Monday, November 18, 2013

4th Cir: "Proof Satisfactory to the Administrator" = De Novo Review of Benefit Claims

Scales-redThanks to friend of the blog, Jon Harkavy, for sending along this potentially important ERISA denial of benefit claim case from the 4th Circuit.

In Cosey v Prudential, (4th Cir. Nov. 12, 2013), the Fourth Circuit held that the common plan formulation "proof satisfactory to the administrator" does not unambiguously confer discretion on the administrator and thus subjects the administrator's decisions to de novo judicial review (as opposed to arbitrary and capricious review under the Firestone/Glenn standard).  

Like Jon, I find this decision interesting, as it has the potential to cut back on the abuse-of-discretion standard of review for many ERISA plans.  However, I suspect that in response to this Court's decision, we are likely to see many plan amendments adding language which more unambiguously states the plan's intention to get the benefit of Firestone discretionary review for its benefit determination decisions.

PS

http://lawprofessors.typepad.com/laborprof_blog/2013/11/4th-cir-proof-satisfactory-to-the-administrator-de-novo-review-of-benefit-claims.html

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