Evaluating Benefits Determination Decisions For ERISA Conflicts Of Interest

by on
in Human Resources

Conflicts of interest in benefits decisions under the Employee Retirement Income Security Act (ERISA) have taken on a new life with extended risks for plan administrators. The Tenth Circuit recently established guidelines for plan administrators when a conflict exists between administering the plan and making benefits payment decisions.

 

Case Of Conflict

An employee was enrolled in her company's long-term disability plan in which the carrier was both the plan administrator and payor of claims. The carrier denied her claims for disability benefits because of a preexisting condition.

 

The employee appealed the benefit decision, supported by a formal request and letters from three doctors, but the carrier again denied the claim. She then sued the carrier for violating ERISA by denying her claim. A district court ruled that the carrier appropriately applied ERISA's "arbitrary and capricious standard of review"...(register to read more)

To read the rest of this article you must first register with your email address.

Email Address:

Related Articles...

    No matches

Leave a Comment