wherever you are listening to Winning Isn't Easy. We love to see your feedback about our podcast, and it helps us grow and improve.Please remember that the content shared is for informational purposes only, and should not replace personalized legal advice or guidance from qualified professionals.

In this episode, Haylie Pomroy is joined by Edward Dabdoub, CEO and Founding Attorney of Dabdoub Law Firm, to discuss disability insurance and the legal challenges faced by individuals living with chronic and post-viral illnesses. He provides a deeper understanding of the Employee Retirement Income Security Act (ERISA) and explains how his firm helps clients navigate disability insurance claims. Edward shares how patients with chronic health conditions can find support and hope throughout the claims process, how individuals can advocate for themselves when seeking benefits, and how legal representation can help serve as a buffer between claimants and insurance companies. Together, they emphasize the importance of working with professionals who understand the complexities of chronic illness in disability litigation. They also discuss the challenges many patients face in the workplace due to limited support and how securing appropriate disability benefits can help create the stability needed to focus on health and recovery. Learn how ERISA and disability insurance claims impact individuals with chronic illness and discover the support available to help protect your rights and future. Tune in to Fast Metabolism Matters. If your body feels like it's running on empty, overburdened, or just not responding the way it used to, Haylie's latest book, Toxic Overload, tells you exactly what to do. Download your free digital copy today and start understanding what your body is trying to tell you.   Free Download: Get Your Copy of Toxic Overload

In this episode, Makenzie Wirth sits down with David Thrush, Principal in Doeren Mayhew's Audit Department and National ESOP Practice Leader, to break down why employee benefit plan (EBP) audits are essential for ESOP companies. With extensive experience in ERISA compliance, employee benefit plan audits, and ESOP administration, David explains how EBP audits support accurate Form 5500 reporting and what companies should be doing now to prepare for upcoming deadlines. From building an annual ESOP calendar to coordinating with service providers, reviewing census data, participant statements, valuations, and distributions, this conversation highlights the year‑round planning and compliance practices every ESOP company must embrace to stay compliant and avoid surprises.If you're looking to strengthen your ESOP processes, improve audit readiness, and stay ahead of regulatory requirements, this episode is a must‑listen.

Misty Leon has spent nearly 25 years at the intersection of law, business, and strategy — as a partner at a boutique firm, Senior Counsel at a Fortune 500 company, and now founder of Practical Counsel Advisors, where she helps small to midsize law firms modernize their operations and navigate AI responsibly.In this episode, Misty shares the winding, intentional journey that led her to finally go out on her own — and why the bravest thing she ever did was stop asking "can I do this?" and start asking "do I even want to?"In this episode, we cover:How Misty accidentally stumbled into ERISA law via a newspaper job listing in Charlotte — and why it opened doors in Big LawWhat five years in-house taught her that she never could have learned at a firmThe moment she realized she was heading toward burnout — and how she caught it before it caught herWhat Practical Counsel Advisors does and why AI readiness is a reputational risk firms can't afford to ignoreWhy "change management" is more than corporate speak — and why it's the piece most firms skipThe mindset shift from powering through to asking whether the path still fitsWhy women don't need more resilience pep talks — and what we actually need insteadThe concept of seasons, and why it's one of the most powerful tools for ambitious women juggling everythingHer legendary legally blonde moment involving a law school interview and a closetConnect with Misty:LinkedIn: Misty LeonWebsite: practicalcounseladvisors.com Resources & Links:Book a connection call with Erin: https://calendly.com/eringerner/connectioncallFollow Erin Gerner on Instagram, Facebook & LinkedIn

Only roughly 50% of new GLP-1 prescriptions were getting approved for coverage in 2023. From a plan sponsor's seat, that looks like pharmacy trend spiking 9%, 12%, even 20% year over year. From a pharma manufacturer's seat, it's half their prescriptions not getting filled. Same market, opposite problems — and that's exactly the lens this episode flips on. In this episode, Stacey Richter speaks with Ophelia Johnson, who built new business channels for a pharmaceutical manufacturer that created the GLP-1 boom and has since launched a consulting practice at e-fi.works, about how cash pay models work from the inside — coupon platforms, telehealth channels, white label pharmacy models, and employer carve-outs — and where the new fees are hiding. WHAT YOU'LL LEARN ✅ How the Inflation Reduction Act, PBM legal scrutiny, drug shortages, and the compounding bypass converged with ~50% GLP-1 prior auth denial rates in 2023 to push pharma into building cash pay channels that cut the PBM out entirely ✅ How the savings coupon model works: manufacturer buys the patient down to a flat transparent cash price via platforms like GoodRx, pays a fixed per-script fee instead of a PBM rebate, and the coupon platform makes the pharmacy whole — transparent math, no black box ✅ How the telehealth channel and white label pharmacy models extend the distribution chain beyond retail — and why shipping costs, credit card fees, dispensing fees, and new supply chain partners create gross-to-net and revenue leakage risk for manufacturers not built for it ✅ Why "direct to employer" is a misnomer: PBM contracts prohibit pharma from selling directly to self-insured employers, so third-party transparent administrators have emerged — but plan sponsors need to run the math first, given ERISA complications and PBM contract leverage ✅ How PBMs are now charging fees for hub-like patient support services to manage the exact prior auth complexity they created — a Whack-a-Mole shift of profitability that everyone needs to map before signing anything ✅ Ophelia's three-part practical advice: map the full patient journey and all ecosystem player incentives before building any new model (pharma); treat affordability as a clinical risk factor (clinicians); demand auditable medication abandonment data rather than settling for rebate yield metrics (plan sponsors) WHY THIS MATTERS If collaboration is the next innovation, everyone has to understand the incentives of every player in the ecosystem — not just their own. The same 50% of unfilled GLP-1 prescriptions that looks like runaway pharmacy trend from a plan sponsor's seat looks, from a manufacturer's seat, like half their market going dark — and both sides are making moves that affect each other. Understanding those moves, where fees are being layered on, and when fair profit tips into what Stacey calls profiteering is what this episode maps. TUNE IN NEXT WEEK Next week is the 401-level companion to this one — Stacey goes solo on the PBM and GPO contracting mechanics behind why cash pay became a thing, and why cheaper or better drugs can inexplicably end up off formulary or buried under prior auth. === LINKS ===

When does a benchmark actually become “meaningful” — and what does that have to do with your retirement committee meetings? In this episode, Eric and ERISA attorney Bonnie Treichel unpack retirement sketchbooks, DOL proposed regs, and how fiduciaries can align process, purpose, and benchmarks without getting lost in the legal weeds.In this episode, Eric and Bonnie Treichel discuss:Purpose and design of Your Retirement SketchbookMaking money conversations a “dinner table” topicBenchmarks and “meaningful benchmarks” in retirement plans3(21) vs. 3(38) fiduciary roles and investment policy statementsDOL proposed regulations, litigation trends, and action items for committeesKey Takeaways:Retirement conversations don't have to be intimidating; using accessible, bite-sized topics can turn money into a normal “dinner table” discussion across generations.An investment policy statement is only useful if it reflects reality; committees must periodically review it and ensure their actual practices match the documented process.Benchmarks are not just numbers on a report; selecting and understanding the right benchmark is central to evaluating performance and defending fiduciary decisions.Delegating to a discretionary investment manager does not eliminate responsibility; plan sponsors still “own” the policy and must prudently select, monitor, and understand their 3(38) relationship.Prudence is about process, and loyalty is about purpose; without both, even technically sound procedures can fail participants if they aren't anchored to what's right for that specific plan and its people.“The big action item is to look at your investment policy statement and see if it says anything about what benchmark is being used. Number two, look at your actual investment report and see, okay, what are the benchmarks being used?” - Bonnie TreichelBonnie's passion is sharing her knowledge with financial advisors. When she founded Endeavor Retirement, her goal was to make retirement legislation easy to understand. She keeps advisors up to date on the rules and regulations through her webinars, presentations, and consultations. The result — advisors and consultants help more people access their retirement savings.Connect with Bonnie Treichel:Website: https://endeavor-retirement.com/ LinkedIn: https://www.linkedin.com/in/bonnietreichel/ Connect with Eric Dyson: Website: https://90northllc.com/Phone: 940-248-4800Email: contact@90northllc.com LinkedIn: https://www.linkedin.com/in/401kguy/ The information and content of this podcast are general in nature and are provided solely for educational and informational purposes. It is believed to be accurate and reliable as of the posting date, but may be subject to change.It is not intended to provide a specific recommendation for any type of product or service discussed in this presentation or to provide any warranties, investment advice, financial advice, tax, plan design, or legal advice (unless otherwise specifically indicated). Please consult your own independent advisor as to any investment, tax, or legal statements made.The specific facts and circumstances of all qualified plans can vary, and the information contained in this podcast may or may not apply to your individual circumstances or to your plan or client plan-specific circumstances.The opinions expressed by guests on the Be More Than a Fiduciary podcast are not necessarily the same as the opinions held by 90 North Consulting, or of Executive Director Eric Dyson.

