News & Analysis as of

Abuse of Discretion Employee Retirement Income Security Act

King & Spalding

Federal District Court Rules United Unlawfully Denied Coverage for Mental Health and Substance Use Disorder Services Based on...

by King & Spalding on

On March 5, 2019, Chief Magistrate Judge Joseph C. Spero of the U.S. District Court for the Northern District of California ruled that United Behavioral Health (UBH), a subsidiary of UnitedHealth Group, violated its fiduciary...more

Proskauer - Employee Benefits & Executive...

Categorical Conflict of Interest Does Not Alter Standard of Review of Benefit Denials

The Second Circuit held that plaintiffs’ allegations that the defendant suffered from a “categorical potential conflict of interest”—because it both funded the plan and was the claim’s decision-maker—did not affect the...more

Saul Ewing Arnstein & Lehr LLP

The Friday Five: Five Current ERISA Litigation Highlights – February 2019

This month's Friday Five brings a quartet of court of appeals decisions: a pair from the Ninth Circuit relating to standard of review, an Eighth Circuit decision upholding a mental illness limitation, and a Sixth Circuit case...more

White and Williams LLP

Cross-Plan Offsetting to Recoup Overpayments to “Out-Of-Network” Providers Held Unreasonable

by White and Williams LLP on

In an opinion filed on January 15, 2019, the Eighth Circuit Court of Appeals upheld the district court’s ruling that UnitedHealth Group’s practice of recovering overpayments made to “out-of-network” providers from one plan by...more

Lane Powell PC

ERISA: Easy Insights into Neutralizing the Effects of “Conflict of Interest” in Disability Determinations

by Lane Powell PC on

You already know that many ERISA plans contain discretionary language, which calls for a court to review the ERISA claim denial under an abuse of discretion standard. But many times a structural “conflict of interest” can...more

Spilman Thomas & Battle, PLLC

ERISA & Employee Benefits Alert: October 2018

Welcome to the first edition of ERISA & Employee Benefits Alert. Our ERISA and Managed Care Group will be providing curated insights and news concerning notable ERISA and managed care issues that highlight current or emerging...more

Holland & Knight LLP

Eighth Circuit Upholds ESOP Administrator's Decision on Death Benefit Claim

by Holland & Knight LLP on

• The U.S. Court of Appeals for the Eighth Circuit has affirmed a U.S. District Court's application of deferential standard to the review of an employee stock ownership plan (ESOP) administrator's decision based on broad...more

Winstead PC

Bullet Proofing Your Claims Procedures

by Winstead PC on

Managing your plan’s claims procedures to avoid successful challenges requires careful attention to all of the requirements in the regulations and in the applicable plan’s or policy’s terms and continual review in light of...more

Kilpatrick Townsend & Stockton LLP

A Recent 5th Circuit ERISA Decision is Not as Far Reaching as it Appears

To reduce the cost of maintaining an ERISA plan and reduce the expense of ERISA litigation, it is helpful to have courts both apply a deferential standard of review and limit the review to the administrative record. If an...more

Lane Powell PC

ERISA: How to Argue that “Conflict Discovery” Should Not Supplement the Administrative Record

by Lane Powell PC on

You know that in ERISA claims where the court is applying the abuse of discretion standard, the court may allow “conflict discovery.” This might include discovery of claims manuals, for example....more

Hodgson Russ LLP

Third Circuit Upholds Penalty Imposed on Plan Administrator for Failure to Provide Documents

by Hodgson Russ LLP on

A plan administrator is required by the Employee Retirement Income Security Act of 1974 (ERISA) to disclose certain governing documents and records within 30 days of receiving a written request....more

Seyfarth Shaw LLP

Timing is Everything: Tenth Circuit Overturns Insurer’s Disability Decision as Arbitrary and Capricious

by Seyfarth Shaw LLP on

Even when a claims administrator approves a claim for disability benefits, its job is not done. That principle was again demonstrated in the recent case Owings v. United of Omaha Life Insurance Co., No. 16-3128 (10th Cir....more

Lane Powell PC

ERISA: Discovery of Claims Procedures to Assess Compliance with DOL Regulations? Not So Fast.

by Lane Powell PC on

You know that failing to follow Department of Labor (DOL) claims regulations can result in the court using the de novo review standard, rather than the abuse of discretion standard in reviewing claim decisions....more

Carlton Fields

Fifth Circuit Vacates Settlement Approval in ERISA Class Action, Remanding With Instructions to Reexamine the Legitimacy of...

