You already know that plans that contain “discretionary language” should enjoy a more deferential review by the trial court.
But when the plan administrator decides and funds the benefit decision, courts view this as a “structural conflict” and impose additional expectations on the claims process.
Sometimes de novo review isn’t all bad.
Here’s the recent…
We all know that ERISA claim administrators must consider and weigh a claimant’s Social Security Administration (SSA) disability determination when deciding whether the claimant is “disabled.”
But what happens when the SSA’s favorable disability determination arrives after the Plan has denied the final appeal?
Do you have to reopen the claim to assess this…