Have a comment or question? Click this sentence to send us a message, and we might answer it in a future episode.Welcome to Season 6, Episode 21 of Winning Isn't Easy. In this episode, we'll dive into Burns and Long-Term Disability.Burn injuries are often viewed as acute medical events, but their effects can extend far beyond the initial incident. Depending on the depth and severity of the injury, burns can lead to lasting complications such as chronic pain, infection, scarring, contractures, and permanent functional limitations that affect a person's ability to work and perform everyday activities. In this episode, attorney Nancy Cavey examines how burn injuries are classified, how they are treated, and the long-term physical consequences they can produce. She discusses the medical progression of burn injuries, the challenges associated with recovery and rehabilitation, and the factors disability carriers consider when evaluating whether a burn-related condition has become a disabling impairment. Together, these issues illustrate how a burn injury can evolve from a temporary medical condition into a Long-Term Disability claim, and why understanding the medical and functional impact of burns is critical when pursuing disability benefits.In this episode, we'll cover the following topics:One - What Burns Are (Definition, Types, Causes)Two - Symptoms, Complications, and TreatmentThree - Burns and Long-Term Disability EvaluationWhether you're a claimant, or simply seeking valuable insights into the disability claims landscape, this episode provides essential guidance to help you succeed in your journey. Don't miss it.Listen to Our Sister Podcast:We have a sister podcast - Winning Isn't Easy: Navigating Your Social Security Disability Claim. Give it a listen: https://wiessdpodcast.buzzsprout.com/Resources Mentioned in This Episode:LINK TO ROBBED OF YOUR PEACE OF MIND: https://mailchi.mp/caveylaw/ltd-robbed-of-your-piece-of-mindLINK TO THE DISABILITY INSURANCE CLAIM SURVIVAL GUIDE FOR PROFESSIONALS: https://mailchi.mp/caveylaw/professionals-guide-to-ltd-benefitsFREE CONSULT LINK: https://caveylaw.com/contact-us/Need Help Today?:Need help with your Long-Term Disability or ERISA claim? Have questions? Please feel welcome to reach out to use for a FREE consultation. Just mention you listened to our podcast.Review, like, and give us a thumbs up wherever you are listening to Winning Isn't Easy. We love to see your feedback about our podcast, and it helps us grow and improve.Please remember that the content shared is for informational purposes only, and should not replace personalized legal advice or guidance from qualified professionals.

Could your business be a franchise — and you don't even know it yet? I sat down with Attorney Gary Remer, who leads the Franchise Group at Maddin Hauser, and we broke down what it takes to turn a business into a scalable franchise model.

In this installment of our Workplace Strategies Watercooler 2026 podcast series, shareholders Tina Bengs (Chicago/Indianapolis), Joseph Cartafalsa (New York), and Michael Riccobono (Morristown) walk through a comprehensive compliance checklist covering mandatory leave and accommodation obligations for disability, pregnancy, and religion, along with family and medical leave laws. The speakers also address how to navigate ERISA, COBRA, and benefit plan terms to help employers keep their organizations compliant and their employees supported.

Let's talk PBM's.  What even is a P-B-M? Pharmacy benefit managers have been around since the 1960's, although back then, they were basically claims processors. Things changed in the 80's and 90's following the first iteration of ERISA when employers saw PBMs as potential cost containment strategies. The industry continued to explode until 2007 when CVS acquired Caremark, and now the market is really consolidated into just three major players. Why does this matter? Well, PBMs control just about everything drug-related in the US these days, and that includes the cost. Given that we have not seen the promised drop in drug prices, Americans and employers are still bearing the burden of this bloated and broken system.  To unpack how this works and what folks are doing about it, we invited back Shawn Gremminger, the President and CEO of the National Alliance of Healthcare Purchaser Coalitions. His organization works with regional coalitions of employers to help them advance health policy, leverage their collective power, and drive market change.

"Within five years of calling us charlatans, that hospital system was sued for multiple millions of dollars by their participants... You can go from charlatan to change agent fast."Is history about to repeat itself in the health benefits world?My guest this week is Jay Gepfert, Managing Partner of Culpepper RFP. Jay spent his corporate career on the retirement and 401(k) side of the industry, where he witnessed a massive fiduciary paradigm shift 15 years ago. Driven by regulatory changes and a wave of aggressive class-action lawsuits, traditional retirement "brokers" were forced to stop taking undisclosed kickbacks, disclose 100% of their compensation, and legally sign on as fiduciaries for their clients.Now, Jay warns that a “tsunami” is hitting the health insurance space. With major lawsuits filed at the end of 2025 targeting plan sponsors and major brokers over voluntary benefits and PBM conflicts, employers can no longer hide behind the "we've always done it this way" excuse.In this episode, we break down exactly what it means for a benefits consultant to legally act as a fiduciary, how hidden compensation and broker overrides create toxic conflicts of interest, and how Jay's firm helps employers run rigorous, process-driven RFPs to audit their vendors and protect themselves from massive legal liabilities.If you are a CFO, HR leader, or benefits consultant trying to navigate the new era of ERISA compliance and Consolidated Appropriations Act (CAA) enforcement, this episode is a stark wake-up call.Thank you to our 2026 sponsors!ParetoHealth: ParetoHealth empowers midsize employers with a long-term solution to reduce volatility and lower overall health benefits costs. Visit https://www.paretohealth.com/fully-insured-vs-self-funding-with-paretohealth-spencer-podcast/?utm_source=youtube&utm_medium=referral&utm_campaign=SelfFundedwSpencer to learn more.Samaritan Fund: A program that connects those who need help to the support they need. We are proud to offer the Samaritan Fund Program. Visit SamaritanFundProgram.com to learn more.Vālenz Health: We're Vālenz Health, your partner in improving health literacy, reducing plan spend, and delivering high-value healthcare. Visit ValenzHealth.com to learn more.Imagine360: Imagine360 helps self-funded employers save on healthcare with smarter health plans. Cut expenses by 20-30% with custom solutions. Contact us today at Imagine360.com.Episode Chapters(00:00:00) Intro(00:01:40) Meet Jay Gepfert and Culpepper RFP (00:03:30) Origin Story: Transitioning from 401(k)s to Health Benefits RFPs (00:06:54) The 401(k) Paradigm Shift: How Retirement Got Cleaned Up (00:08:50) The 2025 Wave of Health Benefits Fiduciary Litigation (00:13:49) Voluntary Benefits and the Commission Tsunami (00:17:19) What it Actually Means to be a Fiduciary for a Plan Sponsor (00:19:05) Mandating Your Broker Becomes a Fiduciary Consultant (00:21:05) Flat Fees, Eliminating Hidden Comp, and Disentangling Commissions (00:27:24) Exposing Toxic PBM Conflicts of Interest (00:30:19) The Customer Experience: Running a Modern Fiduciary RFP (00:35:08) Why Process and Documentation Matter More Than Perfection (00:38:13) The Consolidated Appropriations Act (CAA) & Gag Clauses (00:41:18) The Catalyst: When Will the Market Finally Shift? (00:44:14) The Multi-Million Dollar Lawsuit: From Charlatan to Change Agent (00:48:56) The 5 Questions That Eliminate Status Quo Brokers (00:56:18) The Ideal Plan Sponsor: Proactive vs. Reactive (00:58:54) Shifting the CFO Mindset & Unlocking the Bottom Line (01:04:01) Big Picture: The Breaking Point of Employer-Sponsored Care (01:06:40) Closing ThoughtsKey Links for Social:@SelfFunded on YouTube - https://www.youtube.com/@SelfFundedListen/watch on Spotify - https://open.spotify.com/show/1TjmrMrkIj0qSmlwAIevKA?si=068a389925474f02Follow Spencer on LinkedIn - https://www.linkedin.com/in/spencer-smith-self-funded/

Have a comment or question? Click this sentence to send us a message, and we might answer it in a future episode.Welcome to Season 6, Episode 20 of Winning Isn't Easy. In this episode, we'll dive into The Technical Rules That Decide ERISA Disability Claims.ERISA disability claims are often decided not only by medical evidence, but by technical policy provisions that many claimants never realize will determine the outcome of their case. Terms that appear straightforward (such as “active employment,” “regular attendance” of a physician, or whether a condition is classified as an “injury” or a “sickness”) can significantly affect eligibility for benefits and how long those benefits will last. In this episode, attorney Nancy Cavey examines three real disability cases that illustrate how seemingly minor policy language can have life-changing consequences. She discusses a physician who unknowingly lost his disability coverage after reducing his work hours, an insurer's attempt to deny benefits based on its interpretation of a treatment requirement, and a surgeon whose lifetime benefits hinged on the distinction between an accident and an injury. Together, these cases reveal how technical definitions and policy language can shape the outcome of ERISA disability claims, and why understanding these rules before making critical decisions is essential to protecting disability benefits.In this episode, we'll cover the following topics:One - The Danger of Reducing Your HoursTwo - What Does the Term “Regular Attendance” Mean in an ERISA Disability Claim and How Disability RMS Weaponized “Regular Attendance” to Deny a Valid ClaimThree - How the Difference Between the Terms Accident and Injury Can Impact How Long You Get Your ERISA Disability BenefitsWhether you're a claimant, or simply seeking valuable insights into the disability claims landscape, this episode provides essential guidance to help you succeed in your journey. Don't miss it.Listen to Our Sister Podcast:We have a sister podcast - Winning Isn't Easy: Navigating Your Social Security Disability Claim. Give it a listen: https://wiessdpodcast.buzzsprout.com/Resources Mentioned in This Episode:LINK TO ROBBED OF YOUR PEACE OF MIND: https://mailchi.mp/caveylaw/ltd-robbed-of-your-piece-of-mindLINK TO THE DISABILITY INSURANCE CLAIM SURVIVAL GUIDE FOR PROFESSIONALS: https://mailchi.mp/caveylaw/professionals-guide-to-ltd-benefitsFREE CONSULT LINK: https://caveylaw.com/contact-us/Need Help Today?:Need help with your Long-Term Disability or ERISA claim? Have questions? Please feel welcome to reach out to use for a FREE consultation. Just mention you listened to our podcast.Review, like, and give us a thumbs up wherever you are listening to Winning Isn't Easy. We love to see your feedback about our podcast, and it helps us grow and improve.Please remember that the content shared is for informational purposes only, and should not replace personalized legal advice or guidance from qualified professionals.

