In Ariana M v. Humana Health Plan of Texas, Inc., 2018 WL 1096980 (5th Cir. March 1, 2018), a divided Fifth Circuit issued an en banc ruling that fiinally overturned Pierre v. Conn. Gen. Life Ins. Co., 932 F.2d 1552 (5th Cir. 1991) and concurred with every other Circuit that Firestone Tire & Rubber Co. v. Bruch, 489 U.S. 101 (1989) applies the default de novo standard of judicial review to both legal and factual determinations, thus paving the way for the Texas ban on discretionary clauses (TEX. INS. CODE § 1701.062(a), along with similar bans by 25 other states - Nat'l Ass'n of Ins. Comm'rs, Prohibition on the Use of Discretionary Clauses Model Act ST-42-3-6 (2014), http://www.naic.org/store/free/MDL-42.pdf.) to trigger de novo review of benefit denials of health and disability benefit claims.
The Employee Benefits Security Administration of the U.S. Department of Labor has issued final regulations published in the Federal Register on December 19, 2016 (81 Fed. Reg. 92316) relating to disability benefit claims governed by ERISA.Proposed regulations were initially published for comment on November 18, 2015 at 80 Fed.Reg. 72014; and after considering over 100 comments, the proposed regulations were modified into a final form in order to "promote fairness and accuracy in the claims review process and protect participants and beneficiaries in ERISA-covered disability plans by ensuring they receive benefits that otherwise might have been denied by plan administrators in the absence of the fuller protections provided by this final regulation. The final rule also will help alleviate the financial and emotional hardship suffered by many individuals when they are unable to work after becoming disabled and their claims are denied."
You have likely heard of the Employee Retirement Income Security Act (ERISA) that establishes minimum standards for pension plans in private industry. But, do you know anything about the agency that manages it? To best understand ERISA, it is important to know the history and structure of the agency that manages it.
The ubiquity of forum selection clauses which mandate that disputes over benefits be litigated in locations inconvenient to most workers is undermining ERISA. It has increasingly become a problem for employees who have claims under their employer's benefit plans that, instead of being able to seek redress where they live, have to travel hundreds, if not thousands, of miles to litigate these cases.
Since the Supreme Court's ruling in Heimeshoff v. Hartford Life & Acc.Insur.Co., 134 S.Ct. 604 (December 16, 2013), which held that contractual limitations periods established by ERISA-governed employee benefit plans are enforceable, there has been much confusion about when such limitations periods commence and when they end. A recent ruling from the U.S. Court of Appeals for the First Circuit has gone a long way in easing that confusion.