This month’s Friday Five covers cases relating to personal liability of medical reviewers, when notice violations arise to a claim for relief, how plans must delegate discretionary authority, the rights of plans to terminate benefits, and when fee shifting might not be appropriate on a decision to remand a claim to the administrator.

1. Medical Reviewer Cannot Be Personally Liable for a Denial of Benefits. The plaintiff, proceeding pro se, sued a number of parties related to the termination of her disability benefits. The court dismissed the plaintiff’s state law claims as preempted by ERISA and also determined that the insurer lacked sufficient contacts with the judicial district to render it an appropriate venue. The court further dismissed an independent reviewing physician as a defendant because his only tie to the case (and the denial of benefits) was his engagement by the insurer to provide a medical opinion. As such, absent some role as an administrator or fiduciary under the plan, the physician was an improper party. McCurry v. Mars, Inc., No. 19-4067, 2020 WL 6075872 (N.D. Ill. Oct. 15, 2020).
2. Alleged Notice Violations Without Related Harm Do Not Support an ERISA Claim. In addition to various other grievances with the benefits review process and decisions during the same, the plaintiff asserted that the correspondence related to his claim violated a number of ERISA notice requirements. On summary judgment, the court found, even if there were some technical violations of the notice provision, no resulting harm was incurred. Absent a showing of harm related to the alleged notice missteps, or that an alternative communication would have resulted in a different result on the benefits claim, the court found that the administrator at least substantially complied with the notice provisions, and dismissed the plaintiff’s theory claiming to the contrary. Siebert v. Central States Southeast and Southwest Areas Health and Welfare Fund, No. 18-6681, 2020 WL 6158919 (N.D. Ill. Oct. 21, 2020).
3. Strict Compliance With Plan Procedures Required in Order to Properly Delegate Discretionary Authority to Claims Administrator. In a recent dispute regarding the appropriate ERISA standard of review in an AD&D case, the court rejected the insurer’s attempts to rely on a summary plan description, which did not restrict the method by which discretionary authority could be communicated to the insurer. The summary plan description was seemingly at odds with other plan documents, which provided specific procedures to delegate discretionary authority, including a formal writing and vote. The court found that the plan documents trumped the summary plan description and, absent proof that the explicit procedures for delegation in the plan were followed, no delegation was established. This resulted in the court applying the de novo standard of review. Hampton v. National Union Fire Insurance Company of Pittsburgh, No. 18-6725, 2020 WL 5946967 (N.D. Ill. Oct. 7, 2020).
4. Insurer Able to Terminate Life Insurance Benefits Per Plan Documents Without Incurring Liability. In two consolidated class actions, retirees sued after their company stopped paying premiums on life insurance policies, which resulted in a lapse in coverage. The underlying plan documents, however, expressly stated that the retirees had no current or vested interest in the plan benefits, while the company expressly reserved the right to amend, modify, or terminate the terms of the plan at any time. Under this clear language, because the retirees had no lifetime promise of benefits or other vested right, the court determined that summary judgment in favor of the company was appropriate. Turner v. Allstate Insurance Company, No. 13-685, 2020 WL 5831791 (M.D. Ala. Sept. 23, 2020).
5. Fee Shifting Deemed Not Appropriate on Remand to the Administrator. Normally, at least when some success on the merits is achieved, successful plaintiffs in ERISA disability actions are entitled to reimbursement of attorney’s fees. However, in a recent case, the court found that while the denial of the plaintiff’s LTD claim was generally well-supported, there were certain procedural irregularities which warranted a remand to the administrator. For example, the administrator failed to consider the cumulative effects of the claimed conditions, and also failed to address certain vocational requirements. Following the remand decision, the court further determined that the circumstances warranting the remand did not represent a sufficient success on the merits to further entitle the plaintiff to fee shifting, particularly because the court refused to grant the relief requested by the plaintiff on summary judgment and the remaining holes in the plaintiff’s case for benefits. Woolsey v. Aetna Life Insurance Company, No. 18-578, 2020 WL 5810198 (D. Ariz. Sept. 4, 2020).