"Within five years of calling us charlatans, that hospital system was sued for multiple millions of dollars by their participants... You can go from charlatan to change agent fast."Is history about to repeat itself in the health benefits world?My guest this week is Jay Gepfert, Managing Partner of Culpepper RFP. Jay spent his corporate career on the retirement and 401(k) side of the industry, where he witnessed a massive fiduciary paradigm shift 15 years ago. Driven by regulatory changes and a wave of aggressive class-action lawsuits, traditional retirement "brokers" were forced to stop taking undisclosed kickbacks, disclose 100% of their compensation, and legally sign on as fiduciaries for their clients.Now, Jay warns that a “tsunami” is hitting the health insurance space. With major lawsuits filed at the end of 2025 targeting plan sponsors and major brokers over voluntary benefits and PBM conflicts, employers can no longer hide behind the "we've always done it this way" excuse.In this episode, we break down exactly what it means for a benefits consultant to legally act as a fiduciary, how hidden compensation and broker overrides create toxic conflicts of interest, and how Jay's firm helps employers run rigorous, process-driven RFPs to audit their vendors and protect themselves from massive legal liabilities.If you are a CFO, HR leader, or benefits consultant trying to navigate the new era of ERISA compliance and Consolidated Appropriations Act (CAA) enforcement, this episode is a stark wake-up call.Thank you to our 2026 sponsors!ParetoHealth: ParetoHealth empowers midsize employers with a long-term solution to reduce volatility and lower overall health benefits costs. Visit https://www.paretohealth.com/fully-insured-vs-self-funding-with-paretohealth-spencer-podcast/?utm_source=youtube&utm_medium=referral&utm_campaign=SelfFundedwSpencer to learn more.Samaritan Fund: A program that connects those who need help to the support they need. We are proud to offer the Samaritan Fund Program. Visit SamaritanFundProgram.com to learn more.Vālenz Health: We're Vālenz Health, your partner in improving health literacy, reducing plan spend, and delivering high-value healthcare. Visit ValenzHealth.com to learn more.Imagine360: Imagine360 helps self-funded employers save on healthcare with smarter health plans. Cut expenses by 20-30% with custom solutions. Contact us today at Imagine360.com.Episode Chapters(00:00:00) Intro(00:01:40) Meet Jay Gepfert and Culpepper RFP (00:03:30) Origin Story: Transitioning from 401(k)s to Health Benefits RFPs (00:06:54) The 401(k) Paradigm Shift: How Retirement Got Cleaned Up (00:08:50) The 2025 Wave of Health Benefits Fiduciary Litigation (00:13:49) Voluntary Benefits and the Commission Tsunami (00:17:19) What it Actually Means to be a Fiduciary for a Plan Sponsor (00:19:05) Mandating Your Broker Becomes a Fiduciary Consultant (00:21:05) Flat Fees, Eliminating Hidden Comp, and Disentangling Commissions (00:27:24) Exposing Toxic PBM Conflicts of Interest (00:30:19) The Customer Experience: Running a Modern Fiduciary RFP (00:35:08) Why Process and Documentation Matter More Than Perfection (00:38:13) The Consolidated Appropriations Act (CAA) & Gag Clauses (00:41:18) The Catalyst: When Will the Market Finally Shift? (00:44:14) The Multi-Million Dollar Lawsuit: From Charlatan to Change Agent (00:48:56) The 5 Questions That Eliminate Status Quo Brokers (00:56:18) The Ideal Plan Sponsor: Proactive vs. Reactive (00:58:54) Shifting the CFO Mindset & Unlocking the Bottom Line (01:04:01) Big Picture: The Breaking Point of Employer-Sponsored Care (01:06:40) Closing ThoughtsKey Links for Social:@SelfFunded on YouTube - https://www.youtube.com/@SelfFundedListen/watch on Spotify - https://open.spotify.com/show/1TjmrMrkIj0qSmlwAIevKA?si=068a389925474f02Follow Spencer on LinkedIn - https://www.linkedin.com/in/spencer-smith-self-funded/

Send us Fan MailEpisode 79 of the "Everything Except The Law" podcast has arrived! This time we're speaking with Ben Glass, the founder of Great Legal Marketing, LLC.Ben Glass has been practicing law for over three decades — and for 21 of those years, he's also been running Great Legal Marketing, one of the most trusted organizations in the legal industry for helping attorneys build firms that actually work for their lives.In this episode of Everything Except the Law, host Nick Werker sits down with Ben to talk about how GLM started, why the fundamentals of marketing haven't changed, and what the most important topics are inside GLM's mastermind rooms right now: people, AI, and digital marketing.But this conversation goes deeper than marketing. Ben and Nick trade stories about CrossFit, triple bypass surgery, refereeing youth soccer, and the personal journaling practice that helped Nick transform his own life. Ben opens up about what it really means to build a law firm around happiness, and why the client isn't actually at the top of the priority list.If you've ever wondered whether it's possible to enjoy running a law firm, this episode is for you.Chapters:0:00 Intro & Nick's CrossFit Origin Story2:05 Ben's Triple Bypass & CrossFit Comeback3:37 Soccer Refereeing, Running 4 Miles a Game & Protecting Young Refs5:23 How Great Legal Marketing Got Started 21 Years Ago8:33 Why Law Firms Are an Easy Target for Vendors11:08 How GLM Helps Lawyers Evaluate & Hold Vendors Accountable13:44 The Right Question to Ask Before Spending on Google Ads15:22 The Top 3 Topics at GLM: People, AI & Digital Marketing19:58 Data Quality, Call Tracking & The 83% Referral Rule21:38 The Best First Step for a New Law Firm: Build Your Relationships22:01 Direct Mail, Newsletters & Putting Others First27:31 "Is Someone Wandering Into Someone Else's Office Right Now?"31:36 The Fish Rots at the Head: Culture Starts With the Owner33:12 How to Increase Your Happiness as a Law Firm Owner36:28 Nick's Journaling Journey & Personal Transformation39:06 Mastermind Groups, Accountability & Bragging Rights42:32 How to Join Great Legal Marketing + Renegade Lawyer Marketing BookGuestBen Glass — Founder, Great Legal Marketing | Managing Attorney, Ben Glass Lawgreatlegalmarketing.com | glmsummit.com | benglasslaw.comTopics Covered-How Great Legal Marketing started 21 years ago — and why the appetite was already there-Why the fundamentals of marketing haven't changed and never will (it's all human psychology)-GLM's model: vendor-agnostic education, not a product pitch-The top three mastermind topics right now: people/culture, AI, and digital marketing-Why 83% of Ben Glass Law's revenue comes from human referrals — and what that means for your firm-The best first move for a new lawyer: direct mail, newsletters, and genuine curiosity about others-Why the right question isn't 'how much should I spend on Google Ads?'-Ben's framework for building a firm that fits your life: vision, permission, and people-The four-quadrant exercise for eliminating the things you hate-Why the client is third on Ben's priority list — not first-Mastermind groups: accountability, bragging rights, and seeing that everyone's a little broken-Ben's soccer referee work and his fight to restore sanity to youth sports-Ben's triple bypass surgery and his return to CrossFit-Nick's personal transformation story and the TikTok journal that started it allPeople & Resources MentionedBen Glass — Ben Glass Law (benglasslaw.com) / Great Legal Marketing (greatlegalmarketing.com)Brian Glass — Ben's son and co-leader at Ben Glass Law and Great Legal MarketingGyi Tsakalakis — AttorneySync; presenter at GLM's upcoming boot campConrad Saam — Mockingbird Marketing; presenter at GLM's upcoming boot campDan Kennedy — marketing legend; coined "the money is in the list"Samy Chong — mindset coach (Toronto); Ben's coach for ~12 yearsNick Werker — host, Everything Except the Law PodcastResources:Renegade Lawyer Marketing — Ben Glass's book (available on Amazon)greatlegalmarketing.com — join the email list, find upcoming eventsglmsummit.com — Great Legal Marketing Summit (annual, October)Ben Glass Law — benglasslaw.com (ERISA long-term disability & personal injury, Northern Virginia)Everything Except The Law is a part of the Answering Legal Podcast Network. Learn more about the show here: https://tinyurl.com/4xjerw3w  Interested in learning more about Answering Legal? Book an appointment to speak with us here: https://tinyurl.com/4c9h8xb8 You can also give us a call at 631-212-1899.This podcast is produced and edited by Joe Galotti. You can reach Joe via email at joe@answeringlegal.com.

Employee benefits continue to be a critical component of attracting and retaining talent. According to the Society for Human Resource Management (SHRM), 81% of employers consider both retirement savings and planning benefits and leave benefits to be either "very important" or "extremely important" offerings for their workforce. As organizations compete for talent, retirement plans remain one of the most valued benefits employers provide. In this episode of Let's Have This Conversation, I sit down with Alex Langan, ERISA attorney, Chief Investment Officer, author of the #1 bestselling book 401(k) Exposed, and founder of Langan Financial Group. Alex has built a reputation for challenging conventional wisdom surrounding employer-sponsored retirement plans. After serving as a Pennsylvania Supreme Court clerk and practicing ERISA law, he discovered what he believes is one of the most overlooked issues in corporate America: many employers unknowingly expose themselves to legal and fiduciary risks through the administration of their 401(k) plans. During our conversation, Alex explains why retirement plan providers may not always have incentives aligned with employers and employees, the fiduciary responsibilities many business owners and HR professionals inherit without formal training, and the steps organizations can take to better protect both themselves and their workforce. We also discuss: • Why retirement plans remain one of the most important employee benefits organizations offer • Common misconceptions employers have about fiduciary responsibility • The hidden costs and risks embedded in many 401(k) plans • How employees can become more informed retirement savers • What business owners, CFOs, and HR leaders should be asking their retirement plan providers • Why transparency and education are critical to improving retirement outcomes Alex also shares the philosophy behind Langan Financial Group, an independent financial planning firm focused on personalized guidance rather than product sales or quotas. Their approach centers on understanding each client's goals, challenges, and long-term financial objectives while delivering customized financial planning solutions supported by a dedicated team. Whether you're an HR professional, business owner, executive, or employee participating in a workplace retirement plan, this conversation offers valuable insights into a system that affects millions of Americans every day.   For more information: https://langanfinancialgroup.com/ Email: alex@langanfinancial.com   Learn more about your ad choices. Visit megaphone.fm/adchoices

