This week’s notable decision demonstrates the difficulty of overcoming a district court’s de novo review on appeal in an ERISA case. Like many courts deciding mental health benefits under ERISA, the First Circuit concluded: “This case is not an easy one.” Doe v. Harvard Pilgrim Health Care, Inc., No. 19-1879, __F.3d__, 2020 WL 5405367 (1st Cir. Sept. 9, 2020).

The case previously reached the First Circuit in Doe v. Harvard Pilgrim Health Care, Inc., 904 F.3d 1 (1st Cir. 2018) (Doe I) which reversed the district court’s denial of Doe’s motion to expand the administrative record, vacated an order of summary judgment for Harvard Pilgrim, and remanded to the district court. 

Following remand, and under a de novo standard of review, the district court agreed with Harvard Pilgrim’s determination that continued residential treatment was not medically necessary. Doe appealed. Continue Reading First Circuit Rules in Favor of Harvard Pilgrim Health Care in Dispute Over Denied Residential Treatment Benefits

This week’s notable decision is Black v. Pension Benefit Guar. Corp., No. 19-1419, __ F.3d __, 2020 WL 5201400 (6th Cir. Sept. 1, 2020). Plaintiffs in this case were retirees of Delphi Corporation, an automotive parts supplier and former subsidiary of General Motors. In 2005, Delphi filed for bankruptcy and sought to terminate its pension benefit plan for its salaried workers, including Plaintiffs. The Pension Benefit Guaranty Corporation (“PBGC”) then stepped in and notified Delphi that while it agreed the plan should be terminated, it would seek to be appointed as statutory trustee of the plan. PBGC filed a new civil action to adjudicate termination and transfer of the plan. The bankruptcy court then confirmed Delphi’s bankruptcy plan, which terminated the pension plan. PBGC responded by voluntarily dismissing its civil action, after which it reached a termination and trusteeship agreement with Delphi.  Continue Reading Sixth Circuit Rules in Favor of PBGC in Dispute over Termination of Delphi Corporation’s Pension Plan

This week the Eighth Circuit’s decision in McIntyre v. Reliance Standard Life Ins. Co., No. 19-2367, __F.3d__, 2020 WL 4951028 (8th Cir. Aug. 25, 2020), clarified that when circumstances demand “less deferential review,” this cannot mean de novo review. Why? After all, de novo review is less deferential than abuse of discretion review and multiple Eighth Circuit opinions appeared to sanction this seemingly logical finding. 

After approving Plaintiff’s disability claim for two years, Reliance terminated Plaintiff’s long-term disability claim under the “any occupation” definition of disability. Plaintiff appealed and Reliance upheld its original determination. That finding that came almost seven months after the appeal was submitted—well outside the 90 days allowed. Plaintiff filed suit and the district court ruled in her favor under the de novo standard of review despite the Plan containing a grant of discretionary authority.  Continue Reading Eighth Circuit Jettisons Prior Circuit Precedent Holding that Procedural Irregularities Can Justify a De Novo Standard of Review