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Semien v. Life Insurance Co. of
North America, 2006
U.S.App.LEXIS 2823 (7th Cir. 2/6/2006)(Issues: Standard of
Review, Discovery, Scope of Review).
It is very difficult for us to write about this case because
it is one of our cases and we feel that the ruling was
fundamentally wrong. This case involved a 54 year old
chemical engineer who had worked for BP Amoco until May 2000
when she began receiving disability benefits. After two
years, her benefits were cut off when LINA determined she
could return to work, even though plaintiff had submitted
substantial evidence pertaining to a host of medical and
psychiatric conditions which showed that she remained
disabled.
After submitting a substantial
package of additional evidence following the benefit
termination, the insurer had the file reviewed by a
psychiatrist, Dr. Jack Greener, who initially found Semien
incapable of performing her regular job, but who then wrote a
report finding the plaintiff could perform another job with
less stress. The file was also reviewed by Dr. Eddie Sassoon,
although the court acknowledged it was “unclear exactly what
information he reviewed” in preparing a two page report. Dr
Sassoon found Semien capable of working at a sedentary job;
and LINA also had a vocational counselor list several jobs the
plaintiff was capable of performing which could earn her more
than 80% of predisability earnings. Hence, the benefit denial
was affirmed.
The first issue considered by the
court was the appropriate standard of review. The court
affirmed the lower court’s determination that the summary plan
description was sufficient to confer discretionary authority,
even though the plan document itself named a different insurer
as the party possessing discretion. The court also cited to
the administrative services agreement, but completely
disregarded the fact that the ASA explicitly divested the
insurer of fiduciary responsibility. The ASA’s
description of administrative services reserved to the plan
administrator; i.e., BP Amoco (the entity specifically named
as plan admistrator) sole fiduciary responsibility: “[T]he
plan Administrator shall be the fiduciary designated under
ERISA regulations for the determination of appealed claims and
that in this process LINA shall serve solely as Plan
Administrator’s agent to coordinate and facilitate the appeal
process.” (R. 20 Part IV Tab C, Schedule A at 3).
The Seventh Circuit acknowledged that other circuits require
express delegation of discretionary authority:
Nelson v. EG & G Energy
Measurements Group, Inc.,
37 F.3d 1384, 1388-89 (9th Cir. 1994) (benefit decision by an
employee not explicitly given discretion is reviewed de novo);
Sanford v. Harvard Indus., Inc., 262 F.3d 590, 597 (6th
Cir. 2001) (when a "decision is made by a body other than the
one authorized by the procedures set forth in a benefits
plan," the standard of review is de novo); see also
McKeehan v. CIGNA Life Ins. Co., 344 F.3d 789, 793 (8th
Cir. 2003) ("Insurers are accustomed to de novo judicial
review of their decisions, and therefore we do not infer
discretionary authority when an employer or plan sponsor has
funded its obligations under an ERISA plan by purchasing a
standard-form group insurance policy. Rather, we require
'explicit discretion-granting language' in the policy or in
other plan documents to trigger the ERISA deferential standard
of review." (citations omitted)). Because we find that BP
provided LINA with an express delegation of discretionary
authority to act as plan administrator, we need not reach the
question of whether an implied delegation of authority would
be sufficient to shift discretionary authority from the
original plan administrator to an insurer. *12-*13.
Nonetheless, the court found that
discretion could be “inferred from a series of documents,”
citing Ruiz v. Continental Casualty Co., 400 F.3d 986
(7th Cir. 2005)(March 2005), but disregarding
the fact that Continental was explicitly named in the plan at
issue in that case as a party with discretionary authority.
The court also cited Ruiz for the proposition that LINA
was a “functional” fiduciary and therefore entitled to
discretion.