What happens when a former child actor, ERISA lawyer, and Fortune 500 in-house counsel walks into a coffee shop?In this case, she orders a lavender chai latte* and starts reimagining what a legal career can look like. *served best in an actual coffee mug, preferably with fancy foam art and enjoyed while sitting in a coffee shopIn this episode of Counsel Brew, we sit down with Misty Leon, who at the time of recording was serving as in-house counsel at Texas Instruments. Misty's career has taken her from private practice to the corporate legal department to founder and principal of the freshly launched Practical Counsel Advisors, with a few unexpected stops along the way, including a bread commercial, starring as Dorothy in The Wizard of Oz, and surviving meetings that involved more conversations with a dog named Mr. Barkey than actual legal work.Because every legal career deserves at least one story that makes everyone ask, "Wait...what?"We explore Misty's journey from aspiring child actor and ruby-slipper-wearing Dorothy to respected legal leader and in-house counsel. We talk about intentionally choosing a niche legal practice, navigating major career pivots, and the coaching and self-reflection that helped her discover what she wanted next. Misty shares insights on building meaningful professional relationships, overcoming the hesitation that often keeps talented people from pursuing new opportunities, and embracing growth even when it feels uncomfortable. We also dive into the future of AI and legal operations, the value of staying curious throughout your career, and why having a friend who occasionally tells you to "just do the thing" might be one of the most underrated professional advantages out there.One of the themes we love exploring on Counsel Brew is that successful careers are built through a series of small decisions that often don't seem significant at the time.Attending a bar association event.Following up with someone you genuinely enjoy.Trying something that feels uncomfortable.Volunteering for the panel even when you'd rather hide behind the podium.Misty's career is proof that those moments add up.Also, if you ever find yourself sitting through a two-hour meeting while someone discusses dog treats with their pet, remember: someday it may become podcast content.Listen now:  Find Misty at https://www.linkedin.com/in/misty-a-leon/Learn more about Practical Counsel Advisors at https://www.practicalcounseladvisors.com/Message us at hello@counselbrew.com  Visit us at http://www.counselbrew.com And Follow us @counselbrewhttps://www.linkedin.com/company/counsel-brew/Send us Fan Mail Explicit Rating is for the occasional use of colorful language.

Last August  President Trump signed an executive order directing the Secretary of Labor to, among other things, “reexamine the Department of Labor's guidance on a fiduciary's duties regarding alternative asset investments in ERISA-governed 401(k) and other defined-contribution plans” – a stance widely seen as encouraging the consideration of alternative assets in defined contribution plans, including401(k)s and 403(b)s.Then on March 30, the Labor Department issued a proposedregulation in response to that directive, titled “Fiduciary Duties In Selecting Designated Investment Alternatives.”  However, while it acknowledged that while the executiveorder “focused on fiduciary responsibilities for offering an asset allocation fund that includes investments in alternative assets, the proposed regulation would apply to the selection of any type of investment as a designated investment alternative, including investments in so-called “alternative assets.”That said, the comment period closed with more than 47,000comments!In this episode, Nevin and Fred consider the…alternatives…and the future of the proposal.Episode Resources:Regulations.gov(the comments)DOL Archives - Fred ReishSeason 6 Episode 4: The Investment Selection Proposal | Nevin & Fred % %Talking Points: Retirement Income, Defaults and Fiduciary DutySpecial Edition: Fiduciary Duties In Selecting Designated Investment Alternatives Proposed Rule  https://endeavor- retirement.activehosted.com/index.php?action=social&chash=f770b62bc8f42a0b66751fe636fc6eb0.467&s=f1b8e69fc34995b9d807df36b7a3c6f3AGs, Congressional Democrats Say DOL Proposal Weakens Prudence StandardEBSA's Aronowitz Outlines Fiduciary Framework for ‘Investment Selection Rule'How Many Times Does the DOL Proposed Rule Mention ‘Litigation?'Fiduciary Duties in Selecting Designated Investment Alternatives (the “Investment Selection Rule”)Breaking News: Trump Signs EO to Advance Private Market Investments in 401(k)s

Have a comment or question? Click this sentence to send us a message, and we might answer it in a future episode.Welcome to Season 6, Episode 19 of Winning Isn't Easy. In this episode, we'll dive into When Expertise Isn't Enough: A Doctor's Disability Journey With Long COVID (With Guest Dr. Zeest Khan).Long COVID has challenged not only medicine, but also the disability insurance system. Insurers often characterize these claims as subjective, difficult to measure, or lacking definitive proof, leaving claimants to navigate a process that can struggle to account for fluctuating symptoms and complex limitations. In this episode, attorney Nancy Cavey speaks with Dr. Zeest Khan, a former anesthesiologist whose own experience with long COVID forced her transition from doctor to patient. They discuss how that perspective reshaped her understanding of chronic illness, the realities of pursuing SSDI and Long-Term Disability benefits, the challenges posed by independent medical exams, and why long COVID continues to expose gaps in the way disability claims are evaluated.Check out Dr. Khan's website here: https://longcovidmd.com/In this episode, we'll cover the following topics:One - From Physician to Patient: Identity, Illness, and a New Path Two - Inside the Disability Maze: LTD, SSDI, and System Gaps Three - Advocacy and Strategy: Navigating Claims with Long COVID Whether you're a claimant, or simply seeking valuable insights into the disability claims landscape, this episode provides essential guidance to help you succeed in your journey. Don't miss it.Listen to Our Sister Podcast:We have a sister podcast - Winning Isn't Easy: Navigating Your Social Security Disability Claim. Give it a listen: https://wiessdpodcast.buzzsprout.com/Resources Mentioned in This Episode:LINK TO ROBBED OF YOUR PEACE OF MIND: https://mailchi.mp/caveylaw/ltd-robbed-of-your-piece-of-mindLINK TO THE DISABILITY INSURANCE CLAIM SURVIVAL GUIDE FOR PROFESSIONALS: https://mailchi.mp/caveylaw/professionals-guide-to-ltd-benefitsFREE CONSULT LINK: https://caveylaw.com/contact-us/Need Help Today?:Need help with your Long-Term Disability or ERISA claim? Have questions? Please feel welcome to reach out to use for a FREE consultation. Just mention you listened to our podcast.Review, like, and give us a thumbs up wherever you are listening to Winning Isn't Easy. We love to see your feedback about our podcast, and it helps us grow and improve.Please remember that the content shared is for informational purposes only, and should not replace personalized legal advice or guidance from qualified professionals.

#ThisMorning | Retirement #Risk Radar: Fresh #ERISA #Litigation Highlights | Chris Tobe, CFA, CAIA, The Hackett Group, LLC | #Tunein: broadcastretirementnetwork.com #Aging, #Finance, #Lifestyle, #Privacy, #Retirement, #wellness

Regular maintenance is a fact of life and never questioned. Annual physical. Change the oil in your car. Get your furnace checked out. Regular maintenance makes good sense. When is the last time you performed an annual check-up on your own practice? I'll bet it's been longer than a year. That's not good. My guest today works with practices on all manor of operations, and he'll tell us what to include in a practice annual check up. David Zetter is the founder and President of Zetter HealthCare, LLC in Mechanicsburg, PA and has over 24 years of operational and healthcare experience. David is nationally recognized for his speaking, presentations and healthcare business expertise. He is well versed in regulatory requirements, revenue cycle management, credentialing and contracting, compliance, coding and documentation. He is considered an expert on Medicare, not only by his clients, but also through consultant colleagues and healthcare attorneys across the country. David is an expert on ERISA regulations, which protect over 80% of the claims in the US, and he knows how to stop payor recoupments dead in their tracks and what is legal and illegal in many payor contracts. David's firm works with healthcare professional clients and facilities coast to coast, in all areas of practice and facility management. In this episode Carl White and David Zetter discuss: The value of an annual check-up What to focus on when doing an annual practice check-up What David says to owners who say “we check in each month. We're covered.” Want to be a guest on PracticeCare®? Have an experience with a business issue you think others will benefit from? Come on PracticeCare® and tell the world! Here's the link where you can get the process started. Connect with David Zetter https://zetter.com/ https://www.linkedin.com/company/zetter-healthcare/ https://www.linkedin.com/in/djzetter/ Connect with Carl White Website: http://www.marketvisorygroup.com Email:  whitec@marketvisorygroup.com Facebook:  https://www.facebook.com/marketvisorygroup YouTube: https://www.youtube.com/channel/UCD9BLCu_i2ezBj1ktUHVmig LinkedIn: http://www.linkedin.com/in/healthcaremktg

Have a comment or question? Click this sentence to send us a message, and we might answer it in a future episode.Welcome to Season 6, Episode 18 of Winning Isn't Easy. In this episode, we'll dive into How Claimants Accidentally Destroy Their Own Disability Cases.Sometimes the biggest threat to an ERISA disability claim isn't the insurance company - it's the claimant. Missed treatment, inconsistent statements about daily activities, poor documentation, or even filing a lawsuit incorrectly can destroy an otherwise valid case. In this episode, we examine three real disability claims that unraveled because critical rules weren't followed. We explore how gaps in medical care can violate a policy's “regular care” requirement, how everyday activities like travel or golf can be used to undermine allegations of disabling pain, and how procedural mistakes in federal court can lead to dismissal before a case is ever heard. These cases show how insurers scrutinize not only medical conditions, but also credibility, consistency, and compliance with policy requirements. We also discuss why tactics such as careful documentation, ongoing treatment, and experienced legal guidance are often essential to protecting disability benefits under ERISA.In this episode, we'll cover the following topics:One - Why Not Getting Regular Medical Care or Following Treatment Recommendations Can Doom Your Disability Insurance ClaimTwo - Golfing Dooms Chronic Low Back ERISA Disability ClaimThree - Abraham Lincoln Got It Right! Why Representing Yourself in an Insurance Disability Matter Is Never the Right MoveWhether you're a claimant, or simply seeking valuable insights into the disability claims landscape, this episode provides essential guidance to help you succeed in your journey. Don't miss it.Listen to Our Sister Podcast:We have a sister podcast - Winning Isn't Easy: Navigating Your Social Security Disability Claim. Give it a listen: https://wiessdpodcast.buzzsprout.com/Resources Mentioned in This Episode:LINK TO ROBBED OF YOUR PEACE OF MIND: https://mailchi.mp/caveylaw/ltd-robbed-of-your-piece-of-mindLINK TO THE DISABILITY INSURANCE CLAIM SURVIVAL GUIDE FOR PROFESSIONALS: https://mailchi.mp/caveylaw/professionals-guide-to-ltd-benefitsFREE CONSULT LINK: https://caveylaw.com/contact-us/Need Help Today?:Need help with your Long-Term Disability or ERISA claim? Have questions? Please feel welcome to reach out to use for a FREE consultation. Just mention you listened to our podcast.Review, like, and give us a thumbs up wherever you are listening to Winning Isn't Easy. We love to see your feedback about our podcast, and it helps us grow and improve.Please remember that the content shared is for informational purposes only, and should not replace personalized legal advice or guidance from qualified professionals.

