This week’s notable decision is Rittinger v. Healthy All. Life Ins. Co., No. 17-20646, __F.3d__, 2019 WL 391771 (5th Cir. Jan. 31, 2019), a case involving the denial of coverage for bariatric surgery and follow-up surgery for complications. The Fifth Circuit reversed the district court’s determination in favor of Rittinger and found that Anthem did not abuse its discretion in the handling of Rittinger’s appeals. This is yet another case where the standard of review makes all the difference. As the court explained, “[A]lthough not the paragon of procedural propriety, Anthem satisfied the very low, very deferential abuse-of-discretion standard.” Because the court found that Rittinger is not entitled to any damages, the court dismissed her cross-appeal to determine the exact dollar amount of damages she is owed.
Continue Reading Fifth Circuit Holds that Anthem Did Not Abuse Its Discretion in Denying Coverage for Bariatric Surgery
Employer Must Pay Dependent Life Insurance Benefits to Employee Due to Failure to Provide Summary Plan Description
Happy Monday, ERISA Watchers! Today’s notable decision is a good one on equitable remedies, made possible by CIGNA Corp. v. Amara, 563 U.S. 421 (2011). In Snitselaar v. Unum Life Insurance Company of America, 2019 WL 279995 (N.D. Iowa Jan. 22, 2019), Unum denied Snitselaar’s claim for dependent life insurance benefits on the life of her ex-husband, Gerard, who died about three months following the finalization of their divorce. Unum found that Gerard was no longer an eligible dependent under the terms of the Plan as of the date of the divorce. Snitselaar claimed that when she signed up for the life insurance benefits, she was informed that they could not lose the insurance for life changes after the two-year waiting period and they were never informed about divorce affecting the policy. In addition, the life insurance premiums continued to be deducted from her paychecks after the divorce and even after Gerard’s death. Snitselaar also claimed that neither she nor Gerard were informed of their right to convert to an individual life policy without evidence of insurability after the divorce was finalized.
Continue Reading Employer Must Pay Dependent Life Insurance Benefits to Employee Due to Failure to Provide Summary Plan Description
Court Reconsiders Application of Colorado State Ban on Discretionary Clauses Based on Disability Policy Amendments and SPD
Good morning and Happy Martin Luther King, Jr. Day! There were so many notable and circuit court decisions from this past week it was hard to choose just one noteworthy decision. I decided to go with one awesome decision that may not have gotten as much press coverage as the others – Ellis v. Liberty Life Assurance Company of Boston, No. 15-CV-00090-LTB, 2019 WL 200394 (D. Colo. Jan. 15, 2019). What I love about this decision is that it snatches victory from the jaws of defeat, but it also highlights the real difference the standard of review makes. On a motion for reconsideration, Plaintiff Ellis’s new attorneys, McDermott Law, were able to get the Court to reconsider its previous decision finding that C.R.S. § 10-3-1116(2) does not apply to the discretionary language in the relevant disability policy and entering judgment in favor of Liberty Life under an arbitrary and capricious standard of review. See Ellis v. Liberty Life Assurance Co. of Bos., 333 F. Supp. 3d 1083 (D. Colo. 2018).
Continue Reading Court Reconsiders Application of Colorado State Ban on Discretionary Clauses Based on Disability Policy Amendments and SPD