:: Disclaimer Shields Claims Administrator From Mispresentation Claims

Tenet alleges that it provided approximately $ 241,000 worth of medical services to Sylvester based on UniCare’s representation that Sylvester was covered under the Plan. . . .  Pursuant to the Managed Care Agreement, UniCare …

:: Ninth Circuit Requires Application Of Normal Summary Judgment Rules In Benefits Denial Review

We conclude that a district court must apply the traditional rules of summary judgment when examining evidence outside of the administrative record in an ERISA case, including the requirement that the evidence must be viewed …

:: Sixth Circuit Applies Met Life v. Glenn Factors To Overturn ERISA Disability Benefit Denial

Here, DeLisle offers more than conclusory allegations of bias. Five of the six file reviewers Sun Life relied on were under regular contract with Sun Life. The record reveals that Sun Life’s in-house attorney told …

:: Third Circuit Abandons “Sliding Scale” Approach In Judicial Review of ERISA Benefit Denials

Accordingly, we find that, in light of Glenn, our “sliding scale” approach is no longer valid. Instead, courts reviewing the decisions of ERISA plan administrators or fiduciaries in civil enforcement actions brought pursuant to 29 …

:: District Court Applies Tenth Circuit Weber Opinion In Affirming Benefit Denial

Although Plaintiff does not address whether Defendant’s conflict of interest influenced its decision, Plaintiff argues in its motion for summary judgment that Defendant failed to provide a full and fair hearing. Plaintiff states that there …

:: Fiduciary Exception Eclipses ERISA Fiduciary’s Claim Of Attorney Client Privilege

As applied by the courts in cases brought under ERISA, the “fiduciary” exception to the attorney-client privilege “comes into play when . . . the administrator for an ERISA plan invokes the attorney-client privilege against …

:: District Court Holds That Potential Claim For Benefits Forecloses Other ERISA Relief

On September 13, 2006, Mr. Tebbetts consulted with a doctor because he was experiencing pain in his abdomen, and the doctor ordered a CT scan of Mr. Tebbetts’ abdomen. The doctor sought pre-approval from Defendants …