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Williams v. Unum Life Ins. Co. of Am., No. 20-1694, __ F.4th __, 2021 WL 3729660 (8th Cir. Aug. 24, 2021) (Before Circuit Judges Smith, Arnold, and Stras).

Ever since the Supreme Court’s 1989 decision in Firestone Tire & Rubber v. Bruch, ERISA-governed benefit plans and their insurers have sought to grant themselves discretionary authority in order to ensure a favorable standard of review in court.Continue Reading Eighth Circuit Rules Maine’s Anti-Discretion Law Does Not Apply to Accident Policies

Mayer v. Ringler Assocs. Inc., No. 20-1281, __, F.4th __, 2021 WL 3556473 (2d Cir. Aug. 12, 2021) (Before Circuit Judges Walker, Sack, and Menashi).

This week’s notable decision demonstrates the uphill battle ERISA claimants face in litigation with insurers over their employee benefits, particularly where courts apply the highly deferential abuse of discretion standard. Here, because the court concluded that California’s ban on discretion was inapplicable to the claim of a New York resident, and the claim was governed by the old ERISA claims regulations of pre-January 2017, plaintiff’s defeat was assured. 
Continue Reading What a Difference Discretion Makes

In an April Fool’s day decision, the Eighth Circuit holds that (1) a policy anniversary is not a renewal and thus is insufficient to trigger a State ban on discretion, and (2) absent evidence of insufficient training or experience, an opinion from a nurse constitutes a full and fair review. 

This week the Eighth Circuit’s decision in Roebuck v. USAble Life, No. 19-1855, __F.3d__, 2021 WL 1216217 (8th Cir. Apr. 1, 2021) (Before Colloton, Gruender, and Grasz, Circuit Judges), clarified what triggers Arkansas’s ban on discretionary clauses. As in many states, an Arkansas regulation (“Rule 101”) prohibited the inclusion of discretionary clauses in insurance contracts. The purpose of Rule 101 was to prohibit the conflicts of interest that exist when an insurer responsible for paying disability income benefits has discretionary authority to decide what benefits are due. In effect, the invalidation of discretionary clauses required reviewing courts to apply the less deferential de novo standard of review. But did Rule 101 ban discretionary clauses in a policy that was issued prior to the enactment of the rule? The Eighth Circuit held it did not unless the policy had express language stating a renewal date after the rule’s effective date. 
Continue Reading A Policy Anniversary Is Not a Renewal Date