For the second week in a row, no case stood out as the case of the week. Nevertheless, there were still many interesting rulings, including two decisions concluding that ERISA did not preempt healthcare provider claims, and one decision (Rizzo) that includes a colorful example of the hazards of “Reply All.” (This is a family publication, so you’ll have to click through to find out for yourself what the email said.)
Below is a summary of this past week’s notable ERISA decisions by subject matter and jurisdiction.
Rizzo v. First Reliance Standard Life Ins. Co., No. 3:17-cv-745-PGS-DEA, 2023 WL 6923494 (D.N.J. Oct. 18, 2023) (Judge Peter G. Sheridan). In this case the court found that defendant First Reliance Standard Life Insurance Company arbitrarily and capriciously denied life insurance benefits to plaintiff Jody Rizzo. Reliance Standard appealed to the Third Circuit, which affirmed the grant of summary judgment to Ms. Rizzo and awarded her $79,050 in attorney’s fees and $302.79 in costs in connection with the appeal. Ms. Rizzo and her counsel, attorney Gregory Heizler, then moved for attorney’s fees and costs for the work expended on the district court litigation. Mr. Heizler sought $125,800 in fees and $3,279.88 in costs. To begin, the court stated that the litigation had been “particularly adversarial” and noted behavior by plaintiff’s counsel, including a lurid email, that was “antithetical to the professional standards of our practice and common courtesy.” Nevertheless, the court concluded that fees were justified. It wrote, “the deterrent effects of this decision will serve to discourage Reliance Standard from arbitrarily and capriciously denying a Waiver of Premium application where medical information is available for its review prior to making a benefit determination,” and that “other members of the pension plan will benefit from Reliance Standard’s consideration of medical information prior to determination of its Waiver of Premium decisions, and this decision might deter other insurers from engaging in similar arbitrary and capricious conduct in the future.” The court also expressed that it was not inclined to “deprive a widow of such an award,” especially under these circumstances, where she achieved success on the merits both in the district court and again on appeal. Having established that a fee award is appropriate, the court then turned to assessing the reasonableness of the hourly rate and hours requested. Mr. Heizler sought an hourly rate of $500 per hour, the same rate he was awarded in the Third Circuit’s fee decision. The court found this requested rate eminently reasonable and in line with comparable legal services in the geographic area, “[g]iven the information supplied to the Court – along with a review of the previous cases.” Moreover, the court concluded that the 251.6 hours of work spent on litigation in the district court was reasonable, not inflated, and appropriately documented. Accordingly, the court awarded the full amount of attorney’s fees sought, totaling $125,800. The court then considered an appropriate award of costs. Counsel sought $3,279.88 in costs for reimbursement of travel expenses, filing fees, service of process, record search costs, photocopies, and postage. However, as the court noted, in the revised time sheet counsel submitted $855.13 worth of costs that were not accounted for. Therefore, the court deducted this amount and awarded plaintiff’s counsel $2,424.75 in costs. Finally, the court denied Mr. Heizler’s request for interest on his attorney’s fee award. It stated that it could find no case law supporting this concept, and was unsure how it would even go about calculating interest on such an award.
Breach of Fiduciary Duty
Washington v. Lenzy Family Inst., No. 1:21-cv-1102, 2023 WL 6879788 (N.D. Ohio Oct. 18, 2023) (Judge Meehan Brennan). The core allegations in this action stem from an employer’s failure to remit employee premiums deducted from paychecks to the insurance provider of the company’s ERISA-governed healthcare plan. Plaintiff Leonard Washington sued his former employer, Lenzy Family Institute, Inc., along with its board of directors and its executive director, in connection with this failure, which resulted in the plan’s termination and the Washington family losing their health insurance coverage. Even after the plan was terminated, Lenzy Family Institute continued to deduct premium payments from their employees’ paychecks, and failed to inform them that they had lost their health insurance coverage. Mr. Washington also maintains that defendants never provided him with documentation required under ERISA, including plan documents, the summary plan description, and annual funding notices. Due to his loss of health insurance coverage, Mr. Washington and his family were unable to receive medical care and to procure their prescription medications. Based on defendants’ actions relating to the healthcare plan, Mr. Washington asserted causes of action under ERISA for breach of fiduciary duties, as well as a claim seeking statutory penalties for failure to comply with ERISA’s disclosure and notification requirements. Additionally, Mr. Washington brought two state law causes of action against defendants, one for violation of an Ohio state wage law and another for promissory estoppel. Defendants have not appeared in this litigation. The clerk of the court previously entered a default, and Mr. Washington subsequently moved for default judgment. In this decision his motion for default judgment was denied without prejudice thanks to issues regarding damages and ERISA preemption. First, the court held that Mr. Washington established by his allegations that he is entitled to penalties under ERISA Section 1132(c)(1)(A) for defendants’ failure to provide plan documents as required under Section 1021(f). However, the court was not only unclear about the appropriate start and end dates to apply for the purposes of statutory penalties, but also stated that it required additional information and briefing on reasons why it should use its discretionary power to award Mr. Washington damages at all, and assuming it should, in what amount. Mr. Washington encountered similar problems with his fiduciary breach claims. Again, the court found that Mr. Washington’s allegations entitle him to relief for his breach of fiduciary duty claims asserted under Section 502(a)(3). It held that defendants breached their fiduciary responsibilities by failing to remit the healthcare payments deducted from their employees to the plan and that they misrepresented to Mr. Washington that the money taken out of his paycheck would provide him with health insurance when this turned out not to be the case. Yet, once again, Mr. Washington ran “into hurdles with damages.” The court instructed him to refile his motion with information needed in order to establish what remedies he is seeking for these breaches and to cite supporting caselaw demonstrating that these remedies constitute “appropriate equitable relief” under Section 1132(a)(3)(B). Finally, as alluded to above, the court requested additional information about Mr. Washington’s state law causes of action, specifically addressing whether either of his claims are either completely or expressly preempted by ERISA. For the forgoing reasons, the court denied the motion for default judgment, and Mr. Washington was given time to refile his motion to address all the concerns raised by the court in this order.
Su v. CSX Transportation, Inc., No. 3:22-cv-849-MMH-JBT, 2023 WL 6940242 (M.D. Fla. Oct. 11, 2023) (Magistrate Judge Joel B. Toomey). Magistrate Judge Toomey issued this report and recommendation recommending the court deny the motion of defendants – CSX Transportation, Inc., CSX Pension Plan, Merged UTU Pension Plan, Greenbrier Frozen Union Pension Plan, the CSX Corporation Master Pension Trust, and the plans’ administrative and investment committees – to dismiss Acting Secretary of Labor Julie A. Su’s complaint alleging breaches of fiduciary duties and prohibited transactions under ERISA. Broadly, the Secretary has alleged that defendants used an opaque and unreasonable system to calculate plan fees which “was not appropriately designed to reflect the Company’s expenses or reasonable cost for services provided,” and seeks in this action “a complete reversal” of the $1,323,744.00 in fees the CSX defendants billed for the years 2016-2020. Defendants argued that the complaint fails to state a claim because they were not acting as fiduciaries with regard to the payment for administrative services and expenses, and because the Secretary “effectively concedes that the Plans paid no more than reasonable compensation for the services they received.” Magistrate Toomey was not persuaded by either argument. He pointed out that the complaint demonstrated the ways in which defendants exercised control over plan assets and fees and that this management, as alleged, plausibly demonstrates that defendants were acting as fiduciaries with respect to the allegations of wrongdoing. Furthermore, the Magistrate held that the complaint sets forth its claims in such a way that the court can reasonably infer that defendants are liable for the breaches and misconduct alleged. Contrary to defendants’ position, the Magistrate Judge concluded the complaint does not concede the fees were reasonable, rather the allegations make clear that plaintiff views the compensation paid as excessive and in violation of ERISA. “Moreover, Plaintiff has pleaded that Defendants did not comply with the Plan documents. Thus, even if the Plan documents said one thing, Plaintiff alleges that the reality was different.” Accordingly, the Magistrate found that the allegations in the complaint were nonfrivolous, plausible, and satisfied notice pleading. He therefore recommended the motion to dismiss be entirely denied.
Prime Healthcare Servs.-Lower Bucks, LLC v. Cigna Health & Life Ins. Co., No. 23-1313, 2023 WL 6927330 (E.D. Pa. Oct. 19, 2023) (Judge Anita B. Brody). Plaintiff Prime Healthcare Services is a group of hospitals in Pennsylvania. The hospitals allege that Cigna Health and Life Insurance Company and Cigna Healthcare of Pennsylvania, Inc. have failed to fully reimburse costs of emergency services provided to hundreds of patients insured under Cigna benefit plans. Plaintiff brought a lawsuit in state court asserting state law claims of breach of implied-in-law contract, breach of contract, promissory estoppel, quantum meruit, unjust enrichment, and conversion against the Cigna defendants. The complaint expressly states that Prime Healthcare will “remove any claims from the list once it is ‘able to confirm that the claims are governed by self-funded ERISA plans.” Plaintiff attests that it does not wish to state any cause of action under ERISA. Despite clearly attempting to avoid ERISA preemption issues and asserting only state law causes of action, Prime’s complaint was nevertheless removed by the Cigna defendants to federal court on the grounds that ERISA completely preempts at least some of the claims in the complaint. Prime Healthcare moved for remand. The court agreed with Prime that it is the “master of its complaint,” and that it may choose to plead its claims only on the basis of state law and avoid asserting ERISA claims. Upon analyzing the causes of action under the two-prong Davila preemption test, the court was satisfied that neither prong was met here. It concluded that the hospitals could not have brought claims under ERISA and that their state law causes of action implicate independent legal duties. The court agreed with plaintiff that Cigna’s obligations do not arise under the terms of any ERISA plan and that its duties instead are “owed to Prime under an implied-in-law contract to provide emergency services, under an express contract to pay for post-stabilization services, as well as under state law principles of promissory estoppel, quantum meruit and unjust enrichment, and conversion.” In sum, the court stated that Cigna’s duties “would exist whether or not an ERISA plan existed,” and thus are not dependent on any ERISA plan or its terms. Accordingly, the court granted the motion to remand. However, because it could not definitively conclude that Cigna’s decision to remove the case was objectively unreasonable, the court denied Prime’s request for an award of attorney’s fees and costs in connection with the removal to federal court.
Baytown Med. Center, LP v. UnitedHealthcare Ins. Co., No. 1:23-CV-00142, __ F. Supp. 3d __, 2023 WL 6939177 (E.D. Tex. Oct. 18, 2023) (Judge Michael J. Truncale). An out-of-network hospital, plaintiff Baytown Medical Center, LP, sued UnitedHealthcare Insurance Company in state court under the Texas Insurance Code for failure to pay the usual and customary rate as reimbursement for emergency care it provided to an insured patient. Baytown Medical was paid only $1,764.49 of the $13,811.91 medical costs, and believes this rate of reimbursement is far lower than the usual and customary rate UnitedHealthcare is required to pay under Texas law. UnitedHealthcare removed the case to federal court, arguing that the hospital’s claim is preempted by ERISA. In response, Baytown Medical maintained that its state law claim is not subject to either complete or conflict preemption, and moved to remand the action back to state court. The motion to remand was granted in this order. Although the court found that the first prong of the two-prong Davila preemption test was satisfied because Baytown Medical was assigned benefits by the patient and therefore had derivative standing to assert a claim under ERISA, the court held that the second prong was not met. Specifically, the court concluded that the claim under the Texas Insurance Code implicates an independent legal duty as it does not require a benefit determination under plan terms and because the claim involves the rate of payment rather than the right to payment. Therefore, the court held that the claim against UnitedHealthcare is not completely preempted by ERISA and federal jurisdiction does not exist. As a result, the court remanded the case back to Texas state court.
Medical Benefit Claims
Colin D. v. Morgan Stanley Med. Plan, No. 20-CV-9120-LTS-GWG, 2023 WL 6849130 (S.D.N.Y. Oct. 17, 2023) (Judge Laura Taylor Swain). A father and son, plaintiffs Joseph and Colin D., sued their ERISA-governed healthcare plan, the Morgan Stanley Medical Plan, and its administrators, Optum Group LLC and United Behavioral Health, Inc., after Colin’s stay at a residential treatment center for the treatment of mental health disorders was denied by defendants. Plaintiffs asserted causes of action under ERISA seeking payment of benefits under the plan, and also alleging violations of the Mental Health Parity and Addiction Equity Act. The parties both moved for summary judgment on plaintiffs’ claims. As an initial matter, the court needed to resolve the parties’ dispute over the appropriate standard of review. Although the two sides agreed that