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 …

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

:: 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. …

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

:: 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 …

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

:: 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Accordingly, we find that, in light of Glenn, our “sliding scale” approach is no longer valid.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 …

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

:: 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 …

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

:: Eleventh Circuit Affirms Benefit Denial Under “Multi-Step” Analysis

This court uses a multi-step analysis to guide these reviews of Administrator decisions and the various standards of review. HCA Health Services of Georgia, Inc. v. Employers Health Ins. Co., 240 F.3d 982, 993-95 (11th Cir. 2001). The analysis involves six steps: (1) Apply the de novo standard to determine whether the claim administrator’s benefits-denial …

:: Eleventh Circuit Affirms Benefit Denial Under “Multi-Step” Analysis Read More »

:: Seventh Circuit Rejects “Multi-Factored” Approach In Evaluating Conflict In Vesting Dispute

When a payment of benefits comes out of the plan administrator’s pocket, the administrator has an incentive to resolve a close case in favor of a denial of benefits. . . In any event, a majority of the Supreme Court Justices consider the potential conflict of interest of a plan administrator (or its staff) serious …

:: Seventh Circuit Rejects “Multi-Factored” Approach In Evaluating Conflict In Vesting Dispute Read More »

:: Ninth Circuit Upholds Ban Of Discretionary Clauses

[Regarding discretionary clauses,] the Commissioner’s practice is “specifically directed toward entities engaged in insurance,” Kentucky Ass’n, 538 U.S. at 342, and it “substantially affect[s] the risk pooling arrangement between the insurer and the insured,” more so than other laws which have been upheld by the Supreme Court. The practice of disapproving discretionary clauses is thus …

:: Ninth Circuit Upholds Ban Of Discretionary Clauses Read More »

:: Plan Administrators Cannot Invoke “SPD Prevails” Rule To Cure Plan Language Deficiencies

Here, there are no terms in the plan which allow it to be amended by inserting into the SPD such critical provisions as the administrator’s discretionary authority to interpret the plan or to determine eligibility for benefits. Indeed, this particular plan wholly fails to comply with § 1102(b)(3)’s requirement to include a procedure governing amendment …

:: Plan Administrators Cannot Invoke “SPD Prevails” Rule To Cure Plan Language Deficiencies Read More »