Happy Sunday, ERISA Watchers! This week I want to highlight two unpublished decisions from the Fourth Circuit Court of Appeals, both of which are plan participant friendly. The first case, Odle v. UMWA 1974 Pension Plan, No. 18-1398, __F.App’x__, 2019 WL 2539260 (4th Cir. June 20, 2019), involves a dispute over the amount of a survivor’s annuity benefit award under the United Mine Workers of America 1974 Pension Plan. The court reversed the grant of summary judgment for the Plan and remanded for further proceedings. The court found that the Plan erred by denying Plaintiff the opportunity to review the Dale Coal audit during the administrative process because it prejudiced her ability to pursue further investigation and argument in support of her claim. The audit documented potentially fraudulent underreporting of classified hours and Plaintiff must be given the opportunity to contest the Plan’s denial based on a full disclosure of documents relevant to her claim. The court explained that “procedural guidelines including the right to a full and fair review ‘are at the foundation of ERISA.’”
Continue Reading Fourth Circuit Enforces the Right to a Full and Fair Review under ERISA
Court Finds Administrator’s Conflict of Interest and Procedural Irregularities Warrant De Novo Review
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
Fifth Circuit Reverses Long-Term Disability Victory of Sanitarian Worker
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