Noga v. Fulton Fin. Corp. Emp. Benefit Plan, No. 19-3855, __ F.4th __, 2021 WL 5540848 (3d Cir. Nov. 26, 2021) (Before Circuit Judges Ambro, Krause, and Phipps).

Attorneys who represent benefit plan participants have an uphill battle. Because the courts are often deferential to the decisions of plan administrators – using the abuse of discretion standard of review – participants often have to prove not only that the decisions denying their benefit claims were wrong, but also that they were “unreasonably wrong.”

One way a participant can chip away at this standard is to demonstrate that the administrator has a conflict of interest, or that it handled the claim in a way that calls into question its impartiality. However, it can be difficult to know what kinds of procedural errors are worth highlighting, as a substantial mistake in front of one judge can be a harmless error in front of another. In this published opinion, the Third Circuit has given practitioners some guidance on this issue. Continue Reading Third Circuit Rules That Reliance Standard’s Conflict of Interest and “Irregular” Claim Handling Led to Unreasonable Claim Denial

Santos v. Minn. Life Ins. Co., No. 20-cv-06707-PJH,  2021 WL 5302950 (N.D. Cal. Nov. 15, 2021) (Judge Phyllis J. Hamilton). 

Mother of forensics, Frances Glessner Lee, created the Nutshell Studies of Unexplained Death as a teaching instrument for detectives to help them determine causes of death at crime scenes. Such a tool would have been instrumental in this case in determining whether decedent Samuel Chong’s death was an accident, suicide, or homicide, and consequently whether AD&D benefits ought to be paid to plaintiff Eva Marie Santos, Mr. Chong’s cousin and the administrator of the estate. During a well-being check by the San Francisco police, Mr. Chong was found dead “on the floor in the kitchen, near a table. The gas oven door was found open, but the oven was not in use. Blood (and dried vomit) was noted near his head.” The autopsy report listed the cause of death as blunt force head trauma with subdural hematoma. The manner of death was listed as an accident. The toxicology report found methamphetamine, amphetamine, and Temazepam in the decedent’s blood and urine.  Continue Reading Long-Term Meth User Could Not Have Foreseen Death

Jette v. United of Omaha Life Insurance Co., No. 20-1719, __ F.4th __, 2021 WL 5231971 (1st Cir. Nov. 10, 2021) (Before Circuit Judges Howard and Thompson, and District Court Judge Raul Arias-Marxuach).

ERISA, as our readers know, requires that plan fiduciaries employ a “full and fair” claims procedure for reviewing benefit claims. But courts have grappled with what exactly this entails and specifically, whether this requires that a plan participant or beneficiary making a claim for benefits be given an opportunity to review and respond to medical reports before they are relied upon by the claims administrator to deny the claim. The answer from the First Circuit is a resounding “yes,” regardless of what version of the Department of Labor’s claims regulation applies. Continue Reading First Circuit Holds That Full and Fair Review Requires Timely Disclosure of All Relevant Documents