Hello, ERISA Watchers! There have been quite a few good fee decisions as of late. This week’s notable decision is a fee decision and firm victory in Benjamin v. Oxford Health Ins., Inc., __F.Supp.3d__, 2019 WL 126190 (D. Conn. Jan. 8, 2019), a matter involving denial of residential treatment for a mental and/or behavioral health disorder. In the court’s earlier decision, Benjamin v. Oxford Health Ins., Inc., 2018 WL 3489588 (D. Conn. July 19, 2018), the court found that Plaintiff Benjamin was eligible for attorneys’ fees because the court remanded the claim to Oxford for a full and fair review. Oxford failed to consider Plaintiff’s medical records and apply its own standards of review, including failing to conduct a Medical Necessity review.
Continue Reading Claimant Entitled to Attorney’s Fees for Court-ordered Remand Despite Insurer’s Offer of Voluntary Remand
Ninth Circuit Holds Insurer’s Failure to Issue a Final Decision on Disability Benefit Appeal Results in De Novo Review
Good morning, ERISA Watchers! This is the first ERISA Watch of 2019. There weren’t a lot of decisions this past week due to the holiday. I want to highlight a couple of unpublished Ninth Circuit decisions, both of which reversed the district courts’ grants of summary judgment to the defendant plans in long-term disability matters.
The first is Gordon v. Metropolitan Life Insurance Company, No. 17-16821, __F.App’x__, 2019 WL 102403 (9th Cir. Jan. 4, 2019). The court reversed and remanded the district court’s (Judge Davila) grant of summary judgment to MetLife after erroneously applying abuse of discretion review. The Ninth Circuit found that MetLife’s decision to deny benefits is subject to de novo review because it failed to issue a final decision on Gordon’s appeal, even years after its deadline to do so. The court found that this was a “wholesale and flagrant” violation of both ERISA and the benefit plan and “utterly disregards” MetLife’s duties as a plan administrator. See 29 C.F.R. § 2560.503–1(h)-(j); Abatie v. Alta Health & Life Ins. Co., 458 F.3d 955, 971 (9th Cir. 2006). *Advice to administrators: get those rubber stamps moving faster!
Continue Reading Ninth Circuit Holds Insurer’s Failure to Issue a Final Decision on Disability Benefit Appeal Results in De Novo Review
Court Compels Unum to Produce Information About Its Alleged Forecasting and Targeting of Disability Claims for Termination
I’m pleased to report that this week’s notable decision is a gem of a discovery decision obtained by our firm in the matter of Gray v. Unum Life Insurance Company of America, et al., No. 17-1778-JGB-KKx (C.D. Cal. Sept. 21, 2018) (unreported). Plaintiff alleged that Unum wrongfully terminated her long term disability benefits under the Boy Scouts of America Long Term Disability Plan. Plaintiff filed a motion to compel responses to discovery requests aimed at ascertaining Unum’s business practice of forecasting and targeting disability claims for potential “recoveries” or terminations.
The court granted Plaintiff’s motion to compel Unum to respond to Requests for Production, Nos. 2-5, which seek the following:
• Request No. 2: “All Weekly Tracking Qtr. View Reports for claims within the same Unit(s) to which THE CLAIM was assigned during the time period of May 30, 2016 through and including October 30, 2017.”
Continue Reading Court Compels Unum to Produce Information About Its Alleged Forecasting and Targeting of Disability Claims for Termination