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District Court Provides Roadmap for Opposing Grant of Attorney Fees Even When Court Grants Benefit Claim

"Should plaintiffs always recover attorney fees when the ultimate decision to deny benefits 'was a close call' …and both sides' positions had merit? No. And this new case explains the point." [Messing v. Provident Life and Accident Ins. Co., No. 20-0351 (W.D. MI Aug. 25, 2023)]

Sixth Circuit: Responding to Procedural Objections to Claim Procedures

"This new case highlights the arguments Plaintiffs' may make in challenging claims handling, and how the Sixth Circuit rejected those arguments." [Avery v. Sedgwick Claims Management Services, Inc., No. 22-1960 (6th Cir. July 24, 2023; unpub.)]

Sixth Circuit Describes Plaintiffs' High Burden of Proof to Establish 'Continuous' Disability During the Elimination Period

"This new Sixth Circuit case explains: the very high burden of proof a Plaintiff must meet to establish 'continuous' disability during the Elimination Period; and when medical evidence obtained after the Elimination Period cannot satisfy the Plaintiff's burden to prove disability during the Elimination Period." [Tranbarger v. Lincoln Life & Annuity Co. of New York, No. 22-3369 (6th Cir. May 18, 2023)]

How Much Weight Do Independent Doctor Paper Reviews Get, and Should Rule 52 Bench Trials Be Used to Resolve De Novo Review Cases

"A new case highlights that, in cases applying de novo review, Rule 52 bench trials should be used -- especially when there are factual debates on the diagnosis or severity of impairment of a claimant.... [The case also] highlights that Independent Medical Exams (IME) may be needed more frequently, at least in the Fourth Circuit, due some overly broad language in the opinion concerning the weight to be given 'paper reviews.' " [Tekmen v. Reliance Standard Life Ins. Co., No. 20-1510 (4th Cir. Dec. 16, 2022)]

Ninth Circuit: Why Denial Letters Must Include All Rationale to be Asserted in Litigation

"[T]his new Ninth Circuit decision indicates for the first time that it is 'clear error' for a district court to adopt 'newly presented rationale when applying de novo review.' Even rationale focused on a claimant's credibility must be affirmatively stated in the claim denial, if considered, or it will be deemed a 'newly presented rationale' and must be excluded from consideration by the district court if asserted in the litigation." [Collier v. Lincoln Life Assurance Company of Boston, No. 21-55465 (9th Cir. Nov. 21, 2022)]

Ninth Circuit: Denial Letters Must Include All Rationale to Be Asserted in Litigation

"[T]his new Ninth Circuit decision indicates for the first time that it is 'clear error' for a district court to adopt 'newly presented rationale when applying de novo review.' Even rationale focused on a claimant's credibility must be affirmatively stated in the claim denial, if considered, or it will be deemed a 'newly presented rationale' and must be excluded from consideration by the district court if asserted in the litigation." [Collier v. Lincoln Life Assurance Company of Boston, No. 21-55465 (9th Cir. Nov. 21, 2022)]

Fifth Circuit: District Court Must Remand Claim Back to the Administrator

"Sometimes an ERISA-governed disability benefit claim is denied on a specific issue that precludes the need for a full development of the record on the merits of the claim. E.g., claimant was not eligible for benefits because he was not a full-time employee at the time of disability. But when should courts order remand, after determining the claimant may be eligible for benefits? This new decision provides some helpful guidance." [Newsom v. Reliance Standard Life Ins. Co., No. 20-1994 (5th Cir. February 18, 2022)]

Responding to ERISA Claims: Why You Should Bring Rule 52 Motions Instead of Rule 56 Summary Judgment Motions

"[A] new case highlights why Rule 52 motions may be the preferred motion to efficiently resolve ERISA benefit claims.... In most circuits, with cases involving de novo review, the safer practice is to bring Rule 52 motions for judgment, which allows the court to assess the weight and credibility of the evidence and requires the court to issue findings of fact and conclusions of law." [Avenoso v. Reliance Standard Life Ins. Co., No. 21-1772 (8th Cir. Nov. 30, 2021)]

Fifth Circuit: Plan Administrators Do Not Waive Exclusions That Develop as a Result of Court Decisions Affecting the Disability Claim

"What happens when an ERISA-governed disability claim is denied solely under the 'own occupation' provision, but a reviewing district court concludes the claimant is entitled to 'own' occupation benefits? Does an insurer 'waive' an evaluation of the 'any occupation' provision because the insurer denied the claim solely on the 'own occupation' standard? ... Can the district court evaluate and award continued benefits under the 'any occupation' standard when the insurer has not yet made that assessment?" [Martinez v. Standard Ins. Co., No. 20-10475 (5th Cir. Oct. 5, 2021; unpub.)]

District Court Finds Repeated Calculation Errors Do Not Involve 'Fiduciary Duties'

"[W]hen Aetna discovered its repeated calculation errors and overpayment, it began reducing monthly payments to Morris. Morris sued alleging she was entitled to the higher benefit, and also asserted an ERISA 502(a)(3) claim seeking equitable remedies, like estoppel and waiver, claiming Aetna breached its fiduciary duties to her." [Morris v. Aetna Life Ins. Co., No. 20-821 (C.D. Cal. Aug. 9, 2021)]