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Don Levit
11/17/2008 01:47 PM
Brian:
This is a very interesting case in that, at least in regards to disclosure, the insurer is a fidiciary.
That is actually kind of exciting.
Upon further review, however, while the insurer is a fiduciary, would this court still use the arbitrary and capricious standard for the denial of a claim?
My guess is yes, until Firestone is overturned.
While I was thinking of the conflict of interest, sliding scale, etc., I started to think, but what if the plan is self-funded?
Would that defeat the sliding scale issue and the conflict of interest that a for-profit insurer has?
Then, I remembered, probably not, for the employer has 2 hats: a fidiciary hat and a settlor hat.
At least in a fully insured plan, the insurer wears only the fiduciary hat.
Am I analyzing this correctly?
Can you opine as to how an insurer can be a fiduciary and be able to use the arbitrary and capricious standard?
Don Levit
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