Standard of Review

:: District Court Holds That Procedural Conflict Results In Expanded Discovery Rights

Two types of potential conflicts can be alleged by a plaintiff, a structural conflict or a procedural conflict. “The structural inquiry focuses on the financial incentives created by the way the plan is organized, whereas the procedural inquiry focuses on how the administrator treated the particular claimant.” Post, 501 F.3d at 162. A structural conflict …

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:: New Jersey Insurance Regulation Restricting Discretionary Clauses Fails To Affect ERISA Standard Of Review

Evans makes several other claims, none of which merit fulsome analysis. Evans points to a New Jersey regulation that discretionary clauses are void as contrary to public policy, but the regulation is only applicable as of January 1, 2008, and only prohibits those provisions that claim to reserve sole discretion to the carrier. See N.J. …

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:: 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 at least some of its medical file reviewers that DeLisle was “terminated for cause.” But that is not what Krandall …

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:: After The Finding Of Conflict: How Should Conflicts Of Interest Affect ERISA Judicial Review?

In a recent law review article, I predicted that the level of review of the administrative record after Glenn will vary based upon judicial temperament.   “The Debate Over Deference In The ERISA Setting – Judicial Review Of Decisions By Conflicted Fiduciaries“, 54 South Dakota Law Review 1 (2009).    The Sixth and Fourth Circuit Courts of Appeals …

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:: Sixth Circuit Upholds Michigan’s Discretionary Clause Ban

In  American Council Of Life Insurers v. Ross, No. 08-1406 (March 19, 2009), the Sixth Circuit sustained Michigan’s ban on discretionary clauses against an ERISA preemption challenge, finding that the ban was within ERISA’s savings clause as a permissible state regulation of insurance.  The case is posted here.

:: Eighth Circuit Requires Evaluation Of Conflict Factor As A Tiebreaker

Here the district court concluded Standard was operating under a conflict of interest, but found Hackett failed to prove a serious breach of fiduciary duty. Accordingly, the conflict of interest was not a factor in the district court’s review of Standard’s decision denying benefits. In light of the Supreme Court’s intervening decision in Metropolitan Life …

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:: 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 U.S.C. § 1132(a)(1)(B) should apply a deferential abuse of discretion standard of review across the board and consider any conflict …

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:: First Circuit Vacates District Court Opinion For Post-Glenn Analysis

his appeal has generated thorny questions involving the appropriate standard of judicial review under the Employee Retirement Income Security Act (ERISA), 29 U.S.C. §§ 1001-1461. It is now before us for a second time. Our initial encounter produced a proliferation of views: three separate opinions from the three panelists, each of which grappled with the methodological problem facing …

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:: 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 is no indication that any of the review team was a health care professional, and there is no indication what …

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