With respect to the merits of the
case, the court also upheld the district court’s entry of
summary judgment in the insurer’s favor. The court found:
The reports by the physicians LINA
hired to review Semien's claim demonstrate a thorough
consideration of the available information. These physicians
found Semien capable of activities that would disqualify her
from long-term disability coverage. Although Semien's treating
physicians reached different conclusions as to her abilities,
under an arbitrary and capricious review, neither this Court,
nor the district court, will attempt to make a determination
between competing expert opinions. Instead, an "insurer's
decision prevails if it has rational support in the record."
Leipzig v. AIG Ins. Co.,
362 F.3d 406, 409 (7th Cir. 2004).
The two physician reports prepared
for LINA, coupled with the Transferable Skills Analysis
prepared based upon those reports, provide a sufficient basis
and rational support for the conclusion that Semien was
ineligible for long-term disability benefits. While the
conclusions in the medical reports submitted by Semien are
also rational, "raising debatable points does not entitle
[the claimant] to a reversal under the
arbitrary-and-capricious standard." Sisto v. Ameritech
Sickness and Accident Disability Benefit Plan, 429 F.3d
698, 701 (7th Cir. 2005). *17-*18.
In addition, the court determined
that there was no evidence of bias or inherent flaws in the
reviewing doctors’ findings. The court then made the
following assertion:
The confines of the ERISA statute
and the constraints of judicial resources do not permit this
Court, nor the district courts, to engage in the complex
weighing of expert testimony when a plan administrator has
been granted discretionary authority. Where an insurance plan
gives discretionary authority to a plan administrator, ERISA
provides a limited Article III review. Engaging in the type of
in-depth review Semien advocates not only runs contrary to
statutory intent, but would tax the judicial resources of the
district courts and magistrate judges beyond the breaking
point. *18.
The court essentially repeated the
same conclusion in determining that the district court did not
err in denying plaintiff’s requests for limited discovery in
relation to LINA’s reviewing doctors. Relying on Perlman
v. Swiss Bank Corp. Comprehensive Disability Protection Plan,
195 F.3d 975 (7th Cir. 1999), where the court held no
discovery was appropriate if the “application was given a
genuine application,” the court reiterated that no discovery
is appropriate absent a “prima facie showing of misconduct or
bias” or “a good faith basis to believe that limited discovery
will produce such evidence.” Applying that rule, the court
stated,
In the instant case, a substantial
amount of medical evidence was analyzed by physicians
compensated by LINA. These physicians were not employees of
the company, they did not fail to analyze relevant medical
evidence, and the claimant has not presented any evidence to
demonstrate a prima facie case of misconduct or conflict of
interest. The fact that a plan administrator has compensated
physicians for their consulting services is not, in and of
itself, sufficient to establish a conflict of interest worthy
of further discovery. Although a plan administrator's self
interest may be a "factor" to "weigh" in evaluating plan
determinations, there is no reason to assume independent
consultants are not impartial when evaluating medical records.
See Perlman, 195 F.3d at 981. Thus, we have no basis to
believe that the physicians in this case did not conduct a
full and fair evaluation of Semien's condition. *22 - *23.
Although the court ruled that “the
district court has significant discretion to allow or disallow
discovery requests,” and that “at times additional discovery
is appropriate to ensure that plan administrators have not
acted arbitrarily and that conflicts of interest have not
contributed to an unjustifiable denial of benefits” (*25), the
court found the district court’s ruling in this action was
within its discretion. The court offered as a rationale that
ERISA claims are in the nature of “a review proceeding, not an
evidentiary proceeding,” and that
Congress has not provided Article
III courts with the statutory authority, nor the judicial
resources, to engage in a full review of the motivations
behind every plan administrator's discretionary decisions. To
engage in such a review would usurp plan administrators'
discretionary authority and move toward a costly system in
which Article III courts conduct wholesale reevaluations of
ERISA claims. Imposing onerous discovery before an ERISA claim
can be resolved would undermine one of the primary goals of
the ERISA program: providing "a method for workers and
beneficiaries to resolve disputes over benefits inexpensively
and expeditiously." Perry v. Simplicity Eng'g, 900 F.2d
963, 967 (6th Cir. 1990) (internal citation omitted). While
claimants who believe they are the victims of arbitrary and
capricious benefits decisions should feel free to seek relief
in federal court, trial judges must exercise their discretion
and limit discovery to those cases in which it appears likely
that the plan administrator committed misconduct or acted with
bias.
