ERISA declaration regarding future benefits

From time to time you may see ERISA benefit claimants seeking declarations from the Court regarding “future benefits.”

But there is that old rule, recently recognized again, that such claims should be dismissed because there is no “live case or controversy.”  

To highlight this point, here’s the recent case of  Peer v. Liberty Life Assurance Co.., __ Fed. Appx. __ (11th Cir. February 8, 2019)(“Absent an adverse benefits determination, there is no ripe claim before us.”)

FACTS: Peer brought a claim for ERISA-governed life insurance benefits. She sought (1) a ruling enforcing the Waiver of Premium benefit (this allows a covered person who become “Totally Disabled” while insured to remain eligible for coverage without paying premiums); and (2) a declaration as to “future eligibility of benefits—whether and how [Liberty] will handle her waiver of premium requests in the future.”

ISSUE: Can a Claimant Seek a Declaration of Future Benefits?

11th CIRCUIT COURT OF APPEALS HELD:  NO.

  1. Peer’s Waiver of Premium claim “was moot because Liberty reversed its initial adverse benefits determination and reinstated Peer’s coverage.” By doing so, “there is no further relief that the Court can award [Peer] on her claim for an award of the Waiver of Premium.”  Op. at 3.
  2. The Court denied Peer’s request to make a declaration regarding future benefits because there is no “live case or controversy.”  “Peer must first be deemed not  “Totally Disabled” and that decision must then be administratively reviewed by Liberty….  Absent an adverse benefits determination, there is no ripe claim before us.” Op. at 4-5.
  3.  The Court distinguished this case from Lamuth v. Hartford, 30 F. Supp. 3d 1036 (W.D. Wash 2014)(In Lamuth, the Claimant requested a declaration on a claim “that had been exhausted and repeatedly subject to dispute” involving application of the Pre-existing Condition Limitation). Op. at 4.