Archive for the ‘MetLife v. Glenn’ Category

From The Bench – The Self-Insurer Volume 26* August 2009

By John H. Eggertsen, Esq. and Michael Friedman, Esq.

II. Fifth Circuit Rejects Benefit Decision For Procedural Defects; Can’t Even Assess If Determination was Arbitrary And Capricious

In Lafleur v. Louisiana Health Service Indemnity Company, d/b/a Blue Cross Blue Shield of La., 563 F.3d 148 (5th Cir. 2009), the Fifth Circuit found that Blue Cross Blue Shield of Louisiana (”BCBSL”) was so deficient in its substantive compliance with ERISA’s procedural regulations that it could not even express an opinion as to whether the determination was arbitrary and capricious. Read more

From The Bench – The Self-Insurer Volume 26* August 2009

By John H. Eggertsen, Esq. and Michael Friedman, Esq.

After the U.S. Supreme Court’s recent decision in Metropolitan Life Ins. Co. v. Glenn ___ U.S.___, 128 S. Ct. 2343 (2008), many circuit courts have been applying a magnifying glass to their prior standard of review decisions, and making whatever adjustments they feel are necessary in light of this most recent guidance. We have discussed some of those cases in the past, and may do so again if circumstances warrant. In this discussion, however, we turn to a notable trend that had been emerging pre-Glenn, is continuing unabated and may be accelerating post-Glenn – that trend is the tendency of the courts to examine in greater detail the actual evidence on which claims determinations are based and the administrators’ rationales for making their determinations based on that evidence. Even under an arbitrary and capricious standard of review, generally held to be the most deferential standard, the courts are more willing to take the administrators’ word at face value. In addition, courts are scrutinizing claim determinations with an eye towards ERISA’s procedural requirements, and striking down those that fail to comply. The two cases discussed here are clear evidence of both these trends. Read more

From the August 20, 2009 EBIA Weekly[Fischer v. Liberty Life Assurance Co. of Boston, 2009 WL 2366115 (7th Cir. 2009); Raybourne v. Cigna Life Ins. Co. of N.Y., 2009 WL 2392788 (7th Cir. 2009)]

The Seventh Circuit has decided a pair of LTD benefit cases that consider the impact of the U.S. Supreme Court’s Glenn decision. That case held that if an ERISA plan document gives a plan decisionmaker “discretionary” authority to make benefit decisions, those decisions are entitled to deferential review (i.e., they may be overturned by the courts only if they are arbitrary and capricious) even if the decisionmaker has a conflict of interest. The conflict is just one of the factors that must be considered when implementing deferential review. (See our article on Glenn at http://www.ebia.com/WeeklyArchives/ERISA/CourtCases/19423, and articles on other post-Glenn decisions at http://www.ebia.com/WeeklyArchives/ERISA/CourtCases/19769 and http://www.ebia.com/WeeklyArchives/ERISA/CourtCases/19756 (subscription required).) The Seventh Circuit cases summarized below illustrate how different underlying facts affect the Glenn analysis. Read more

The number of cases that apply the Supreme Court’s opinion in Metropolitan Life Insurance Company v. Glenn, 128 S. Ct. 2343 (2008) , when reviewing a decision to deny employee benefits by an administrator with a conflict of interest, continue to grow. The most recent example is Raybourne v. Cigna Life Insurance Company of New York, No. 08-2754 (7th Cir. 2009), where the plaintiff was a participant in his employer’s long-term disability benefits plan. Read more

[Denmark v. Liberty Life Assurance Co. of Boston, 2009 WL 1219438 (1st Cir. 2009)] For a copy:http://http://www.ca1.uscourts.gov/cgi-bin/getopn.pl?OPINION=05-2877P.01A

The First Circuit has reviewed its analysis of the standard of review applicable in ERISA benefits litigation and found the need for only modest refinements in light of the U.S. Supreme Court’s Glenn decision. Read more

Estate of Schwing v. Lilly Health Plan, 2009 WL 989114 (3rd Cir. 2009)

The circuit courts continue to address the U.S. Supreme Court’s Glenn decision on the standard of review applicable in ERISA benefits litigation. The more deferential standard applies if the plan document gives the plan decision maker “discretionary” authority to make benefit decisions. In Glenn, the Supreme Court held that a decision maker’s conflict of interest does not change the standard of review, but must be considered as a factor when applying the abuse of discretion standard. Read more

The Ninth Circuit, in Daic v. Hawaii Pacific Health Group Plan for Employee of Hawaii Pacific Health, No. 06-17324, 2008 WL 3862074 (9th Cir. Aug. 13, 2008) analyzed whether MetLife, the insurer who administered the ERISA plan but was not a specifically names fiduciary, was nonetheless a plan fiduciary and whether, in light of Glenn the district court erred by inadequately considering MetLife’s structural conflict of interest. Read more

The Supreme Court held in MetLife vs. Glenn that conflicted interests require a higher standard of review whenever the claims adjudicator and the claims financier were the same.  Thus, any claim contested in court will confer a significant advantage to the arrangement where the claims are adjudicated by an independent third party and paid by an independent employer.  This means a disadvantage where the claims are both adjudicated and paid by the same two parties, such as employer’s self-administered and self-funded plan or fully insured plans. Read more