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
Claimant Entitled to Attorney’s Fees for Court-ordered Remand Despite Insurer’s Offer of Voluntary Remand
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 I want to highlight a couple of unpublished Ninth Circuit decisions, both of which reversed the district courts’ grants of summary judgment to the defendant plans in long-term disability matters.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