*27. Hence, the judgment was
affirmed.
Discussion:
This ruling is based on a number of
fundamental misconceptions. Without any statutory or
constitutional authority at all, the Seventh Circuit has
limited the Article III powers of the federal courts and
grossly deviated from Congress’ intent in passing the ERISA
law. Article III, Section 2 of the United States
Constitution states:
The judicial power shall extend to all cases, in law and
equity, arising under this Constitution, the laws of the
United States, and treaties made, or which shall be made,
under their authority;--to all cases affecting ambassadors,
other public ministers and consuls;--to all cases of admiralty
and maritime jurisdiction;--to controversies to which the
United States shall be a party;--to controversies between two
or more states;--between a state and citizens of another
state;--between citizens of different states;--between
citizens of the same state claiming lands under grants of
different states, and between a state, or the citizens
thereof, and foreign states, citizens or subjects.
No limitation
on the authority created by that provision was established by
the ERISA law which explicitly provides as its purpose:
It is hereby declared
to be the policy of this chapter to protect interstate
commerce and the interests of participants in employee benefit
plans and their beneficiaries, by requiring the disclosure and
reporting to participants and beneficiaries of financial and
other information with respect thereto, by establishing
standards of conduct, responsibility, and obligation for
fiduciaries of employee benefit plans, and by providing for
appropriate remedies, sanctions, and ready access to the
Federal courts. 29 U.S.C. §1001(b).
The Seventh
Circuit’s ruling is fundamentally at odds with the purpose of
the ERISA statute. Nowhere in the statute or legislative
history is there support for the conclusion that a goal of the
ERISA statute is to provide "a
method for workers and beneficiaries to resolve disputes over
benefits inexpensively and expeditiously." The citation for
that comment can be traced to Senate Report 93-383
accompanying S.1179, a predecessor to the bill that eventually
became the ERISA law. In that bill, a provision that was
never enacted provided for a grievance or arbitration
proceeding before the Secretary of Labor; and the report
refers to such a proceeding as providing “the opportunity to
resolve any controversy over [ ] retirement benefits under
qualified plans in an inexpensive and expeditious
manner…Accordingly, the committee has decided to provide that
controversies as to retirement benefits are to be heard by the
Department of Labor.” S.Rep. 93-383, reprinted in 1974 U.S.
Code Cong. & Admin. News 5000. The addition of welfare
benefits to the ERISA law did not even come about until the
bill was before the conference committee, and nothing
contained in House Conf. Rep. 93-1280 reiterates a provision
for an administrative mechanism to resolve pension or even
welfare disputes. The only discussion in that report is a
recitation of what is now contained in §502 of the ERISA law
providing for a “civil action” to be brought by a participant
or beneficiary to recover benefits due under the plan.
See, 1974 U.S. Code
Cong. & Admin. News at 5107. This is further confirmed by
remarks made by Senator Jacob Javits, one of ERISA’s main
sponsors, who explained that House conferees were opposed to
an administrative dispute mechanism “on grounds it might be
too costly to plans and a stimulant to frivolous benefit
disputes, and at their insistence it was dropped in
conference.” 3 Legislative History of ERISA, n. 4 at 4769.
Since all of the legislative
history relating to the ERISA law describes a participant or
beneficiary’s cause of action as a “civil action” without any
specific restriction or limitation, there is no basis
whatsoever for restricting ERISA claimants’ ability to utilize
the adjudicative rights they possess under the Federal Rules
of Civil Procedure. Rule 1 of the Federal Rules of
Civil Procedure states that the Rules apply to “all suits of a
civil nature” with the exception of certain actions enumerated
in Rule 81, none of which encompass ERISA claims. Nor is
there any other legislative limitation on ERISA claims.
