The standard of judicial review utilized in cases brought under the Employee Retirement Income Security Act (ERISA) is critical and may even be outcome-determinative. The parties often vehemently assert their positions in litigation, with the plaintiffs strenuously claiming the right to a de novo standard of judicial review, while the defendants argue just as forcefully for a deferential standard.
The Employee Retirement Income Security Act is so pervasive in its scope that it broadly pre-empts all state laws that relate to employee benefit plans. However, ERISA pre-emption is extremely complex, and it has provoked more than a dozen Supreme Court cases that have examined the breadth of ERISA pre-emption in a number of ways. […]
A recent decision by the 6th U.S. Circuit Court of Appeals presented a checklist of issues that were found to have demonstrated arbitrary and capricious conduct in the denial of disability benefits. The case of Shaw v. AT&T Umbrella Plan No. 1, 2015 WL 4548232 (6th Cir. July 29), involved Raymond Shaw, a 39-year-old customer […]
On December 1, 2014, the U.S. Court of Appeals heard oral argument in the case of Mary C. Fontaine v. Metropolitan Life Insurance Company. The issue before the court was whether an Illinois insurance regulation banning discretionary clauses in health and disability insurance policies survives ERISA preemption claims. The lower court ruled in Fontaine’s favor. […]
In Cerone v. Reliance Standard Life Ins.Co., 2014 U.S.Dist.LEXIS 46529 (S.D.Cal. March 28, 2014), after the plaintiff’s accidental death claim based on the death of her husband was denied and her appeal exhausted, Debra Cerone filed suit against Reliance Standard Life Insurance Company. The issue decided in this opinion was whether the de novo or abuse of discretion standard of review applied.
From time to time we comment on court opinions relevant to disability insurance and ERISA litigation – Gerhardt v. Liberty Life Assur.Co. of Boston, 2013 U.S.App.LEXIS 23912 (8th Cir. November 29, 2013)(Issue: Independent Medical Examinations; Transferable skills analysis). Lisa Gerhardt, a nurse, applied for disability benefits from her employer’s group long-term disability insurance company in […]