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Good morning, ERISA Watchers!  Piggybacking on last week’s notable decision discussion, this week’s notable decision is McIntyre v. Reliance Standard Life Insurance Company, No. CV 17-5134 (JRT/DTS), 2019 WL 2267054 (D. Minn. May 28, 2019), a case analyzing an insurer’s history of biased claims administration when it comes to determining the conflict of interest and standard of review.

At issue in McIntyre is whether the plaintiff, a nurse disabled by Charcot Marie Tooth Syndrome (“CMT”), is entitled to long-term disability benefits under the “Any Occupation” standard in the Reliance Standard disability policy.  (CMT is a neurological disorder that affects peripheral nerves.)  If you’re in a hurry for the happy ending, the court’s answer is YES.  Let’s examine how the court got there.  
Continue Reading Court Finds Administrator’s Conflict of Interest and Procedural Irregularities Warrant De Novo Review

Hello, ERISA Watchers!  On this Memorial Day weekend, let’s take a moment to commemorate the men and women who made the ultimate sacrifice for their country and to reflect on the luxuries and freedoms that we enjoy today as a result.

Moving on from the solemnity, this week’s notable decision is an icy one for plan participants.  In Nichols v. Reliance Standard Life Insurance Company, No. 18-60499, __F.3d__, 2019 WL 2223614 (5th Cir. May 23, 2019), the Fifth Circuit reversed a district court decision that I happily reported on July 8, 2018 (Your ERISA Watch – Court Examines Two Decades of Reliance Standard Life Insurance Company’s Abuse of Discretion in Disability Benefit Claims).
Continue Reading Fifth Circuit Reverses Long-Term Disability Victory of Sanitarian Worker

I’m pleased to report this week’s notable decision is a firm victory in the case of Dowdy v. Metro. Life Ins. Co., No. 16-15824, __F.3d__, 2018 WL 2223722 (9th Cir. May 16, 2018), which involved a denial of benefits under an AD&D Plan.  Dowdy was involved in an automobile accident and sustained a serious injury to his left leg, which was eventually amputated below the knee.  Dowdy and his wife sought accidental dismemberment benefits under an insurance policy provided by his employer and insured and administered by Metropolitan Life Insurance Company.  MetLife denied the benefits on the basis that Plaintiff’s diabetes contributed to the decision to amputate Plaintiff’s leg and the AD&D policy has an exclusion for any loss caused or contributed to by an illness or infirmity.  The district court declined to consider evidence outside of the “administrative record.”  On the merits, the district court found that diabetes caused or contributed to the need for amputation and Plaintiff’s loss was excluded under the policy.
Continue Reading Ninth Circuit Holds That Substantial Contribution Standard Applies to AD&D Policy Exclusion and Reverses Denial of Benefits