Further,
contrary to the court’s conclusion, ERISA claims are not
review proceedings. That canard was introduced following
Firestone Tire & Rubber Co. v. Bruch, 489 U.S. 101 (1989)
by Perry v. Simplicity Engineering and convincingly
rebutted by Professor Jay Conison in his article, “Suits for
Benefits under ERISA,” 54 U.Pitt.L.Rev. 1, 57-60 (1992):
Yet even if there
were some basis for believing hat the treatment of a benefit
suit as an evidentiary proceeding would interfere with “prompt
resolution of claims by the fiduciary,” the rationale would
still fail. For it to be plausible, one would have to add two
premises: that “prompt resolution of claims” is something
Congress intended for the protection of sponsors and
fiduciaries; and that such protection of sponsors and
fiduciaries is more important than protection of the
participants’ right to receive benefits due. Merely to state
thee premises is to reveal their untenability.
Further, to
deem ERISA benefit disputes as “review proceedings” depends on
a fundamental assumption that a fair and objective underlying
decision had been made, thus treating plan administrators as
if they were administrative agencies. However, that analogy
has been soundly rejected from other sources. In
Herzberger v. Standard Insur.Co., 205 F.3d 327 (7th Cir.
2001), the court reiterated the point expressed earlier in
Van Boxel v. Journal Co. Employees Pension Trust, 836 F.2d
1048, 1050 (7th Cir. 1987) that “Pension fund trusts are not
administrative agencies,” nor are they “policy-makers; they
are interpreters of contractual entitlements.” Herzberger
added that the courts have drawn a mistaken analogy
between ERISA-governed disability benefit claims and Social
Security claims by pointing out that the “Social Security
Administration is a public agency that denies benefits only
after giving the applicant an opportunity for a full
adjudicative hearing before a judicial officer, the
administrative law judge.” 205 F.3d at 332. ERISA claims are
not accorded comparable treatment. The Eleventh Circuit has
also issued a stern caution against importing “administrative
agency concepts into the review of ERISA fiduciary
decisions.” Brown v. Blue Cross & Blue Shield of Alabama,
Inc., 898 F.2d 1556, 1564 n. 7 (quoting Van Boxel)
(11th Cir. 1990). Brown further observed that ERISA
benefit determinations “are not discretionary in the sense,
familiar from administrative law, of decisions that make
policy under a broad grant of delegated powers.” Id.
Similarly, the Third Circuit recognized in Luby v.
Teamsters Health, Welfare and Pension Trust Funds, 944
F.3d 1176, 1183 (3d Cir. 1991):
Plan administrators
are not governmental agencies who are frequently granted
deferential review because of their acknowledged expertise.
Administrators may be laypersons appointed under the plan,
sometimes without any legal, accounting or other training
preparing them for their responsible position, often without
any experience in or understanding of the complex problems
arising under ERISA, and, as this case demonstrates, little
knowledge of the rules of evidence or legal procedures to
assist them in factfinding.
Also see,
DeBofsky, “The Paradox of the Misuse of Administrative Law
in ERISA Benefit Claims,” 37 John Marshall L.Rev. 727
(2004)(pointing out that the fundamental due process
protections preserved in administrative law are absent in
ERISA cases).
Nor is there
even support for the economic efficiency argument in the
Firestone opinion, which explicitly rejected the
possibility that the increased cost of additional litigation
constitutes grounds for limiting court review; the ruling
further provides ammunition for an argument that claimants
should not fare worse under ERISA as they did before its
enactment. 489 U.S. at 114. Certainly, had Semien’s claim
been litigated in state court under the law of the State of
Illinois, both discovery and an evidentiary hearing would have
been available to her. Taking away those rights could not
possibly have been what Congress intended.
