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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  I want to highlight a couple of unpublished Ninth Circuit decisions, both of which reversed the district courts’ grants of summary judgment to the defendant plans in long-term disability matters.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

Good morning, ERISA Watchers!  It was quite the week for ERISA decisions and it was difficult to pick just one notable decision, but the winner is Griffin v. Hartford Life & Accident Ins. Co., No. 17-1251, __F.3d__, 2018 WL 3624872 (4th Cir. July 31, 2018).  The Fourth Circuit affirmed the district court’s determination that abuse of discretion, rather than de novo, applies to Hartford’s decision terminating long term disability benefits and its conclusion that Plaintiff failed to show that Hartford Life’s decision was unreasonable. 

On the standard of review, Griffin contended that the relevant plan documents gave Hartford Life full discretion to determine eligibility for benefits.  However, the decision to terminate his benefits was made by Hartford Fire Insurance Company, which is an affiliated corporation in The Hartford group of companies.  This was based on the W-2 tax forms for the Hartford employees who made the termination decision which showed that they were employees of Hartford Fire. 
Continue Reading Fourth Circuit Rules for Hartford Life In Long Term Disability Denial

I’m pleased to report that today’s notable decision, Ariana M. v. Humana Health Plan of Texas, Inc., No. 16-20174, __F.3d__, 2018 WL 1096980 (5th Cir. Mar. 1, 2018), is a case handled by our firm attorneys – Lisa Kantor, Peter Sessions, Elizabeth Green – and our esteemed colleagues, Jim Plummer and Amar Raval of Berg Plummer Johnson & Raval, LLP. 

Since 1991, the Fifth Circuit Court of Appeals, which presides over Texas, Mississippi, and Louisiana federal law, has administered a rule in employee benefit cases. That rule stated that federal courts were required to show deference to the factual findings of a benefit plan administrator, regardless of whether the benefit plan conferred such authority on the administrator. Pierre v. Conn. Gen. Life Ins. Co., 932 F.2d 1552 (5th Cir. 1991).
Continue Reading Fifth Circuit Overturns 25-Year-Old Precedent That Disadvantaged Plan Participants