Claims Processes and Standard of Review in ERISA Litigation
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2017.07.05 Substantial Compliance Suffices re Claims Procedures. The 8th Circuit held as follows in Cooper v. MetLife:
2017.03.20 Failure to Follow Claims Procedures Results in De Novo Review (2nd Cir.). Halo v. Yale Health Plan 819 F.3d 42 (2d Cir. 2016) essentially holds that an administrator must strictly comply with DOL claim regulations or lose the benefit of the arbitrary and capricious standard of review. That result occurred in Schuman v. Aetna Life Ins. Co. (D. CT 2017.03.20), and resulted in de novo review.
2016.07.25 ERISA Penalties - Not for Failing to Produce Relevant Emails, Etc. In Lee v. ING Group, the 9th Circuit held that --
2016.04.21 Burden Shifts to Employer re Corporate Form and Participant Records, in Benefit Claim Dispute. In Estate of Barton v. ADT, a 9th Circuit Panel held as follows, quoting here from the court's summary of its decision:
2016.02.17 Procedural Stumbles in Claim Processing do not trigger De Novo Review. In Messick v. McKesson, the 10th Circuit remanded a disability claim for second-stage review under the plan's claims procedures, because the employer's initial claim denial letter was sent to the wrong address. The court's decision began by noting that "not all procedural irregularities require de novo review," and went on to find as follows:
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