Insurance Law and Coverage Disputes Blog » ERISA

Eleventh Circuit Adopts Davila, the Supreme Court’s ERISA Preemption Test

Jennifer McAdam — Mon, 15 Feb 2010 17:15:29 +0000

More that five years after the U.S. Supreme Court decided Aetna Health Inc. v. Davila, 542 U.S. 200 (2004), the Eleventh Circuit officially adopted the Court’s ERISA complete preemption test. Conn. State Dental Ass’n v. Anthem Health Plans, Inc., 2009 U.S. App. LEXIS 28773 (11th Cir. Fla. Dec. 30, 2009). The court determined that some of the plaintiff’s state law claims were properly removed pursuant to § 502(a)(1)(B), ERISA’s civil enforcement provision, 29 USCS § 1132(a)(1)(B). Id. at *2.

Dentists Rutt and Egan and Connecticut State Dental Association brought state law claims against Anthem for improper “‘downcoding’ and ‘improper bundling,’ as a means of underpaying participating dentists for services they performed.” Id. at *3. Anthem removed the case to federal court on the basis that the claims…

Seventh Circuit Court of Appeals Still “Pondering” Conflict Analysis

Robyn Anderson — Mon, 04 Jan 2010 15:36:22 +0000

In Majeski v. Metropolitan Life Ins. Co., the Seventh Circuit Court of Appeals admitted that it “is still pondering . . . just how to consider a plan administrator’s conflict of interest.” 2009 WL 5088720 (7th Cir. Dec. 29, 2009) (emphasis in original). The court continued to reject a blanket rule that would force a reviewing court to weigh conflict in every case, instead opting for a case-by-case inquiry that weighs conflict only if it is relevant based on its gravity. “Gravity” of conflict might be discerned from the reasonableness of the claim procedures, the safeguards implemented to minimize the conflict and the “terms of employment” of the decision-maker’s staff, the court suggested. The court rejected that the conflict inquiry…

May Day: The Eighth Circuit Relaxes Constitutional Standing and the Twombly-Iqbal Pleading Standard in ERISA Cases

Michael Cessna — Mon, 07 Dec 2009 22:19:31 +0000

The Eighth Circuit has swung to the left. In two recent decisions, the Eighth Circuit has reached results that would make the Ninth Circuit blush. First, in In re Prempro Prods. Liability Litig., 2009 WL 3518245 (8th Cir. Nov. 2, 2009), the Eighth Circuit threw aside Daubert and held admissible expert testimony that through the alchemy of differential diagnosis one may divine the cause of breast cancer.

Now we have Braden v. Wal-Mart Stores, Inc., 2009 WL 4062105 (8th Cir. Nov. 25, 2009), in which the Eighth Circuit dramatically relaxes the standards governing standing and pleading in ERISA cases. Reversing the district court’s dismissal of a putative class action against Wal-Mart alleging the violation of fiduciary duties imposed by ERISA, the Eighth…

Conflicting Opinions on Conflict Discovery

Robyn Anderson — Fri, 30 Oct 2009 21:19:30 +0000

For a recent case analyzing post-Glenn discovery in ERISA benefit cases, check out the opinion of the U.S. District Court for the Northern District of Illinois in Garvey v. Piper Rudnick LLP Long Term Disability Insurance Company, 2009 WL 3260010, (N.D. Ill. Oct. 9, 2009). In that case, the court considered whether an attorney claimant was entitled to conflict discovery in his disability case.

The Garvey court conducted a fairly thorough overview of post-Glenn discovery cases in the Seventh Circuit and elsewhere. While noting the varying approaches – everything from no discovery to expanded discovery – the court ultimately allowed the claimant to conduct limited discovery under the pre-Glenn Seventh Circuit principles of Semien v. Life Ins. Co. of N. Amer.,…

Sophistry and Glenn

Michael Cessna — Wed, 16 Sep 2009 16:46:56 +0000

We have previously cited in this space Chief Justice Roberts’ admonition in his concurring opinion in Metropolitan Life Insurance Co. v. