The Tenth Circuit upheld a claims administrator’s decision denying a claim for residential mental health treatment as not medically necessary. In so holding, the Court rejected plaintiff’s argument that the claims administrator’s refusal to produce data on its historical denial rates for mental health treatment warranted a de novo review because that information was not
arbitrary and capricious
Categorical Conflict of Interest Does Not Alter Standard of Review of Benefit Denials
By Neil V. Shah on
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 application of the arbitrary and capricious standard of review in the absence of a showing by the plaintiffs that the conflict actually affected the…
Plan Participant Waived Remedy for Untimely Benefits Determination
By Benjamin Flaxenburg on
The Seventh Circuit rejected a disability plan participant’s argument that an untimely decision denying his claim for long-term disability benefits warranted changing the standard of review from arbitrary and capricious to de novo. In so ruling, the Court explained that had plaintiff filed suit once the time for a timely decision had passed (because his…
Ninth Circuit Rules That Harmless Procedural Violation Does Not Alter Standard of Review
By Madeline Chimento Rea on
The Ninth Circuit held that a plan administrator’s failure to render a decision on a long-term disability benefits claim within the period mandated by the plan and ERISA did not alter the standard of review that the court should apply to the plan fiduciary’s decision concerning the claim. Plaintiff Isela Dimery received long-term disability benefits until Reliance Standard Life Insurance, the plan administrator and fiduciary, declined to continue paying the benefits.