the plan grants discretionary authority to the United defendants, plaintiffs argued that defendants violated the Department of Labor’s claims handling regulations by violating minimum notice standards, and thus defendants are not entitled to deference. They claimed that defendants’ denial letters did not explain which specific plan provisions or Optum Level of Care Guidelines criteria were applied in making the benefit determinations and that the letters never specifically discussed medical necessity. The court agreed with plaintiffs that the letters failed to reference specific plan provisions upon which the denials were based, and that this “regulatory violation was [not] inadvertent or harmless.” Thus, the court determined that plaintiffs were entitled to de novo review of the denial of benefits. However, the court did not grant either party summary judgment on the Section 502(a)(1)(B) claim for denial of benefits. Instead, it identified conflicting evidence in the medical record that created genuine issues of material fact as to whether the treatment at the residential facility was medically necessary as defined by the plan. The court expressed that to make such a determination it would need to weigh various opinions of medical professionals, which “is outside the scope of the Court’s authority in a traditional summary judgment posture.” Given these material disputed factual issues, the court declined to award summary judgment to either party, and held off ruling on the claim for benefits until after it can hold a bench trial on the administrative record. The court then moved on to the Parity Act violation claims. Plaintiffs maintained that the plan violated the Parity Act in two ways, one by providing reimbursement for travel and lodging expenses for medical and surgical treatments, but not for mental health treatments, and two by using guidelines outside of the plan (the “Optum Guidelines”) only for mental health treatment and not for other kinds of analogous medical treatment at skilled nursing facilities. The court started with the travel expenses claim. It ultimately concluded that plaintiffs failed to identify an analogous medical/surgical treatment in the same classification as their residential mental healthcare treatment, because the plan only provides for travel and lodging reimbursement “when using an in-network facility.” The mental health benefits for which plaintiffs seek coverage were out-of-network, meaning the benefits could not be compared to in-network medical or surgical treatment. Accordingly, the court granted judgment in favor of defendants on this claim. It did so for plaintiffs’ other Parity Act claim as well. There, the court held that the use of the Optum Guidelines was not a violation because the plan uses another set of comparable guidelines, the MCG Guidelines, for skilled nursing facilities. Although not identical to one another, the court concluded that these two sets of guidelines “do not impose materially different limitations on treatment claims for residential mental health facilities as opposed to skilled nursing facilities.” Therefore, the court found that plaintiffs did not carry their burden of proving a Parity Act violation, and entered summary judgment in favor of defendants on both Parity Act claims.
Pension Benefit Claims
Tseng v. Welch Foods Inc., No. 1:20-cv-11486-GAO, 2023 WL 6847039 (D. Mass. Oct. 17, 2023) (Judge George A. O’Toole, Jr.). In 2019, defendant Welch Foods Inc. reduced its Pension Restoration “top-hat” Plan’s accrual interest rate from 9.5% to 4%, changing the rate for the first time since the plan’s inception in 1997. That decision consequently lowered the amount of annual benefits provided under the plan to its participants. A group of those participants challenged the interest rate change through the plan’s administrative appeals process, and then, after the decision was upheld on appeal, commenced this lawsuit. They claim that the reduction in accrual interest rate violated the plan terms, which offer “lifetime” benefits. In this action they sought a court order overturning the interest rate change. The parties filed cross-motions for summary judgment. Before resolving the parties’ dispute, the court settled on the appropriate review standard. As the plan grants its administrator discretionary authority, the court concluded that arbitrary and capricious review was the applicable standard for the summary judgment motions. Under deferential review, and upon consulting the terms of the plan, the court held that the Welch defendants were able to adjust the rate as they saw fit. “The fact that the rate was not adjusted for many years does not establish that the rate could not, under the Plan documents, ever be adjusted. The Plan plainly provides otherwise. Adjusting the annual accrual to a more conservative 4 percent, though disadvantageous to the participants, was a decision plainly authorized by the explicit language of the Plan.” Based on these findings, the court concluded that it was not an abuse of discretion to lower the accrual interest rate of the top-hat plan, and as a result, the court granted judgment in favor of the defendants.
