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Text of First Circuit Opinion: Plan Language Was Not Sufficient to Grant Discretionary Authority to Claims Administrator (PDF)
U.S. Court of Appeals for the First Circuit Link to more items from this source
Feb. 19, 2016
19 pages. "[A] grant of discretionary decisionmaking authority in an ERISA plan must be couched in terms that unambiguously indicate that the claims administrator has discretion to construe the terms of the plan and determine whether benefits are due in particular instances.... The phraseology that BCBS chose to use in the Certificate to describe its decisionmaking authority is capable of supporting reasonable differences of opinion as to the nature and extent of the authority reserved to BCBS.... [T]hat phraseology is insufficiently distinct to constitute a clear grant of discretionary decisionmaking authority." [Stephanie C. v. Blue Cross Blue Shield of Massachusetts HMO Blue, Inc., No. 15-1531 (1st Cir. Feb. 17, 2016)]

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