Explicit articulation of reasons for decisions

Lexology has posted a note by C. Mark Bongard (Of Counsel, Dinsmore & Shohl LLP, Lexington, KY), "A benefit claim denial must be more than a mere conclusion - a reminder from the 7th Circuit".

Have you ever had a benefit claim denied? If so, was the explanation thorough and well reasoned or did it state conclusions without explanation? A case from the 7th Circuit decided July 23, 2009 (Love v. National City Corporation Welfare Benefits Plan, No. 07 C 50048) reminds us that ERISA requires a claim denial to explain why the claim is denied. ... The Court [ruled] that both claim denials failed to meet the ERISA standard under the statute and Department of Labor regulations to provide specific reasons for the denial. Therefore, the plan's decision to deny benefits was arbitrary. ... The moral of this tale is that a little exposition can save some time and effort in the long run - and result in compliance with ERISA.

Many statutes and regulations require decision-makers (private or government) to articulate reasons for their decisions, especially when denying some benefit. This aspect of procedural justice provides a record for review - even if the only review available is political or press - and helps legitimate the system by offering some psychological satisfaction to the applicant. EMM