Pleading Issues & Procedure
Hall v. Fraternal Order of Police, No. 22-1823, 2023 WL 6847363 (E.D. La. Oct. 17, 2023) (Judge Jay C. Zainey). Plaintiff Sonya Hall, on behalf of herself and the estate of her late husband, officer Mark Hall, brought this lawsuit against the Fraternal Order of Police, Crescent City Lodge No. 2, Reliance Standard Insurance Company, and Federal Insurance Company alleging state law causes of action on the basis that she has not received life insurance benefits under a policy belonging to Mr. Hall. Defendant Federal Insurance Company moved to dismiss the single claim against it for breach of contract pursuant to Rule 12(b)(6). It argued that ERISA governs the plan at issue and that Ms. Hall’s breach of contract claim alleged in her complaint is completely preempted by ERISA. Moreover, Federal Insurance Co. claimed that Ms. Hall cannot allege a cause of action under ERISA and she failed to exhaust administrative remedies prior to commencing this action. Before reaching any decision on defendant’s grounds for dismissal, the court first settled the issue of whether the policy at issue is governed by ERISA, and, by extension, whether it has federal subject matter jurisdiction in this litigation. It answered both queries in the affirmative. The court was satisfied that the plan exists, that it does not fall under ERISA’s safe harbor provision because the employer contributes to the plan, and that the plan meets ERISA’s definition of an employee benefit plan, as it is an insurance plan offered by an employer to employees to provide benefits to those employees in the event of death or dismemberment. Accordingly, the court found the policy qualifies as an ERISA-governed plan, and therefore moved on to consider the issue of preemption. Here, the court held that ERISA undoubtedly preempts the bad faith breach of contract claim for failure to pay plan benefits. “Such a claim clearly falls within the parameters of Section 1132(a)(1)(B), and within the standards set forth in Davila and Ellis. Therefore, the state law claim set forth by Hall is completely preempted by ERISA.” Accordingly, the motion to dismiss was granted as to the preemption of the breach of contract claim. However, the court concluded that leave should be given to Ms. Hall to amend her complaint and replead her claim against Federal Insurance Company as a claim for benefits under ERISA. It also informed Ms. Hall that she should include facts about exhausting administrative remedies within her amended complaint, or advance arguments why she did not or could not have exhausted remedies prior to filing her lawsuit. Thus, the motion to dismiss was denied to the extent that Federal argued that Ms. Hall failed to state a claim under ERISA and failed to exhaust the administrative process. Consequently, Ms. Hall was given these instructions by the court and granted leave to amend her complaint in this manner.
Taylor v. BW Wings Mgmt., No. 1:22-CV-0106-HAB-SLC, 2023 WL 6847030 (N.D. Ind. Oct. 17, 2023) (Judge Holly A. Brady). Plaintiff Nick Taylor is an employee of BW Wings Management, LLC. He, his wife, and their minor child, Z.T., were all covered under BW Wings Management LLC Employee Benefit Plan, an ERISA-governed welfare plan, when Ms. Taylor was diagnosed with an aggressive form of breast cancer. On July 29, 2020, Ms. Taylor was scheduled for surgery related to her cancer diagnosis. However, right before the surgery was scheduled to take place, the co-owner of BW Wings informed the family “that Ms. Taylor’s and Z.T.’s health insurance was improperly implemented under the Plan outside the open enrollment period and the health insurance for Mrs. Taylor and Z.T. under the Plan would end” immediately. So, Ms. Taylor and her son had their health insurance under the plan retroactively cancelled, and because she no longer had health insurance and could not afford to pay the cost of the surgery without insurance, Ms. Taylor was forced to cancel and postpone her medically necessary surgery. In this action the Taylors have sued the company for interference with their health benefits under ERISA Section 510, and levied state law claims for promissory estoppel, breach of fiduciary duty, fraud, constructive fraud, and intentional infliction of emotional distress. BW Wings moved to dismiss the complaint for failure to state an ERISA Section 510 claim, and moved to dismiss the state law claims as preempted by ERISA Section 514(a). Defendant’s motion was denied in this order. The court found the complaint plausibly alleges facts to sketch a viable Section 510 claim under ERISA and that it could infer defendants took away the beneficiaries’ coverage to avoid paying for costly surgery. “The complaint need not lay out all the facts that must eventually be proved to prevail at trial – that is what discovery is for.” The court was clear that the Taylor family need not prove their entitlement to benefits at this stage of the proceedings. “Rather, taking the allegations as true, the Taylors have pled they were entitled to dependent benefits under an ERISA plan…they were granted benefits under an ERISA plan, and those benefits were rescinded by the Defendant to prevent paying for Mrs. Taylor’s surgery.” The factual disputes are for a later stage of litigation, the court stressed, and stated that it was persuaded the family alleged sufficient facts to infer a plausible Section 510 claim. Turning to ERISA preemption, the court held that the conflict preemption argument “is not properly raised in a motion to dismiss,” as it is an affirmative defense. Thus, the court declined to dismiss the family’s complaint.
