Roy Harmon has a comment
on a recent district court decision denying benefits to a claimant under an AD&D policy. The case, Dove v. The Prudential Life Ins. Co.,
2009 U.S. Dist. LEXIS 41896 (D. Kan. 2009), refers to Tenth Circuit precedent to determine how to analyze whether an insurer abuses its discretion in denying ERISA benefits. The precedent the court refers to, Weber v. GE Group Life Ass. Co.,
541 F.3d 1002, 1011 (10th Cir. 2008) identifies the four factors a court will typically consider as: "(1) the decision was the result of a reasoned and principled process, (2) is consistent with any prior interpretations by the plan administrator, (3) is reasonable in light of any external standards, and (4) is consistent with the purposes of the plan." Despite its citation to Weber
, the Dove
decision doesn't identify or meaningfully analyze these four factors.
I've blogged on a number
of previous occasions
about the scope of discovery in ERISA benefit denial cases, especially in light of Met Life v. Glenn
, 128 S.Ct. 2342 (2008). Another aspect of the discussion about the availability of discovery, at least in the Tenth Circuit, are these four factors identified in Weber
and other Tenth Circuit precedent. The first three factors seem to clearly contemplate the need for either the willingness of an insurer to provide information relating to these issues in the mandatory pre-litigation appeal process or discovery once in litigation. Does a claimant need to request information relating to these factors before llitigation begins? If not, can a claimant request that information for the first time in litigation?
It seems quite evident that if a claimant does request that information in the pre-litigation appeal process and is stonewalled (which is likely to occur), the claimant can conduct discovery on those issues in litigation. Otherwise, how could a court competently consider the identified factors? In light of the fiduciary duty obligations outlined in ERISA that apply to insurers who both administer and pay claims, a good argument can be made that the insurer has an obligation as part of its claims procedure obligations to provide information relating to these factors in its claims file regardless of whether the claimant specifically asks about these factors or not. At least, a fiduciary in the Tenth Circuit would be well advised to follow that practice.
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