Apr 27, 2017
Last week I fulminated about the Seventh Circuit's Semien decision. Among other things, I was troubled by the language in that case suggesting that the federal judiciary did not have the ability to meaningfully review denials of ERISA claims by insurers or self funded plans. As the Semien court states: "Congress has not provided [the federal judiciary] with the statutory authority, nor the judicial resources, to engage in a full review of the motivations behind every plan administrator’s discretionary decisions." Slip opinion, p. 17.
I said, with some indignation, that this was nonsense and was contrary to the language of the statute. Since then I've come across a statement from the Supreme Court that puts the matter to rest. In Rush Prudential HMO v. Moran, the Supreme Court states:
"Whatever the standards for reviewing benefit denials may be, they cannot conflict with anything in the text of the statute, which we have read to require a uniform judicial regime of categories of relief and standards of primary conduct, not a uniformly lenient regime of reviewing benefit determinations.
. . . Not only is there no ERISA provision directly providing a lenient standard for judicial review of benefit denials, but there is no requirement necessarily entailing such an effect even indirectly. "
You can't reconcile the language of the Seventh Circuit in Semien with the language of the Supreme Court in Rush Prudential. And we all know which Court is preeminent.
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