by Carlton Fields on

The Fifth Circuit recently vacated a class action settlement that included unsecured and uncollateralized future payments to the plaintiffs, while providing a swift and complete payout of fees to class counsel. The case...more

Seyfarth Shaw LLP

Plotting A Course To Defeat Claims Of Insurer Bias

by Seyfarth Shaw LLP on

Seyfarth Synopsis: In a strong decision for insurers, the Eighth Circuit affirmed summary judgment for the administrator, rejected plaintiff’s conflict of interest argument, and found that it was not arbitrary for the...more

Lane Powell PC

ERISA Plan Choice-of-Law Provisions: Dog Whisperer’s Disability Claim Reviewed Under Abuse of Discretion Standard of Review

by Lane Powell PC on

An issue dogging claims administrators is: What effect do choice-of-law provisions have on the standard of review of ERISA benefit decisions?...more

Seyfarth Shaw LLP

Fifth Circuit: Discretionary Ban Does Not Mandate De Novo Review

by Seyfarth Shaw LLP on

In Ariana M. v. Humana Health Plan of Texas, Inc., No. 16-20174 (5th Cir. Apr. 21, 2017), the Firth Circuit concluded that Texas’ ban on discretionary clauses in certain insurance policies did not require a de novo review of...more

Proskauer Rose LLP

The ERISA Litigation Newsletter - October 2016

by Proskauer Rose LLP on

Editor's Overview - This month, we look at the implications of the two federal district court cases from California that applied the ban on discretionary clauses typically found in ERISA plans to self-insured plans. The...more

Nossaman LLP

Long Term Disability Payments: Standard for Abuse of Discretion

by Nossaman LLP on

Insurance for long term disability – payments to an insured who is prevented from earning his or her income due to long term disability – is a fruitful field for litigation for many reasons. Though the insurance may be...more

Jackson Lewis P.C.

“Off the Rails:” A Plan Administrator’s Burden

by Jackson Lewis P.C. on

When an ERISA plan provides the plan administrator with discretion to interpret the terms of the plan, the administrator’s claims and appeals decisions are generally reviewed by courts under a lenient standard of review such...more

Lane Powell PC

ERISA (6th Circuit): Mental Nervous Limitations and Dealing with Arguments of “Organic Cause”

by Lane Powell PC on

You know that most ERISA disability plans contain a 24-month limitation related to mental/nervous disabilities. But what happens when the claimant alleges the mental illness is “organically caused”? Is that enough to...more

Lane Powell PC

ERISA: Sixth Circuit — No Conflict of Interest with Multi-Employer Benefit Plan, Saving Abuse of Discretion Standard of Review

by Lane Powell PC on

You already know that evidence of a “conflict of interest” can change the standard of review the court applies in ERISA claims. But proper structuring of multi-employer benefit plans can avoid an inherent conflict of...more

Lane Powell PC

ERISA — 10th Circuit: What Happens When a “Procedural Irregularity” Occurs in an Appeal Denial?

by Lane Powell PC on

You know that procedural irregularities in an appeal denial of a claim for ERISA-governed benefits can change the standard of review from arbitrary and capricious to de novo review. But not all the time. The claimant should...more

Jackson Walker

Fifth Circuit Upholds ERISA Disability and Life Benefit Denials

by Jackson Walker on

In two decisions issued last month, the Fifth Circuit upheld ERISA plan denials of disability and life benefits, confirming its deferential approach in most ERISA benefit cases....more

Lane Powell PC

ERISA: When Does A Claimant Get To “Augment” The Administrative Record?

by Lane Powell PC on

You already know that judicial review of ERISA claims generally will be limited to the administrative record considered by the claim administrator. But the courts will allow claimants to augment the record if ERISA...more

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JD Supra Privacy Policy

Updated: May 25, 2018:

JD Supra is a legal publishing service that connects experts and their content with broader audiences of professionals, journalists and associations.

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Information for EU and Swiss Residents

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Privacy Officer
JD Supra, LLC
10 Liberty Ship Way, Suite 300
Sausalito, California 94965

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California Privacy Rights

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Privacy Officer
JD Supra, LLC
10 Liberty Ship Way, Suite 300
Sausalito, California 94965

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Changes in Our Privacy Policy

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Contacting JD Supra

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How We Use Cookies and Other Tracking Technologies

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Updates to This Policy

We may update this cookie policy and our Privacy Policy from time-to-time, particularly as technology changes. You can always check this page for the latest version. We may also notify you of changes to our privacy policy by email.

Contacting JD Supra

If you have any questions about how we use cookies and other tracking technologies, please contact us at: privacy@jdsupra.com.

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