Are you drowning in unmanageable debt, trying to outrun compounding interest, or tapping into your future just to make minimum payments? It's time to stop the bleeding and erase the stigma. For decades, the word "bankruptcy" has been buried under a mountain of shame, myths, and misconceptions —but what if it's actually the ultimate financial off-ramp designed to protect you, hit the reset button, and pave the way to true wealth? In this powerful episode, host Scott Carson sits down with Adrienne Hines, a powerhouse bankruptcy attorney with over 30 years of experience. Known widely as the "Ladylike Lawyer," Adrienne is on a mission to bust the biggest myths surrounding bankruptcy and show Americans how to break free from the trap of predatory interest rates. Whether you are a struggling homeowner, an entrepreneur bouncing back from a bad deal, or someone facing uncontrolled medical bills, Adrienne details the exact rules, timelines, and financial safeguards that are built directly into the U.S. Constitution to give you a fresh start. Adrienne drops an absolute masterclass on navigating the legal system, mapping out how the process works on both the consumer and business sides. Learn the distinct differences between a magical Chapter 7 debt wipeout and a strategic Chapter 13 restructuring. Discover how to completely shield your 401(k) and retirement accounts from collectors, and why taking out a debt consolidation loan might actually be the worst move you could make. If you are ready to remove the emotional clutter of financial stress and shift your path toward building actual wealth, this episode is your blueprint. Key Topics Covered:The $10,000 Rule of Thumb: Adrienne breaks down the exact baseline of when it is time to stop guessing and start consulting a professional. Chapter 7 vs. Chapter 13 Demystified: A comprehensive look at the "magical" Chapter 7 wipeout versus a Chapter 13 reorganization plan. The Income Test & Regional Realities: How household income brackets dictate your filing options, with specific real-world examples. Capitalism, Risk, and the Constitution: Why the Founding Fathers codified bankruptcy laws to promote bold risk-taking and avoid debtors' prisons. The Magic of the Automatic Stay: How uploading your petition instantly freezes foreclosures, sheriff sales, and aggressive garnishments. The High-Income Business Owner Loophole: Discover the critical "50% business debt" caveat that lets high earners bypass traditional means testing. The Top 6 Triggers of Bankruptcy: Debunking the overspending myth by outlining the actual structural causes of American financial stress. The 3-2-240 Tax Discharge Secret: The 5 strict, overlapping IRS rules required to legally wipe out back income taxes through bankruptcy. Protecting the Nest Egg: Why your 401(k) and ERISA retirement accounts are 100% safe—and why cashing them out is a critical error. The Timeline to a 720 Credit Score: A realistic look at buying cars and restoring an elite credit profile much sooner than you think. Bankruptcy is not a death sentence; it is a profound legal tool structured to pull you off the predatory compounding interest merry-go-round. The longer you sit in financial misery, the less time you have to fund your retirement or scale your next big business venture. Take personal responsibility by exploring your rights, mapping out a transparent legal solution, and stepping confidently into your financial future. Head over to TheLadylikeLawyer.com to access Adrienne's elite national consumer bankruptcy referral network and start taking action today!Watch the Original VIDEO HERE!Love the show? Subscribe, rate, review, and share!Here's How »Join Note Night in America community today:WeCloseNotes.comScott Carson FacebookScott Carson TwitterScott Carson LinkedInNote Night in America YouTubeNote Night in America VimeoScott Carson InstagramWe Close Notes Pinterest

I wanted to talk to a lawyer 'cause, yeah, lawyers are the ones that see stuff that falls the whole way down to the level of legal action. But I wanted to find out what are the main categories of things that wind up in legal land when it comes to broker or EBC (employee benefit consultant) payment agreements. Like, what are the top ways that compensation agreements go horribly awry? For a full transcript of this episode, click here. If you enjoy this podcast, be sure to subscribe to the free weekly newsletter to be a member of the Relentless Tribe. Doug Aldeen, my guest today, rose to the challenge. And let me just state for the record that, while there are a whole lot of brokers and EBCs who would or do engage in some of these practices, there are also many who do not; and/or it might not be the broker/EBC themselves but the company that they work for who is up to some of the things that we're gonna be talking about in the episode today. But I really, for sure, want to support the gang of honest actors, great fee-based, integrity-based brokers and EBCs; and I wanna support them all day long, many of whom listen to the show and are part of the Relentless Health Value Tribe. But let's talk about how the rent-seeking ones roll so that you can spot them. See what they did there. So, yeah … the first kind of ground zero that Doug and I talk about today is just up-front direct compensation agreements, which may be just ridiculously complicated and/or ridiculously expensive compared to what others are charging for a similar group. Where there's mystery, there is margin. That is so relevant in so many situations, and this is just another one of them. So then, after that, Doug and I move on; and we get into three categories of stuff that sits in that undisclosed or maybe even disclosed zone, where just the whole model of payments is problematic on its face. First up (and this is a biggie), brokers/EBCs recommending rent-seeking solutions to their clients. Like, a broker or EBC suggests a solution to their client where the solution itself makes money on a perverse incentive, and then the broker or EBC gets a piece of that action, which might be called shared savings. So, yeah … even if the dollars to the broker or EBC are disclosed, a naive plan administrator might not see that overcharge for what it really is—and Doug gives a bunch of examples in the show that follows. Chris Deacon (post) and Justin Leader (post) also wrote posts about this. Donovan Pyle wrote a whole book about it. Okay … the next big category of typical payment model methodologies that Doug Aldeen (again, a lawyer) has seen plans get themselves into trouble with their EBCs and brokers—the ones who are sharks, I mean, circling the plan like it's a gold mine—this big category is undisclosed payments from vendors who the plan doesn't realize have a business relationship with the EBC or broker. This can also be a whole basket of solutions that the EBC/broker wants to install, which is basically this problematic payment model at scale. And, right, this matters because then the plan doesn't know if this particular point solution, PBM, stop-loss carrier … Right? They think their broker EBC is recommending it because it's the best option for that particular plan, not understanding that it's the right option for the broker or EBC. And these dollars can be undisclosed because, to a certain extent, the Consolidated Appropriations Act, it's a little bit unclear on certain points. There's some loopholes if you go looking for them because you are so inclined. We get into more detail on this later on. After this, Doug offers a really great roadmap with six steps in it for any plan to really think about as they consider. First, the maybe integrity of their broker or EBC and what is being recommended to the plan. And that's important because, look—and we say this in the conversation that follows, but I'm gonna say it again here loudly—if a plan realizes that their broker or EBC is not really serving the best interest of the plan, there are great options out there. There are great EBCs and brokers who are honest, upstanding that really care about their clients, their plans, their members, and doing the right thing. But telling the difference between the not-so-good ones and the good ones takes some diligence, takes some validation on the part of the plan sponsor. It just does. But the amount of dollars that can be saved is millions, and this is actually, saving those millions is actually better for the plan because it's not like those dollars were going in somebody's pocket. It's not like they were being put toward better, safer, lower premiums. These are dollars that can be cut, and the plan is actually better. My guest today, as I have mentioned at least several times already, is Doug Aldeen, who is a well-known attorney who has spent many years in the self-insured space. This podcast is sponsored by Aventria Health Group, and I do want to give a shout-out and a thanks to our 2026 series underwriter Payerset. Thank you so much for your financial support. That helps keep this podcast on the air. And with that, here is my conversation with Doug Aldeen. Also mentioned in this episode are Chris Deacon, Justin Leader, Donovan Pyle, Mark Cuban, Cost Plus Drugs, Aventria Health Group, Payerset, Cynthia Fisher, Lee Lewis, AJ Loiacono, Dave Chase, Nautilus Health, 32BJ, Andreas Mang, Jon Camire, and Tom Nash. For a list of healthcare industry acronyms and terms that may be unfamiliar to you, click here.   You can learn more on Doug's Web site and by following Doug on LinkedIn.   Doug Aldeen is an Austin, Texas–based Employee Retirement Income Security Act (ERISA) healthcare attorney. From 1997 to 2006, he served both as associate general counsel and general counsel for provider-sponsored HMOs in Champaign-Urbana, Illinois, and San Antonio, Texas. During his tenure at Health Alliance Medical Plans in Urbana, Illinois, he had a front-row seat to the US Supreme Court ERISA case in Pegram v. Herdrich. Since 2007, Doug has owned and operated his own law firm that serves the US self-funded market. In 2016, he served as ERISA counsel for the Berkley Research Group, who served as an advisor to the private equity firm Hellman and Friedman that purchased a majority stake in MultiPlan for $7.5 billion. From 2019 to 2024, Doug served on the government relations committee for the Self-Insurance Institute of America during the period when the Consolidated Appropriations Act was being implemented. In 2022, Doug was featured by KXAN television in Austin in an investigative piece that examined the collection practices of a local hospital. KXAN's investigative work resulted in an Edward Murrow award for public service. For the past 10 years, he has published "The Sunday Morning Bathroom Read" on LinkedIn, which features a weekly tongue-in-cheek review of recent events and the implications to the self-funded market in the US healthcare industry. 00:00 Introduction to this episode. 00:59 A caveat for the record on this episode. 02:11 The first problematic payment model discussed in this week's episode. 03:27 The second problematic payment model discussed in this week's episode. 06:16 The conversation with Doug Aldeen. 06:27 Why is reviewing broker/EBC compensation so important? 08:05 The Ohio Potato Company anecdote. 10:28 The first way brokers/EBCs might get paid. 11:45 What "cost of savings" means. 12:31 EP457 with Cynthia Fisher. 14:07 A rent-seeking solution that requires a cost-benefit analysis. 19:16 Why the broker/EBC is sometimes in the dark about vendor kickbacks. 21:46 Where the CAA is unclear. 22:23 EP508 with Lee Lewis. 22:58 EP379 with AJ Loiacono. 24:04 Actionable advice for plan sponsors. 24:57 The second piece of actionable advice for plan sponsors. 25:22 The third piece of actionable advice for plan sponsors. 26:08 Demystifying the commission structure. 27:35 Using a broker RFP from an open source. 27:54 EP484 with Dave Chase. 28:31 Why you should be auditing data and claims. 29:29 EP478 (Part 1) and EP479 (Part 2) with Andreas Mang and Jon Camire. 31:29 The importance of having an "out." 33:11 Why the broker community may be at substantial risk. 35:30 EP419 with Andreas Mang. Recent past interviews: Click a guest's name for their latest RHV episode! Dr Siva and Dr Monica Lypson, Betsy Seals, Patrick Nelli, Lee Lewis, Stacey Richter with 15 experts (EP507), Jerry DiMaso, Dr Ahilan Sivaganesan, Ryan Jacobs  