The Seventh
Circuit also diminishes the societal importance of employee
benefits – surely the protection of employee benefits deserves
the full attention of Article III courts. Insurance company
statistics show that “one out of five 35-year-olds will
experience a disability that lasts three months or more before
age 65.”
www.massmutual.com/mmfg/service/di/whygetdi.html. Working
women are even more adversely affected and are deemed “three
times more likely than men to miss work due to a disability
related illness.”
www.efmoody.com/insurance/disabilitystatistics.html.
According to the Social Security Administration, more than 2.1
million individuals applied for Social Security disability
insurance in 2005, a 4.39% increase over the prior year.
www.ssa.gov/OACT/STATS/dibStat.html.
Other
statistics how that approximately 50 million Americans who
work in the private sector participate in retirement plans
regulated by ERISA. Life, health and disability plans cover
even more people. J. Wooten, The Employee Retirement
Income Security Act of 1974 – A Political History (U.Cal.
Press 2005). Still others have observed that “decisions
whether and how to ensure that disability does not lead to
poverty are obviously of great societal importance.”
Radford Trust v. Unum Life Insur.Co. of America, 321
F.Supp.2d 226, 240 (D.Mass. 2004). Because Social Security
does not completely fill that role, society relies on private
insurers. Yet, as Chief Judge Young observed,
There are also obvious drawbacks to
relying on private insurers, however. Although the profit
motive drives companies toward efficiency, it creates a
substantial risk that they will cut costs by denying valid
claims. The market is somewhat inapt to punish insurers for
engaging in such practices, particularly if the denials are
not too flagrant, because the complexity of the insurance
market and the imperfect information available to consumers
make it difficult to determine whether an insurer is keeping
its costs down through legitimate or illegitimate means. An
individual claimant who encounters an insurance company that
is disposed to deny valid claims must struggle to vindicate
his rights at a time when he is at his most vulnerable. Often
a newly disabled person will simultaneously confront increased
medical bills and either termination of employment or
diminished pay.
The judiciary provides a check on
these potential abuses; under ERISA, aggrieved claimants can
seek redress in the courts of justice. Congress and the courts
have made two decisions, however, that limit this checking
effect. The first is to place limitations on judicial review
of plan administrators' and fiduciaries' decisions similar to
the ones placed on judicial review of governmental agency
action, even though, unlike officials in governmental
agencies, administrators and fiduciaries are not answerable to
the public or to elected officials. Second, and perhaps more
troubling, the courts have interpreted ERISA to restrict or
eliminate the role of juries in deciding disputes between
claimants and insurers. See Liston, 330 F.3d at 24 & n.4;
Andrews-Clarke v. Travelers Ins. Co., 984 F. Supp. 49, 63 &
n.74 (D. Mass. 1997). In the process, they have removed one
of the most important guarantees of fairness in the judicial
process. Id. at
240-41.
Another district court surveyed the
ERISA landscape and announced:
Caveat Emptor!
This case attests to a promise bought and a promise broken.
The vendor of disability insurance now tells us, with some
legal support furnished by the United States Supreme Court,
that a woman determined disabled by the Social Security
Administration because of multiple disabilities which prevent
any kind of work cannot be paid on the disability insurance
she purchased through her employment. The plan and insurance
language did not say, but the world should take notice, that
when you buy insurance like this you are purchasing an
invitation to a legal ritual in which you will be
perfunctorily examined by expert physicians whose objective it
is to find you not disabled, you will be determined not
disabled by the insurance company principally because of the
opinions of the unfriendly experts, and you will be denied
benefits. Loucks v. Liberty Life Assur.Co. of Boston,
337 F.Supp.2d 990 (W.D.Mich. 2004)(vacated following
settlement).
The media has also begun focusing
on ERISA and the need for more penetrating judicial review.
