ERISA Standard of Review

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Changed definition halts disability benefits

A production supervisor for an engineering company sought disability benefits after aggravating a back injury when he fell down a flight of stairs. Plaintiff Alfredo Ruiz applied for benefits from Continental Casualty Co. and submitted certification from his attending physician, who reported that due to physical limitations, Ruiz ”may not work.” Additional records were later […]

Case guidelines not meant as rigid formula that dictates outcome

A recent ruling from the 1st U.S. Circuit Court of Appeals upheld an insurance company’s denial of health-care benefits for psychiatric treatment. Although the underlying facts are compelling, the most interesting aspect of the ruling was the court’s discussion of civil procedure and judicial standards of review under the Employee Retirement Income Security Act. The […]

When can a Social Security determination be admitted into evidence in an ERISA long-term disability benefit case?

Because federal courts generally consider the scope of their review of an ERISA benefit denial as being limited to review of a record, what happens if significant material evidence such as a Social Security determination becomes available only after the claim appeals are exhausted. If the standard of judicial review is arbitrary and capricious, it […]

Finding conflicts of interest

A recent case involving the FedEx disability program, Mason v. Federal Express Corp., 2016 WL 706163 (D. Alaska February 22, 2016), illustrated how exposure of conflicts of interest in a claim determination affects a court’s review of the evidence. The case involved Maurice Mason, a FedEx employee who suffered from an auto-immune disorder known as […]