#ThisMorning | #Alts & #ERISA #Accountability - #Fiduciary Filter | Knut A. Rostad, The Institute for the Fiduciary Standard | #Tunein: broadcastretirementnetwork.com #Aging, #Finance, #Lifestyle, #Privacy, #Retirement, #wellness

Are you drowning in unmanageable debt, trying to outrun compounding interest, or tapping into your future just to make minimum payments? It's time to stop the bleeding and erase the stigma. For decades, the word "bankruptcy" has been buried under a mountain of shame, myths, and misconceptions —but what if it's actually the ultimate financial off-ramp designed to protect you, hit the reset button, and pave the way to true wealth? In this powerful episode, host Scott Carson sits down with Adrienne Hines, a powerhouse bankruptcy attorney with over 30 years of experience. Known widely as the "Ladylike Lawyer," Adrienne is on a mission to bust the biggest myths surrounding bankruptcy and show Americans how to break free from the trap of predatory interest rates. Whether you are a struggling homeowner, an entrepreneur bouncing back from a bad deal, or someone facing uncontrolled medical bills, Adrienne details the exact rules, timelines, and financial safeguards that are built directly into the U.S. Constitution to give you a fresh start. Adrienne drops an absolute masterclass on navigating the legal system, mapping out how the process works on both the consumer and business sides. Learn the distinct differences between a magical Chapter 7 debt wipeout and a strategic Chapter 13 restructuring. Discover how to completely shield your 401(k) and retirement accounts from collectors, and why taking out a debt consolidation loan might actually be the worst move you could make. If you are ready to remove the emotional clutter of financial stress and shift your path toward building actual wealth, this episode is your blueprint. Key Topics Covered:The $10,000 Rule of Thumb: Adrienne breaks down the exact baseline of when it is time to stop guessing and start consulting a professional. Chapter 7 vs. Chapter 13 Demystified: A comprehensive look at the "magical" Chapter 7 wipeout versus a Chapter 13 reorganization plan. The Income Test & Regional Realities: How household income brackets dictate your filing options, with specific real-world examples. Capitalism, Risk, and the Constitution: Why the Founding Fathers codified bankruptcy laws to promote bold risk-taking and avoid debtors' prisons. The Magic of the Automatic Stay: How uploading your petition instantly freezes foreclosures, sheriff sales, and aggressive garnishments. The High-Income Business Owner Loophole: Discover the critical "50% business debt" caveat that lets high earners bypass traditional means testing. The Top 6 Triggers of Bankruptcy: Debunking the overspending myth by outlining the actual structural causes of American financial stress. The 3-2-240 Tax Discharge Secret: The 5 strict, overlapping IRS rules required to legally wipe out back income taxes through bankruptcy. Protecting the Nest Egg: Why your 401(k) and ERISA retirement accounts are 100% safe—and why cashing them out is a critical error. The Timeline to a 720 Credit Score: A realistic look at buying cars and restoring an elite credit profile much sooner than you think. Bankruptcy is not a death sentence; it is a profound legal tool structured to pull you off the predatory compounding interest merry-go-round. The longer you sit in financial misery, the less time you have to fund your retirement or scale your next big business venture. Take personal responsibility by exploring your rights, mapping out a transparent legal solution, and stepping confidently into your financial future. Head over to TheLadylikeLawyer.com to access Adrienne's elite national consumer bankruptcy referral network and start taking action today!Watch the Original VIDEO HERE!Book a Call With Scott HERE!Sign up for the next FREE One-Day Note Class HERE!Sign up for the WCN Membership HERE!Sign up for the next Note Buying For Dummies Workshop HERE!Love the show? Subscribe, rate, review, and share!Here's How »Join the Note Closers Show community today:WeCloseNotes.comThe Note Clo

What if you could score and rank hundreds of investment funds in mere moments, based on your unique preferences? In this episode of the Registered Investment Advisor Podcast, Seth Greene interviews Eric Smith, J.D., Chairman & CEO of Decision Technologies Corporation, who discusses their patented decision assistant technology, designed to help investment professionals score and rank mutual funds and ETFs. This powerful tool allows advisors to customize 48 performance factors, enabling them to select the best funds for their clients and providing deeper insights than traditional rating systems like Morningstar. Tune in to learn how this innovative software can transform how you evaluate investments, optimize portfolios, and strengthen client relationships. Key Takeaways: → Why investment professionals often struggle to understand how their choices compare across the market. → How Decision Technologies' patented tool helps users score and rank investment funds objectively. → How this tool allows you to create personalized ranking systems tailored to your client's goals. → How real-time ranking allows users to monitor funds and adjust as market conditions change. → Decision Technologies provides a game-changing tool for attracting new clients and managing existing investments more effectively. Eric S. Smith, J.D., is the Chairman, CEO, and Co-Founder of Decision Technologies Corporation (DTC), where he co-invented the company's patented decision-assistance technology. This technology powers DTC's Professional RapidReview Tool (ProRRT) for investment advisors and its Retail Investment Tracking Application (RITA) for individual investors. DTC's transformative technology enables both groups to make informed investment decisions in an increasingly complex financial landscape. Additionally, Mr. Smith serves as President of Trustee Empowerment & Protection, Inc. (TEPI), an SEC-registered investment adviser that helps retirement plan sponsors mitigate risks associated with class-action lawsuits. A licensed institutional investment consultant and attorney with over 22 years of experience in corporate and ERISA law, Eric brings a client-centric perspective to financial services, focusing on empowering individual investors and their advisors. He has spoken at various conferences on fiduciary responsibility, investment decision-making, and the flaws in the financial services marketplace. Connect With Eric: Website: https://decisionengines.tech/ https://prorrt.com/ LinkedIn: https://www.linkedin.com/in/eric-smith-82558710/ Learn more about your ad choices. Visit megaphone.fm/adchoices

Have a comment or question? Click this sentence to send us a message, and we might answer it in a future episode.Welcome to Season 6, Episode 17 of Winning Isn't Easy. In this episode, we'll dive into Why ChatGPT Can't Get Your ERISA Disability Claim Right (and What Actually Works).Let's say you're living with fibromyalgia, chronic fatigue syndrome, postural orthostatic tachycardia syndrome, multiple sclerosis, Parkinson's disease, or recovering from a stroke, and the high-stakes, cognitively demanding job you once handled now feels out of reach. What should you do next? Stop working and file for ERISA disability benefits? Talk to an attorney? Or rely on generalized advice from online tools or AI? In this episode, we examine why one-size-fits-all answers (typically provided by AI) often miss the mark. Disability carriers don't evaluate claims in the abstract, they scrutinize how your specific symptoms translate into functional limitations, especially when cognitive impairment is involved. Drawing on real cases, we break down how insurers assess these conditions, where claimants go wrong, and why incomplete or generic guidance can jeopardize otherwise valid claims. We also explore how an evidence-driven approach, backed by experienced legal guidance, can make the difference between approval and denial. If you're navigating a complex disability claim tied to cognitive or neurological conditions, this episode offers a clearer view of what actually matters, and how to protect your benefits.In this episode, we'll cover the following topics:One - When ChatGPT Gives You the Wrong AnswerTwo - How Disability Carriers Really Evaluate Cognitive Impairment ClaimsThree - The “Own Occupation” Trap and How to Win Your CaseWhether you're a claimant, or simply seeking valuable insights into the disability claims landscape, this episode provides essential guidance to help you succeed in your journey. Don't miss it.Listen to Our Sister Podcast:We have a sister podcast - Winning Isn't Easy: Navigating Your Social Security Disability Claim. Give it a listen: https://wiessdpodcast.buzzsprout.com/Resources Mentioned in This Episode:LINK TO ROBBED OF YOUR PEACE OF MIND: https://mailchi.mp/caveylaw/ltd-robbed-of-your-piece-of-mindLINK TO THE DISABILITY INSURANCE CLAIM SURVIVAL GUIDE FOR PROFESSIONALS: https://mailchi.mp/caveylaw/professionals-guide-to-ltd-benefitsFREE CONSULT LINK: https://caveylaw.com/contact-us/Need Help Today?:Need help with your Long-Term Disability or ERISA claim? Have questions? Please feel welcome to reach out to use for a FREE consultation. Just mention you listened to our podcast.Review, like, and give us a thumbs up wherever you are listening to Winning Isn't Easy. We love to see your feedback about our podcast, and it helps us grow and improve.Please remember that the content shared is for informational purposes only, and should not replace personalized legal advice or guidance from qualified professionals.