Warren v. The Lincoln Nat’l Life Ins. Co., No. 2:23-cv-00601-GMN-EJY, 2023 WL 6850193 (D. Nev. Oct. 16, 2023) (Judge Gloria M. Navarro). In a brief decision, the court granted defendant The Lincoln National Life Insurance Company’s motion to dismiss plaintiff Allanna Warren’s lawsuit for failure to state a claim. Ms. Warren asserted state law causes of action against Lincoln in a single-paragraph complaint alleging a conspiracy between the Las Vegas Police and Lincoln for racial profiling, discrimination, and misuse of medical information. Although somewhat unclear, the lawsuit also stems from an improper denial of ERISA-governed disability benefits, and possibly seeks a court order granting disability benefits. Lincoln therefore argued the state law causes of action are preempted by ERISA. The court ultimately could not reach a definitive finding on the issue of ERISA preemption given the “limited allegations” in the complaint. Nevertheless, the court was sure that Ms. Warren’s complaint as currently pled was insufficient to infer the wrongdoing alleged, stating that “it currently consists of nothing more than the ‘unadorned, the-defendant-unlawfully-harmed-me accusation.’” Accordingly, the motion to dismiss was granted, and Ms. Warren was given 21 days to file an amended complaint to address and remedy its current deficiencies.
Standard of Review
Stout v. Smith Int’l, No. 6:22-CV-06036, 2023 WL 6882790 (W.D. La. Oct. 18, 2023) (Judge Terry A. Doughty). Plaintiff Charles Robert Stout commenced this action against Metropolitan Life Insurance Company (“MetLife”) and Smith International, Inc. seeking a court order reinstating his terminated long-term disability benefits. In this order the court examined whether MetLife has discretionary authority under the plan, and by extension what the appropriate standard of review of the denial ought to be when it comes time to decide the ultimate merits issues of the disability benefits decision. As a preliminary matter, the court found that there was no genuine issue of material fact about whether MetLife is a fiduciary under the long-term disability plan. The terms of the plan unambiguously vest MetLife with the authority to deny or approve submitted claims, verify claimants’ continuing disabilities, and conduct appeals of any initial denials it may make. The court held that the authority to carry out these tasks clearly establish MetLife is a fiduciary under ERISA. The tricker issue was whether the plan language, which does not expressly invoke the phrase “discretionary authority,” nevertheless vests MetLife with such authority. In order to answer this question, the court wrote that it was required to “look to ‘the breadth of the administrators’ power.’” The plain language of the plan “holds that benefits terminate when a claimant is no longer disabled and MetLife has specific authority to verify whether claimants do, in fact, remain disabled.” This language was understood by the court as granting MetLife with discretionary authority to terminate a claimant’s benefits when he or she cannot prove their continuing disability. Accordingly, the court explained that the defendants are entitled to a deferential standard of review and therefore granted judgment to them on this issue.
Davis v. United of Omaha Life Ins. Co., No. 6:23-cv-57-ACA, 2023 WL 6849438 (N.D. Ala. Oct. 17, 2023) (Judge Annemarie Carney Axon). Plaintiff Laura Davis and defendant United of Omaha Life Insurance Company agreed to bifurcate this disability benefits action into two phases. In the first and present phase, the parties each moved for partial summary judgment as to the standard of review the court should use in evaluating the disability termination decision. Ms. Davis argued that United of Omaha did not provide her with an opportunity to respond to an amended report or that report’s new evidence for denial before issuing its final appeal determination, which she asserts is in violation of ERISA’s claims handling procedure regulations. As a result of this violation, Ms. Davis maintained that United of Omaha “forfeited as a matter of law entitlement to deferential review standard.” In response, United of Omaha argued that this violation was de minimis because the amended report at issue only corrected an identified typo in the original report, meaning that there was no new grounds or evidence that Ms. Davis was unable to respond to. United of Omaha thus contended that the arbitrary and capricious standard of review applies because the plan grants it discretionary authority to determine eligibility for benefits. The court agreed with defendant that “even if United of Omaha violated ERISA’s regulations, the violation was de minimus.” It stated that Ms. Davis did not suffer harm or prejudice by not receiving an opportunity to respond to the amended report, because she was able to respond to the original report, which was nearly identical. Therefore, the court felt that under the circumstances, United of Omaha demonstrated that the claims procedure violation “was for good cause and part of the ongoing, good faith exchange of information with Ms. Davis.” Accordingly, the court denied Ms. Davis’ motion. Instead, the court held that it would stick with the Eleventh Circuit’s unique six-step framework for evaluating ERISA plan benefit denials, evaluating first if the decision was de novo wrong and then, assuming that it was, progressing to an analysis of the denial under deferential review. The court also declined to depart from this framework by skipping the first de novo review step of the Eleventh Circuit’s framework and proceeding directly to the following five steps applicable to arbitrary and capricious review, which it understood defendant to be requesting in its motion. As a result, the court also denied United of Omaha’s partial summary judgment motion to establish an arbitrary and capricious review standard.