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Good morning, ERISA Watchers! There were no notable circuit court decisions from this past week, so exercising some editorial discretion, this week’s notable decision is a firm victory in a discovery dispute involving a self-funded long-term disability plan, Chacko v. AT&T Umbrella Benefit Plan No. 3, No. 2:19-CV-01837-JAM-DB, 2020 WL 1984171 (E.D. Cal. Apr. 27, 2020). 

Before going into the decision, I want to take a step back to discuss the Ninth Circuit’s decision in Demer v. IBM Corporation LTD Plan, 835 F.3d 893 (9th Cir. 2016). Demer alleged that there was (1) a structural conflict of interest since MetLife both decided claims for the disability plan and was responsible for paying those claims; and (2) at least two of the doctors that MetLife hired to review the medical records “have performed a significant number of reviews for MetLife and have received significant compensation for their services.” Demer, 835 F.3d at 900. The court then analyzed these two areas of conflict separately: the structural conflict of interest and the financial conflict of independent physician consultants. Id. at 900-903.
Continue Reading Courts Find Discovery of Independent Physician Consultants’ Financial Conflict Permissible in Absence of Structural Conflict

Good morning, ERISA Watchers! This was a slow week in the circuit courts for ERISA decisions so this week’s notable decision is the unpublished decision in Strickland v. AT&T Pension Benefit Plan, No. 18-15336, __F.App’x__, 2020 WL 1873358 (9th Cir. Apr. 15, 2020). 

Plaintiff Vanmark Strickland appealed a district court ruling upholding the denial of his claim for pension disability benefits under the AT&T Pension Benefit Plan (“the Plan”). The Plan is administered by Sedgwick Claims Management Services, which operates as AT&T Integrated Disability Service Center (“IDSC”). The district court reviewed the benefits decision applying an abuse of discretion standard of review. 
Continue Reading Ninth Circuit Upholds Denial of Pension Disability Benefits Under AT&T Pension Benefit Plan

This week’s first notable decision, Meyers v. Kaiser Found. Health Plan, Inc., No. 19-15051, __F.App’x__, 2020 WL 1673078 (9th Cir. Apr. 6, 2020), is a cautionary tale for claimants seeking out-of-network treatment under a Kaiser health plan. Meyers brought the action on behalf of her teenage daughter, A.M., a covered dependent under the Kaiser medical plan. Meyers sought reimbursement of medical expense for A.M.’s treatment at Elevations residential treatment center for approximately four months in 2016. 

District Court Judge Lucy Koh granted judgment for Kaiser following a bench trial. Meyers appealed.

While the parties disputed the standard of review, the Ninth Circuit agreed with the district court— even under de novo review, Kaiser’s denial was proper. 
Continue Reading Ninth Circuit Holds Kaiser Not Liable for Out-of-Network Mental Health Treatment Benefits