Comment on the Show by Sending Mark a Text Message.Are you prepared to fight for your rights when it comes to severance negotiation? In the latest episode of the Employee Survival Guide®, Mark Carey unveils the often-ignored yet crucial skill of negotiating severance packages. Many employees, operating under 'at will' employment, find themselves with limited leverage unless they arm themselves with the right knowledge and tactics. This episode is your essential guide to understanding severance agreements, especially those governed by the Employee Retirement Income Security Act (ERISA), which can unlock specific rights for employees. Throughout this insightful discussion, Mark shares actionable strategies for negotiating severance pay that can make a significant difference in your financial future. He emphasizes the importance of not settling for the first offer, advocating for lump-sum payments, and negotiating mutual non-disparagement clauses that protect your reputation. Understanding the implications of cooperation clauses in severance agreements is vital, especially when they could require you to assist in ongoing litigation without compensation. This episode is packed with legal advice for employees that can empower you to navigate severance negotiations successfully. Mark's insights are designed to equip you with the knowledge needed to advocate for yourself in the workplace. Whether you're dealing with discrimination, retaliation, or simply the challenges of a hostile work environment, understanding your rights can transform your career trajectory. From age discrimination to sexual harassment, knowing how to negotiate effectively can make all the difference. This episode of the Employee Survival Guide® is not just about severance negotiation; it's about empowering employees to take control of their careers and ensure they receive the benefits they deserve. Join us as we delve into the intricacies of severance packages and explore how you can maximize your benefits when leaving a job. With Mark Carey as your guide, you'll learn insider tips for employees that can help you navigate employment law issues and workplace disputes with confidence. Don't miss this opportunity to gain valuable insights into severance negotiation that can help you secure your financial future and protect your rights as an employee. Tune in now to transform your approach to severance negotiation and take the first step towards a more empowered career!  If you enjoyed this episode of the Employee Survival Guide please like us on Facebook, X and LinkedIn.  We would really appreciate if you could leave a review of this podcast on your favorite podcast player such as Apple Podcasts and Spotify. Leaving a review will help other employees find the Employee Survival Guide.  For more information, please contact our employment attorneys at Carey & Associates, P.C. at 203-255-4150, www.capclaw.com.Disclaimer:  For educational use only, not intended to be legal advice. 

In this episode of Friday Fiduciary Five, Eric Dyson talks about the challenges of ERISA fiduciary training, emphasizing the need for meaningful education that moves beyond simple "box-checking" exercises. He highlights the Behavioral Governance Institute's innovative approach to learning, which utilizes a Special Purpose Avatar (SPA) to facilitate interactive, high-retention training.Eric describes a specific scenario in which he used the avatar to assess and sharpen his expertise regarding 408(b)(2) disclosures, benchmarking, and RFPs. By providing scenario-based quizzes and real-time feedback, the avatar ensures a practical, hands-on understanding of complex regulations. Eric encourages service providers and plan committee members to adopt these modernized training methods to better fulfill their fiduciary responsibilities.Connect with Eric Dyson: Website: https://90northllc.com/Phone: 940-248-4800Email: contact@90northllc.com LinkedIn: https://www.linkedin.com/in/401kguy/ The information contained herein is general in nature and is provided solely for educational and informational purposes.It is not intended to provide a specific recommendation of any type of product or service discussed in this presentation or to provide any warranties, financial advice, or legal advice.The specific facts and circumstances of all qualified plans can vary, and the information contained in this podcast may or may not apply to your individual circumstances or to your plan or client plan specific circumstances.The opinions expressed by guests on the Be More Than a Fiduciary podcast are not necessarily the same as the opinions held by 90 North Consulting, or of Executive Director Eric Dyson.

The history of money explains why the financial system works the way it does today. In this episode, Jim and Nick walk through the major shifts that changed the American financial landscape, from the gold standard to fiat currency, the rise of Wall Street retirement plans, and the creation of the MEC line. They unpack how control of capital slowly moved away from individuals and toward governments, banks, and financial institutions. Along the way, they explain why wealthy families continued using whole life insurance while the public was encouraged to move money into qualified plans and market-based products. The conversation also covers universal life insurance, policy efficiency, and why long-term stability matters more than flashy illustrations. Understanding these historical shifts helps explain why Infinite Banking remains relevant for people seeking greater control, liquidity, and long-term certainty. Key Takeaways: - The gold standard placed limits on monetary expansion - Fiat currency accelerated inflation and currency debasement - ERISA and 401(k)s redirected capital toward Wall Street - Whole life insurance remained a core asset for wealthy families - Long-term policy strength matters more than short-term efficiency Chapters 00:00 Lessons From History 02:54 The Gold Standard Explained 05:15 Nixon Ends the Gold Standard 06:39 Fiat Currency and Inflation 07:43 ERISA, 401(k)s, and Wall Street 10:00 The Shift Away From Whole Life Insurance 12:22 Universal Life and Policy Design Risks 14:49 MEC Lines and the 7-Pay Test 19:38 Why Fragile Policies Break Down 21:09 Why Wealthy Families Kept Using Whole Life Insurance ______________________________ If you're ready to breakaway and start making real wealth, then join our free community.  Get access to new daily content, on-demand courses on how money works and Infinite Banking, a Q&A video library, reading library, worksheets, calculators, and more.  

We bring compliance specialist Carol Taylor back to unpack why employers keep getting blindsided by benefit plan obligations like RXDC reporting, PBM disclosures, and fiduciary duties under ERISA. We map the real-world risks, the paperwork traps that cause rejected filings, and the simple audit habits that keep penalties from stacking up. • RXDC reporting basics and why it exists • why employers still miss RXDC years later • where legal responsibility lands even when vendors file • practical steps for HIOS access and employer uploads • CAA 2026 expansion of PBM disclosure and rebate rules • what PBM transparency can reveal about pricing and compensation • ERISA fiduciary exposure for employers and individual decision-makers • how advisors draw boundaries to avoid functional fiduciary status • renewed ACA employer mandate enforcement around 1094 and 1095 filings • why a mental health parity enforcement pause does not remove MAPEA duties • ongoing No Surprises Act IDR problems and cost impacts • using a compliance audit checklist and reviewing E&O coverage limits 

Have a comment or question? Click this sentence to send us a message, and we might answer it in a future episode.Welcome to Season 6, Episode 16 of Winning Isn't Easy. In this episode, we'll dive into When Insurance Companies Get It Wrong (and Sometimes Lose).Insurance companies often claim they're just “following the plan” when denying disability benefits. But in many ERISA cases, the real dispute isn't whether someone is disabled, it's how the insurer interprets the evidence, which medical opinions it chooses to credit, and how far it will go to defend a denial once it's made. From surveillance footage that captures only moments of activity to peer reviews that dismiss extensive medical records, disability carriers frequently rely on selective evidence and insurer-retained experts to justify cutting off benefits. In this episode, we examine three real cases where federal courts scrutinized those tactics. We explore how insurers used surveillance to terminate Long-Term Disability payments, rejected claims involving cognitive dysfunction and dysautonomia despite significant documentation, and relied on medical opinions built on assumptions that weren't supported by the record. Along the way, we break down how ERISA's deferential standard shapes these disputes, why courts sometimes find insurer decisions arbitrary or inconsistent, and what these rulings reveal about the strategies carriers use during claim reviews. If you're pursuing Short- or Long-Term Disability benefits, this episode offers a closer look at how denial decisions are defended, and what can happen when a court concludes the insurer got it wrong.In this episode, we'll cover the following topics:One - How Physical Therapy Notes Prompted Surveillance and How Hartford Used Surveillance Against a Disability Policyholder Who Suffered Chronic PainTwo - Cognitive Dysfunction, Fatigue, and Dysautonomic Symptoms as a Result of COVID Vaccination Results in Disability Benefit LitigationThree - How Appalachian Regional Health Care Wrongfully Denied a Disability Retirement Claim and What One Federal Judge Had to SayWhether you're a claimant, or simply seeking valuable insights into the disability claims landscape, this episode provides essential guidance to help you succeed in your journey. Don't miss it.Listen to Our Sister Podcast:We have a sister podcast - Winning Isn't Easy: Navigating Your Social Security Disability Claim. Give it a listen: https://wiessdpodcast.buzzsprout.com/Resources Mentioned in This Episode:LINK TO ROBBED OF YOUR PEACE OF MIND: https://mailchi.mp/caveylaw/ltd-robbed-of-your-piece-of-mindLINK TO THE DISABILITY INSURANCE CLAIM SURVIVAL GUIDE FOR PROFESSIONALS: https://mailchi.mp/caveylaw/professionals-guide-to-ltd-benefitsFREE CONSULT LINK: https://caveylaw.com/contact-us/Need Help Today?:Need help with your Long-Term Disability or ERISA claim? Have questions? Please feel welcome to reach out to use for a FREE consultation. Just mention you listened to our podcast.Review, like, and give us a thumbs up wherever you are listening to Winning Isn't Easy. We love to see your feedback about our podcast, and it helps us grow and improve.Please remember that the content shared is for informational purposes only, and should not replace personalized legal advice or guidance from qualified professionals.

