Fontaine v. Metropolitan Life Insurance Company

DeBofsky Sherman Casciari Reynolds won a landmark decision in Fontaine v. Metro. Life Insurance Company, which upheld a challenge to the Illinois Insurance Regulation barring health and disability insurance companies from incorporating provisions in their policies that would trigger an “arbitrary and capricious” standard of court review – 50 Ill. Admin. Code § 2001.3. The court ruled the regulation was “saved” from preemption under ERISA and that the regulation not only applied to the insurance policy, but also invalidated other benefit plan provisions intended to evade the insurance regulation. The result was that the disability benefit denial at issue in the case had to be evaluated under the de novo standard of judicial review and that the lower court ruling in favor of Fontaine was upheld.