In most cases, denials of ERISA plan benefits by administrators who have been granted discretionary authority to interpret and apply the plan are reviewed under an abuse of discretion standard, and may only be reversed if the denial was arbitrary and capricious. Such deference, however, is not without limits, and there are circumstances in which
Standard of Review
Ninth Circuit Defers to Plan Design and Administrative Discretion on Bounds of Mental Health Coverage
By Joseph Clark, Seth Safra & Aaron Weiss on
A recent decision by the U.S. Court of Appeals for the Ninth Circuit (Wit et al. v. United Behavioral Health and Alexander et al. v. United Behavioral Health) exemplifies the challenge in balancing a desire to cover evolving treatments for mental health and substance abuse disorders against plan sponsors’ and insurers’ general authority…
Choice-of-Law Plan Provision Enforced As A Matter of Federal Common Law
By Russell Hirschhorn & Kyle Hansen on
The Tenth Circuit recently concluded that, as a matter of federal common law, a choice-of-law provision in a long-term disability insurance policy, which was part of the plaintiff’s employer’s ERISA plan, must be enforced because a “clear, uniform rule . . . is required to ensure plan administrators enjoy the predictable obligations and reduced administrative…
Best Practices in Administering Benefit Claims #8 – Facing Litigation of Benefit Claims
Up to now, our blog series has focused on best practices for implementing a plan’s claims and appeals procedure. We shift gears this week to see how following these best practices pays dividends if a participant’s (or beneficiary’s) claim is denied and the participant decides to pursue the claim for benefits in court (or, if…