ERISA Standard of Review

Deferential Review Process Needs Fair Standards

by Mark Debofsky | Jan 18, 2012 | ERISA Standard of Review

Should courts be giving deference to benefit decisions made by insurance companies? Although the U.S. Supreme Court ruled in Firestone Tire v. Bruch, 489 U.S. 101 (1989), that deference was permissible in Employee Retirement Income Security Act (ERISA) benefit claims disputes, the court pointed out that the default standard of adjudication should be de novo, which means a court weighs the evidence afresh and gives equal consideration to both plaintiff and defendant.

A lesson: Don’t overlook other sources of evidence

by Mark Debofsky | May 6, 2011 | Disability Benefits, ERISA Standard of Review

In many Employee Retirement Income and Security Act (ERISA) cases, the standard of review applied by a court is often the key factor in determining the outcome of a dispute over disability cases. Such cases often involve conflicting medical opinions and, where the insurer has properly reserved discretionary authority, it almost always wins the battle […]

The standard of review can affect application of offsets

by Mark Debofsky | Jul 12, 2010 | ERISA Standard of Review, Offsets to Disability Benefits

Two recent district court rulings ,Day v. AT&T Disability Income Plan, 2010 U.S.Dist.LEXIS 61477 (N.D.Cal. June 8, 2010) and Riley v. Sun Life and Health Assur.Co., 2010 U.S.Dist.LEXIS 61881 (D.Neb. June 18, 2010), starkly illustrate how the standard of review in ERISA cases can dramatically impact the application of offsets against benefits payable. In both […]

A split in the circuits exists for ERISA benefit disputes

by Mark Debofsky | Feb 1, 2010 | ERISA Standard of Review, Pain and Disability

A recent ruling from the 1st Circuit illustrates a marked disparity between how different federal circuits adjudicate ERISA claims. In Richards v. Hewlett-Packard Corp., 2010 U.S.App.LEXIS 1010 (1st Cir., Jan. 19), the plaintiff, Edward Richards, who worked for Digital Equipment Corporation from 1984 to 1991 as a software engineer, became disabled at age 39 due […]

Applying deferential standard of review in evaluating claims

by Mark Debofsky | Dec 21, 2009 | ERISA Standard of Review

In McGahey v. Harvard University Flexible Benefits Plan, 2009 U.S.Dist. LEXIS 115364 (D.Mass. Dec. 11, 2009), the court wrestled with how to apply a deferential standard of review in evaluating a claim for disability benefits. The plaintiff, Rosemary McGahey, who had worked as the director of residential dining at Harvard University, injured her right knee when she slipped on ice while at work in February 2004.

Battle over standard of review likely to continue

by Mark Debofsky | Nov 2, 2009 | ERISA Standard of Review

Earlier this year, I wrote about a significant ruling issued by the 6th U.S. Circuit Court of Appeals, American Council of Life Insurers v. Ross, 558 F.3d 600 (March 18) (“Discretionary clauses under heavy fire, Chicago Daily Law Bulletin April 6). Ross upheld the authority of states to ban clauses in insurance policies that give insurers discretion to decide health and disability claims and thus trigger a deferential standard of court review over such claims.