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This week’s notable decision demonstrates the difficulty of overcoming a district court’s de novo review on appeal in an ERISA case. Like many courts deciding mental health benefits under ERISA, the First Circuit concluded: “This case is not an easy one.” Doe v. Harvard Pilgrim Health Care, Inc., No. 19-1879, __F.3d__, 2020 WL 5405367 (1st Cir. Sept. 9, 2020).

The case previously reached the First Circuit in Doe v. Harvard Pilgrim Health Care, Inc., 904 F.3d 1 (1st Cir. 2018) (Doe I) which reversed the district court’s denial of Doe’s motion to expand the administrative record, vacated an order of summary judgment for Harvard Pilgrim, and remanded to the district court. 

Following remand, and under a de novo standard of review, the district court agreed with Harvard Pilgrim’s determination that continued residential treatment was not medically necessary. Doe appealed.
Continue Reading First Circuit Rules in Favor of Harvard Pilgrim Health Care in Dispute Over Denied Residential Treatment Benefits

This week the Eighth Circuit’s decision in McIntyre v. Reliance Standard Life Ins. Co., No. 19-2367, __F.3d__, 2020 WL 4951028 (8th Cir. Aug. 25, 2020), clarified that when circumstances demand “less deferential review,” this cannot mean de novo review. Why? After all, de novo review is less deferential than abuse of discretion review and multiple Eighth Circuit opinions appeared to sanction this seemingly logical finding. 

After approving Plaintiff’s disability claim for two years, Reliance terminated Plaintiff’s long-term disability claim under the “any occupation” definition of disability. Plaintiff appealed and Reliance upheld its original determination. That finding that came almost seven months after the appeal was submitted—well outside the 90 days allowed. Plaintiff filed suit and the district court ruled in her favor under the de novo standard of review despite the Plan containing a grant of discretionary authority. 
Continue Reading Eighth Circuit Jettisons Prior Circuit Precedent Holding that Procedural Irregularities Can Justify a De Novo Standard of Review

Retirement plan participants received a partial victory from the Eighth Circuit Court of Appeals in one of several actions brought against large universities for the alleged mismanagement of their section 403(b) retirement-savings plans. In Davis v. Washington Univ. in St. Louis, No. 18-3345, __F.3d__, 2020 WL 2609865 (8th Cir. May 22, 2020), the plan participants alleged two separate breach of fiduciary duty claims. The first claim alleges that Washington University allowed the investment-management fees and record-keeping expenses “to get out of control.” The second claim alleges that Washington University allowed several underperforming investments to stay in the plan for too long. The district court (E.D. Mo. – St. Louis) granted the University’s motion to dismiss both claims. The plan participants appealed. The Eighth Circuit affirmed in part, reversed in part, and remanded for further proceedings.
Continue Reading Eighth Circuit Revives Excessive Fee Litigation against Washington University