United Policyholders’ brief addressed the first question certified for review by the United States Supreme Court: “Whether an administrator that both evaluates and pays claims under a plan governed by the Employee Retirement Income Security Act (ERISA), 29 U.S.C. 1001 et seq., is operating under a conflict of interest that must be weighed on judicial review of a benefit determination.” The current regime of ERISA benefit adjudication under the arbitrary and capricious standard of review consists of no more than a lenient “administrative” review without any opportunity for trial proceedings or even the taking of discovery absent a preliminary showing that an actual conflict infected the claim determination. See, e.g., Semien v. Life Insurance Co. of North America, 436 F.3d 805 (7th Cir.); cert. denied 127 S. Ct. 53 (2006). That manner of adjudication, coupled with the limited remedies available under ERISA, enhances the danger of conflicted plan administrators’ misbehavior. UP argues that the Court should hold that when the insurer of employee benefits both determines the eligibility to receive benefits and is responsible for paying the benefits out of its own funds, a conflict exists that must be factored into the deference, if any, to be accorded the benefit claim determination.
Met Life vs. Glenn, Wanda
Court U.S. Supreme Court
Case Number 06-923
- United States
Court: U.S. Court of Appeals, 3rd Circuit
Case Number: 03-4363
ERISA should not preempt state insurance laws.
Court: Massachusetts District Court
Case Number: 05-2877
- Objective evidence of disability
Anti-consumer and anti-policyholder affects of denying coverage in disability cases involving both a disease that is difficult to document objectively and an overwhelming amount of medical evidence that favors a finding of complete disability. Long term care insurance companies are sometimes permitted too much discretion…
Court: U.S. Court of Appeals, 9th Circuit
Case Number: 04-15328
Participants and Beneficiaries suing on behalf of an ERISA plan under 502(a) (2) should be able to seek money from the plan in the same manner as a fiduciary. Petition for rehearing.
Court: U.S. Court of Appeals, 11th Circuit
Case Number: 01-10829-GG
Scope of ERISA preemption after Unum Life Insurance v. Ward. United Policyholders argued that remedial state statutes regulate insurance and should not be pre-empted by ERISA.