The story of how a law intended to protect employee benefits
has been used to shield insurers was told in the Los
Angeles Times by Peter G. Gosselin in his article, “The
Safety Net She Believed in Was Pulled Away When She Fell.”
(August 21, 2005). Another reporter observed, “All this makes
ERISA cases much harder to litigate than regular civil
cases.” Karin Rives, “Premiums paid, claims denied,”
Raleigh News-Observer December 11, 2005. Even the
authoritative medical journals have concluded that “ERISA
plans have a financial incentive to deny care…without
liability, there is nothing in the law to counterbalance the
financial incentive to deny care.” Mariner, “What Recourse? –
Liability for Managed-Care Decisions and the Employee
Retirement Income Security Act,”
New England Journal of Medicine
343: 592, 595 (August
24, 2000).
Consequently, contrary to both the
language of the statute and Congressional intent, the courts
have created a situation aptly characterized by University of
Chicago economist Steven D. Levitt as “freakonomics.” Levitt
and his co-author Stephen J. Dubner, in their book
Freakonomics, focus on how economic incentives often lead
to perverse unintended results, some beneficial, but many of
which are harmful. Clearly, when insurers are motivated by
profits and have no worry about paying damages or even having
the reasons given for their determinations given close
scrutiny, there is an opportunity for mischief. The parent of
LINA, CIGNA, Inc., reported an overall loss in 2002 that was
turned into a significant profit according to the
corporation’s 2004 annual report. Page 29 of that report
attributes “improved expense management” as one of the keys to
profitability. Although one of CIGNA’s competitors, the
UnumProvident Corporation, has received a significant amount
of adverse publicity for its claims tactics, why should there
be any reason to believe that UnumProvident is a rogue and
that other insurers are not behaving in the same manner under
the identical system of incentives? Could that perhaps be
what is meant by “improved expense management?”
The problem, therefore, with the Seventh Circuit’s treatment
of Kathleen Semien’s disability claim, is not that courts lack
the resources to deal with such claims; it is that they need
to find the resources to do so. The solution is at hand.
Unlike other court systems that place the burden of
investigation on the court system itself, which would
understandably concern a judiciary worried about having to
readjudicate complex disability claims, the Federal Rules of
Civil Procedure place the tools of discovery in the hands of
private litigants to prove their claims and/or disprove their
opponent’s defenses. Discovery should be allowed in all cases
where it is sought.
The Seventh Circuit’s approach of allowing discovery in ERISA
cases only if the insured can come forth with credible
evidence justifying discovery applies circular reasoning. How
is an insured to prove bias without the means of investigating
the witness? The Supreme Court pointed out that “physicians
repeatedly retained by benefits plans may have an incentive to
make a finding of 'not disabled' in order to save their
employers money and preserve their own consulting
arrangements." Black & Decker Disability Plan v. Nord,
538 U.S. 822, 832, 155 L. Ed. 2d 1034 (2003). Without
discovery, though, that proposition can never been proven.
The case cited in Semien,
Bennett v. Unum Life Ins. Co. of Am.,
321 F. Supp. 2d 925, 932-33 (E.D. Tenn. 2004), allowed a
claimant to pursue discovery because the fruits of discovery
taken in prior actions suggested bias. Likewise,
Gunn v. Reliance Standard Life Insur.Co., 399 F. Supp. 2d
1095 (C.D.Cal. 2005) relied on a deposition which showed that
the consultant retained by the insurer derived a substantial
portion of his overall earnings from the defendant. In most
cases, though, litigants are not fortunate enough to have such
forthright evidence of bias; and without discovery, there is
no way to determine whether the plan administrator overlooked
key evidence. As set forth by the United
States Supreme Court in Motor Vehicle Manufacturers
Association v. State Farm Mutual Automobile Insurance Co.,
463 U.S. 29, 43 (1983), a decision is arbitrary and capricious
if the decision-maker 'entirely failed to consider an
important aspect of the problem [or] offered an explanation
for its decision that runs counter to the evidence.' ''
Discovery is essential in order for a party to meet that
burden.
