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For those of us waiting for a court to follow the reasoning in the remarkable Wit v. United Behavioral Health, 2019 WL 1033730 (N.D. Cal. Mar. 5 2019) decision earlier this year, we got it last week with the decision in S.B. v. Oxford Health Ins., Inc., No. 3:17-CV-1485 (MPS), __F.Supp.3d__, 2019 WL 5726901 (D. Conn. Nov. 5, 2019). In sum, Judge Michael Shea found that Oxford’s denial of a 16-year-old’s residential treatment for an eating disorder was arbitrary and capricious and remanded to Oxford for further consideration. 

To start, the court did not accept Plaintiff’s argument that a de novo standard of review should apply because United Behavioral Health Services, Inc. (“UBH”), not Oxford, made the benefit determination. Plaintiff contended that although UBH made the benefit determination, there is no indication that the Plan gives UBH discretionary authority. The court found that the Plan language contemplates the delegation of authority to third parties with the definition of “Us, We, Our” which included not only Oxford but also anyone to whom Oxford “legally delegate[s] performance,” including UBH. 
Continue Reading District Court Finds Oxford’s Denial of Teen’s Residential Treatment Arbitrary and Capricious Due to Reliance on UBH Guidelines

This week’s notable decision is Card v. Principal Life Insurance Company, No. 18-6095, __F.App’x__, 2019 WL 5618182 (6th Cir. Oct. 31, 2019), where the Sixth Circuit concluded that Principal Life Insurance Company was arbitrary and capricious when it denied Plaintiff Card’s claim for disability benefits.  

Card was a registered licensed practical nurse who worked the night shift providing patient care and supervising nursing assistants.  In February 2013, a specialist in hematology/oncology diagnosed her with chronic lymphocytic leukemia, a type of blood and bone marrow cancer.  Over the following six months, Card began experiencing a worsening of symptoms, including night sweats, fatigue and exhaustion.  Bloodwork showed an increase in Card’s white blood cell count and lymphocytes.  She could not afford to see the specialist again nor afford more bloodwork as recommended by her primary care physician.  Though her doctor recommended disability, Card continued to work with accommodations.  She stopped working in December 2013 due to fatigue and weakness that left her feeling unable to perform her job.  
Continue Reading Sixth Circuit Revives Nurse’s Disability Benefit Claim Against Principal Life Insurance Company

This week’s notable decision is a district court decision in Estate of Colleen J. Brownell v. Lyczak, et al., 2019 WL 5485392 (D.N.J. Oct. 25, 2019), which is another cautionary tale for the notion that murder doesn’t pay, well at least a murder conviction.

In this case, Defendant Lyczak pleaded guilty to murdering his girlfriend, Colleen Brownell, who was a plan participant in a 401(k) Employee Savings Plan (“the Plan”) administered by her former employer, Defendant PHH Corporation.  Lyczak was Brownell’s named primary beneficiary.  In other words, in the event of her passing, Lyczak was to receive all the money in her Plan account.  The plaintiff is the Estate of Colleen J. Brownell.  

The Estate moved for summary judgment on the basis that Lyczak’s guilty plea to the murder disqualifies him from being a beneficiary of Brownell’s 401(k) account.  Lyczak did not respond and PHH did not oppose the motion.  
Continue Reading Murder of Plan Participant Disqualifies 401(k) Beneficiary