California Insurance Litigation Blog

California Insurance Litigation Blog

Category Archives: Standard of Review

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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

California District Court Rules That a Treating Physician’s Observations are “More Persuasive” Than a Paper Reviewer’s Contrary Opinions

Posted in Case Updates, Disability Insurance, ERISA, Standard of Review
When reviewing a claim for disability insurance, insurers and other claim administrators often rely on the opinions of paid physicians to support their improper denial decisions.  For example, a disability insurance company will hire a doctor to conduct a “paper review” – that is, reviewing an insured’s medical records, without actually examining the insured – … 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

In an ERISA Case, What Actions Will Reduce the Level of Discretion Afforded the Claims Administrator/Insurer?

Posted in ERISA, Insurance Questions and Concepts, Standard of Review
This article continues our series of articles answering basic questions about insurance law and the Employee Retirement Income Security Act of 1974 (commonly referred to as “ERISA”).  This one addresses:  In a lawsuit governed by ERISA, what actions taken by the claims administrator (usually an insurance company such as Blue Cross/Blue Shield or CIGNA) will … Continue Reading

California Bans the Inclusion of Policy Provisions Giving Insurance Companies Discretionary Authority to Decide Claims

Posted in ERISA, Insurance Commissioner, Legislation, News, Standard of Review
In a major victory for consumers, Governor Jerry Brown signed a bill that makes discretionary clauses – typically contained in ERISA-governed life, health and disability insurance policies/ERISA plans void and unenforceable in new or renewed policies.  SB 621 was authored by Senate Insurance Committee Chair Ron Calderon (D-Montebello) and sponsored by Insurance Commissioner Dave Jones, … 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

Governor Schwarzenegger Vetoes AB 1868 That Would Have Banned Discretionary Clauses in Group Insurance Policies

Posted in ERISA, Legislation, News, Standard of Review
Today Governor Schwarzenegger vetoed AB 1868 that would have banned discretionary clauses in group insurance policies.  This is a disappointment to consumer groups but not to insurers who rely on them.  Currently, the Department of Insurance bans them in group policies anyway.  Here are the Governor’s comments on why it was vetoed: To the Members … Continue Reading

Disability Policy Discretionary Clauses Come Under Congressional Attack

Posted in ERISA, Legislation, News, Standard of Review
Policyholder/Employee groups who have group disability insurance coverage through their employers and who find themselves operating in the byzantine world of ERISA have long criticized discretionary clauses contained in such ERISA policies.  These often have the effect of giving insurance companies firmer ground to support claim denials because the “abuse of discretion” standard of review … 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