Jim and Chris discuss listener emails on IRMAA appeals, Social Security survivor benefits, a Venn Diagram PSA, Roth IRA spousal rollover and the five-year rule, and Rollover IRA protections. (8:15) A listener asks whether their parents should appeal an IRMAA surcharge—triggered by a one-time annuity payout—on the basis of loss of pension income. (17:15) George asks how a serious health diagnosis may affect his Social Security strategy, including whether his wife should claim on her own record now and delay survivor benefits until he would have reached age 70. (35:30) A listener shares a Venn Diagram PSA 38:15) The guys hear from someone who used spousal rights to roll his late wife’s Roth 401k into his own Roth IRA, and wants to know whether doing so reset the five-year clock on her previously qualified funds. (54:00) Jim and Chris address whether the ERISA protections of 401k and 403b plans are reason enough to avoid rolling them into IRAs, and whether an umbrella insurance could offer additional Rollover IRA protections. The post IRMAA, Social Security, Roth 5-Year Rule, Rollover IRA Protections: Q&A #2619 appeared first on The Retirement and IRA Show.

Susie Injijian was running out of resources and out of time. She had put a few hundred thousand dollars into the premises liability case, got some litigation funding, and invested most of her retirement savings to bring it to trial. Tune in as she and host Dan Ambrose break down the complex case that dragged on from 2018, with two trials, until July 3, 2023, when it all paid off with a jury verdict of $25.5 million. “It was career-changing for me. I mean, my dreams came true because of it, and that's no exaggeration,” she says.Train and Connect with the Titans☑️ Susie Injijian | LinkedIn☑️ Injijian Law Office☑️ Trial Lawyers University☑️ TLU On Demand Instant access to live lectures, case analysis, and skills training videos☑️ TLU on X | Facebook | Instagram | LinkedIn☑️ Subscribe Apple Podcasts | Spotify | YouTube2026 Programming☑️ Turning Witness Testimony into an Experience for the Jury, May 8 - 9, Hermosa Beach, CA☑️ TLU Beach, June 3-6, Huntington Beach, CAEpisode SnapshotSusie is the mother of TLU coach Georgio Injijian, whom she brought on to co-try the case after her original co-counsel abandoned ship in early 2022 with trial set for October.Susie's client, an electrician, suffered severe burn injuries on his right arm when a fuse he was changing at an industrial property exploded in his hand.Susie took the case right before the statute of limitations, filed a cross complaint against the property owner and tenant, and financed it herself.The first trial in October 2022 ended in a mistrial after a defense lawyer claimed a family emergency mid-jury selection. The defense offered $600,000 to settle. Susie rejected it.After the mistrial, Susie attended TLU Live in Las Vegas, connected with a jury consultant, and went to trial in April 2023.During trial, the defense was caught running an unauthorized shadow jury — a demographically matched group secretly watching the Zoom feed. The judge offered a mistrial, but Susie declined because the case was going well.Susie waived $450,000 in specials (medical bills subject to an ERISA lien and lost wages) to avoid anchoring the jury low and instead builtan entirely non-economic damages case.On July 3, 2023, the jury delivered a $25.5 million verdict after a day and a half of deliberations.Post-verdict, the defense brought a motion for a new trial. At that point, she had the total judgment at over $33 million. The defense asked to go to mediation; Susie said “no.”Produced and Powered by LawPods

The Nurses Report on America Out Loud with Ashley Caputo, RN, FMP – This episode of The Nurses Report explores how Pharmacy Benefit Managers shape access to medications, often leading to delays and denials. It examines carve-outs, ERISA limits, and real patient impacts while highlighting the growing need for transparency, advocacy, and patient-centered decision-making in today's healthcare system...

The Nurses Report on America Out Loud with Ashley Caputo, RN, FMP – This episode of The Nurses Report explores how Pharmacy Benefit Managers shape access to medications, often leading to delays and denials. It examines carve-outs, ERISA limits, and real patient impacts while highlighting the growing need for transparency, advocacy, and patient-centered decision-making in today's healthcare system...

In this episode of Friday Fiduciary Five, Eric Dyson talks about the top five potential risks and considerations for ERISA plan fiduciaries in light of proposed guidance from the Department of Labor's Employee Benefits Security Administration (EBSA). He emphasizes that Safe Harbor is not a shield but a presumption, requiring ongoing monitoring and documentation.Connect with Eric Dyson: Website: https://90northllc.com/Phone: 940-248-4800Email: contact@90northllc.com LinkedIn: https://www.linkedin.com/in/401kguy/ The information contained herein is general in nature and is provided solely for educational and informational purposes.It is not intended to provide a specific recommendation of any type of product or service discussed in this presentation or to provide any warranties, financial advice, or legal advice.The specific facts and circumstances of all qualified plans can vary, and the information contained in this podcast may or may not apply to your individual circumstances or to your plan or client plan specific circumstances.The opinions expressed by guests on the Be More Than a Fiduciary podcast are not necessarily the same as the opinions held by 90 North Consulting, or of Executive Director Eric Dyson.

When it comes to the law, the reflex is to say “I just want to stay out of trouble.” Of course you do, but can the law ever be your friend? Yes it can, especially if you know it better than the guy on the other side of the table. My guest today is an expert on ERISA, a law that is quite broad and applies to practices almost daily. He helps his clients apply ERISA to their benefit, and he'll give us a few tips on this episode. David Zetter is the founder and President of Zetter HealthCare, LLC in Mechanicsburg, PA and has over 24 years of operational and healthcare experience. David is nationally recognized for his speaking, presentations and healthcare business expertise. He is well versed in regulatory requirements, revenue cycle management, credentialing and contracting, compliance, coding and documentation. He is considered an expert on Medicare, not only by his clients, but also through consultant colleagues and healthcare attorneys across the country. David is an expert on ERISA regulations, which protect over 80% of the claims in the US, and he knows how to stop payor recoupments dead in their tracks and what is legal and illegal in many payor contracts. David's firm works with healthcare professional clients and facilities coast to coast, in all areas of practice and facility management. In this episode Carl White and David Zetter discuss: ERISA – its definition and scope, and the role of a fiduciary How practice owners can invoke ERISA to fight health insurance carriers 1) on systematic denials, 2) when the carrier is negligent, and 3) if a dispute goes to court How to fight an ERISA dispute related to a denial or underpayment Want to be a guest on PracticeCare®? Have an experience with a business issue you think others will benefit from? Come on PracticeCare® and tell the world! Here's the link where you can get the process started. Connect with David Zetter https://zetter.com/ https://www.linkedin.com/company/zetter-healthcare/ https://www.linkedin.com/in/djzetter/ Connect with Carl White Website: http://www.marketvisorygroup.com Email:  whitec@marketvisorygroup.com Facebook:  https://www.facebook.com/marketvisorygroup YouTube: https://www.youtube.com/channel/UCD9BLCu_i2ezBj1ktUHVmig LinkedIn: http://www.linkedin.com/in/healthcaremktg

Jim and Chris discuss listener emails on Social Security benefits for a family with a disabled adult child, survivor benefits, ERISA vs. non-ERISA 403(b) protections, a listener PSA on Monte Carlo simulations, special needs trusts, and how a revocable living trust handles a primary home transfer. (5:00) A listener asks whether her husband’s early Social Security filing while still working would suspend her child-in-care benefits, and whether his benefit would be recalculated to his Full Retirement Age amount once the earnings limit no longer applies. (20:20) George wonders whether survivor benefits for his wife would be based on his age-70 amount or her Full Retirement Age amount. (25:15) Jim and Chris take a question about the differences between ERISA and non-ERISA 403(b) protections, and whether state IRA protections offer comparable coverage. (39:45) The guys share a listener PSA pointing them to a recent Retirement Answer Man episode on Monte Carlo simulations. (44:00) Georgette enquires which assets belong in a special needs trust and how to structure it tax-efficiently. (54:45) A listener asks how a primary home transfers to children through a revocable living trust and what the selling process looks like. The post Social Security, ERISA, Trusts: Q&A #2616 appeared first on The Retirement and IRA Show.

This episode exposes the misleading language behind “best interest” financial sales practices, using the insurance-backed fight against the Department of Labor's fiduciary rule as the main example. Don and Tom explain why rolling money from a 401(k) or 403(b) into an IRA can leave investors vulnerable to commissions, conflicts, vague disclosures, and expensive products dressed up as advice. They break down the difference between true fiduciary advice, so-called best-interest standards, and bare-minimum suitability, then answer listener questions on pension-heavy asset allocation, Delaware Statutory Trusts, and why some seemingly clever planning ideas are often more trouble than they're worth.0:00 “Federation of Americans for Consumer Choice” irony and setup0:52 Fiduciary rule battle with the Department of Labor (and why it keeps dying)1:43 Who's really behind the “consumer choice” push (insurance industry)2:41 Why retirement rollovers (401k → IRA) are the financial “wild west”3:13 $841B rollover stat and loss of ERISA protections4:34 Who actually operates under a true fiduciary standard5:14 Why rollovers require serious skepticism (fees, conflicts, hidden costs)6:10 Form BI and the illusion of “best interest”7:09 Insurance “best interest” rules and the loophole problem8:23 Disclosure theater: legal cover vs real transparency9:40 What a fiduciary does NOT guarantee (returns, cost, communication)10:47 Why even fiduciaries can be expensive10:58 The three standards explained: fiduciary vs best interest vs suitability12:02 “It's not terrible” — the low bar of suitability13:03 Advice vs sales pitch: how most investors get fooled13:38 Listener case: pension-heavy early retirement plan17:18 Pension as “bond substitute” debate19:08 Portfolio breakdown and fund choices (Vanguard, Avantis)20:55 Simplicity vs complexity across multiple accounts21:58 Risk reduction suggestion despite strong financial position24:13 Delaware Statutory Trusts (DSTs): tax deferral vs massive fees25:59 DST downsides: illiquidity, lack of control, high commissions26:29 Bottom line on DSTs: “pay your taxes and move on”27:12 Listener suggestion: “Can I afford it?” segment27:50 Why personalized affordability segments are impractical29:37 Show longevity discussion and future timeline31:11 Financial Physics book plug (Kindle version now available)Questions? Comments? Click!