The Seventh Circuit’s suggestion of insurer neutrality has
also been questioned by the Third Circuit which challenged the
economic assumptions underlying such a conclusion. In
Pinto v. Reliance Standard Life Insur.Co., 214 F.3d 377,
388 (3d Cir. 2000), the court found that “potential
self-dealing warrants that fiduciary insurer’s decisions be
closely inspected.” The court then noted,
However, ERISA
litigation generally arises only in close cases, and there
would seem to be insufficient incentive for the carrier to
treat borderline cases (unlikely to become cause celebres)
with the level of attentiveness and solicitude that Congress
imagined when it created ERISA “fiduciaries.” Rather,
insurance carriers have an active incentive to deny close
claims in order to keep costs down and keep themselves
competivie so hat companies will choose to use them as their
insurers, an economic consideration overlooked by the Seventh
Circuit.
Likewise, the Third Circuit observed that while pension plans
are set up in the nature of trusts, where “money paid into the
fund may be used only for maintaining the fund and paying out
pensions,” the typical insurance company is structured such
that its profits are directly affected by the claims it pays
out and those it denies.” Id.
Perhaps all of this is the reason why there is substantial
disagreement among the Circuits about how to go about deciding
ERISA claims. Raising significant doubts about the validity
of opinions obtained from consultants retained by plans to
review claim files rather than examine claimants, the Sixth
Circuit recently issued a trio of opinions which explicitly
direct parties to seek discovery on potential bias: Calvert
v. Firstar Finance, Inc., 409 F.3d 286 (6th Cir. 2005);
Kalish v. Liberty Mutual/Liberty Life Assur.Co. of Boston,
419 F.3d 501 (6th Cir. 2005);
Evans v. UnumProvident Corp.,
2006 U.S.App.LEXIS 1359 (6th Cir.
1/20/2006). In particular, Footnote 2 to the Calvert
opinion suggested that discovery would provide the
court with “a better feel for the weight to accord this
conflict of interest.” Therefore, in order to protect
employee benefits, ERISA’s paramount purpose, courts must
allow the claimants to take necessary discovery, especially if
they face the daunting arbitrary and capricious standard of
review. It is well-nigh impossible to demonstrate the
arbitrariness of a claim decision without the tools of
discovery, especially here, where the court even acknowledges
that it has no idea what evidence was reviewed by LINA’s
reviewing doctor. The same could be said for the vocational
consultant, since the only evidence that individual identified
having reviewed was the amended report prepared by the
consulting psychiatrist.
Finally, there is a disturbing element to the manner in which
the court applied a deferential standard of review. The
Seventh Circuit has been strongly moving in the direction of
requiring explicit discretionary authority, as evidenced both
by Herzberger, supra. and
Diaz v. Prudential Insur.Co. of
America,
422 F.3d 635 (7th Cir. 2005).
After acknowledging substantial contrary authority from other
circuits requiring that discretion be delegated to the
appropriate named fiduciary, the Seventh Circuit split from
the Sixth, Eighth and Ninth Circuits, as well as the explicit
requirements of 29 U.S.C. §1105 in allowing discretion to be
“implied” from a series of documents. Particularly since the
explicit plan document delegated discretion to an entity other
than the one that made the claim determination, and because
the administrative services agreement expressly disclaimed
fiduciary responsibility by anyone other than the employer,
who was named as plan administrator, the application of an
arbitrary and capricious standard of review was contrary to
the authority of Firestone v. Bruch.
This regime must be changed. The American worker will not be
protected until this new Carthage is destroyed (Carthago
delenda est!) and ERISA claimants are given the same
rights in court as any other civil litigant is afforded.
This note appeared in the Disability E-News Alert! For subscription information, please go to www.disabilityenewsalert.com .