California Insurance Litigation Blog

California Insurance Litigation Blog

Category Archives: Abuse of Discretion

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Third-Party ERISA Administrator Abused Discretion by Denying Medical Coverage: A Tale of What Not to Do

Posted in Abuse of Discretion, Administrative Record, Conflict of Interest, ERISA, Fiduciary Duty, Health Insurance, Standard of Review
Sometimes an administrator so unashamedly abuses its discretion in handling an insurance claim that its actions constitute a textbook example of “what not to do” for other administrators and the ensuing decision provides a clear illustration of how courts apply an abuse of discretion standard of review under the Employee Retirement Income Security Act (“ERISA”).  … Continue Reading

Ninth Circuit Emphasizes Need for an Insurer to Have a Meaningful Dialogue With the Claimant When Denying Benefits

Posted in Abuse of Discretion, ERISA, Health Insurance
A recent Ninth Circuit Court of Appeals decision reaffirmed the need for plan administrators to state the reasoning behind their denial of coverage.  In Lukas v. United Behavioral Health,  __ F.3d __, 2013 U.S. App. LEXIS 1230 (9th Cir. Jan. 17, 2013) the Ninth Circuit was faced with evaluating whether the district court properly weighed … Continue Reading

Can an ERISA Claims Administrator Engage in Post-Trial Discovery Regarding Benefit Issues? No, Says District Court

Posted in Abuse of Discretion, Attorneys Fees, Case Updates, Disability Insurance, Discovery, ERISA
In what may be a matter of first impression, Judge Cormac J. Carney of the United States Federal District Court for the Central District of California denied Sun Life and Health Insurance Company’s Objections to Proposed Judgment in an ERISA long-term disability insurance claim case handled by McKennon Law Group PC.  As detailed here, Robert … Continue Reading

McKennon Law Group Wins Disability Insurance Lawsuit Against Sun Life And Health Insurance Company Following Trial

Posted in Abuse of Discretion, Conflict of Interest, Disability Insurance, ERISA, News, Standard of Review
On November 27, 2012, following a trial before Judge Cormac J. Carney of the United States Federal District Court for the Central District of California, Robert J. McKennon and Scott E. Calvert of the McKennon Law Group secured a victory for their client in a lawsuit against Sun Life and Health Insurance Company.  Representing the … Continue Reading

Ninth Circuit Rules that California’s Mental Parity Act Requires Health Insurers to Pay for Certain “Medically Necessary” Treatment for Mental Illnesses

Posted in Abuse of Discretion, Case Updates, ERISA, Health Insurance
In an important decision, the Ninth Circuit Court of Appeals ruled that California’s Mental Health Parity Act (“Parity Act” ) requires that health insurers cover certain medically necessary treatment for certain mental illnesses, even if the insurance policy explicitly excludes such coverage.  In Harlick v. Blue Shield of Calif., __ F.3d __ (9th Cir.  August … Continue Reading

Claim Administrator’s Failure to Contact Treating Physicians Found To Be An Abuse Of Discretion Under ERISA

Posted in Abuse of Discretion, ERISA
Under ERISA, insurers/claim administrators are required to give every insurance claim a full and fair review. Courts in the Ninth Circuit have construed this requirement in a manner that requires insurers/claim administrators to do more than simply have an in-house physician or nurse conduct a paper review of medical records.  This trend continues with the … Continue Reading

Ninth Circuit Clarifies ERISA’s Full and Fair Review Standard by Imposing New Requirements on Plan Administrators in Salomaa Case

Posted in Abuse of Discretion, ERISA
ERISA requires that an administrator provide a claimant with a “full and fair” review of a denial decision.  In a recent ruling entitled Salomaa v. Honda Long Term Disability Plan, __ F.3d __, 2011 U.S. App. LEXIS 4386 (9th Cir. Cal. Mar. 7, 2011) the Ninth Circuit Court of Appeals imposed a new requirement that … Continue Reading

In ERISA Cases, The Standard of Review Really Does Matter

Posted in Abuse of Discretion, De Novo Review, ERISA, Standard of Review
The Thursday December 1, 2010 edition of the Los Angeles Daily Journal featured the article co-written by Robert J. McKennon and M. Scott Koller, entitled “In ERISA Cases, The Standard of Review Really Does Matter,” in the Perspective column. It explains why it is important to identify and appropriately utilize the Standard of Review in ERISA cases.  The article is posted below with … Continue Reading

ERISA Claimant Retains Burden of Proof For Establishing Disability Under a De Novo Standard of Review

Posted in Abuse of Discretion, Case Updates, De Novo Review, ERISA
The question of who has the burden of proof can often decide the outcome of litigation.  Given its importance, it is common to see litigants attempt to shift that burden to the opposing side in order to secure a tactical advantage.  Recently, in Muniz v. Amec Construction Management Inc., __ F.3d __, 2010 WL 4227877 … Continue Reading

Under ERISA , Procedural Deficiencies Not Considered When the Standard of Review is De Novo

Posted in Abuse of Discretion, Case Updates, De Novo Review, Disability Insurance, ERISA
Litigation pursuant to the Employee Retirement Income Security Act (“ERISA”) is rather unique.  Unlike most cases, ERISA disputes are based on a limited scope of permissible evidence.  The range of that scope is ultimately dependent on which standard of review is employed by the courts.  Typically, when the standard of review is abuse of discretion, … Continue Reading

What Does a Deferential Standard of Review Mean in ERISA Cases? The U.S. Supreme Court Gives Some Clarification

Posted in Abuse of Discretion, Case Updates, ERISA, News
The federal courts have for a long time struggled with how to apply the deferential standard of review to actions taken by ERISA plan administrators in light of the United States Supreme Court holding in Firestone Tire & Rubber Co. v. Bruch, 489 U.S. 101 (1989).  Firestone held that an ERISA plan administrator with discretionary … Continue Reading

District Court Applies Abuse of Discretion Standard of Review After Montour

Posted in Abuse of Discretion, Case Updates, Conflict of Interest, ERISA, News, Standard of Review
Recently, in Montour v. Harford Life & Accident, 582 F.3d 933 (9th Cir. 2009), the Ninth Circuit Court of Appeals, in one of its most important cases, adopted a new standard of reviewing ERISA abuse of discretion cases where the insurer has a conflict of interest.  The court held that a “modicum of evidence in … Continue Reading

“Top Hat” ERISA Plans Are Not Entitled To Special Treatment

Posted in Abuse of Discretion, Case Updates, Conflict of Interest, Disability Insurance, ERISA, News
The Ninth Circuit recently addressed, for the first time, whether the standard of review analysis for “top hat” ERISA plans is the same as for other ERISA plans.  In Sznewajs v. U.S. Bancorp Amended and Restated Supplemental Benefits Plan, 572  F.3d 727 (9th Cir. 2009), Franciene Sznewajs, the ex-wife of co-defendant Robert Sznewajs, challenged the Plan’s decision … Continue Reading

Ninth Circuit Clarifies Application of Abuse of Discretion Review When Insurer Has a Conflict of Interest

Posted in Abuse of Discretion, Case Updates, Conflict of Interest, Disability Insurance, ERISA, News
After the United States Supreme Court decided MetLife Ins. Co. v. Glenn in which the Court held that a reviewing court must consider the conflict of interest arising from the dual role of an insurer acting as a plan administrator and payor of plan benefits as a factor in determining whether the insurer abused its … Continue Reading