In cases brought under the Employee Retirement Income Security Act, the standard of judicial review applied by the district court is critical to the outcome of the litigation, and when the district court makes factual findings, courts of appeals review those findings under the clear error standard. […]
The Employee Retirement Income Security Act permits aggrieved individuals whose employee benefit claims have been denied to bring a civil action to recover benefits claimed to be due […]
A concurrence to a Sept. 22 opinion issued by the U.S. Court of Appeals for the Fifth Circuit[1] in a case involving a health insurance raises serious concerns about the manner in which courts review benefit claim denials under the Employee Retirement Income Security Act […]
What is contra proferentem? Carlile v. Reliance Standard Life Insurance Co.[1] is a textbook illustration of the doctrine that construes ambiguities in insurance policies in favor of the insured and against the insurer. In February, the U.S. Court of Appeals for the Tenth Circuit affirmed a ruling by the U.S. District Court for the District […]
The most critical issue in Employee Retirement Income Security Act benefits litigation is the standard of judicial review applied by the courts. Under the deferential arbitrary and capricious standard of review, the court reviews a claim record compiled by the insurance company[1] to determine whether a claim denial was “downright unreasonable”[2] and not merely wrong. Because […]
In Ariana M v. Humana Health Plan of Texas, Inc., 2018 WL 1096980 (5th Cir. March 1, 2018), a divided Fifth Circuit issued an en banc ruling that finally overturned Pierre v. Conn. Gen. Life Ins. Co., 932 F.2d 1552 (5th Cir. 1991) and concurred with every other Circuit that Firestone Tire & Rubber Co. v. […]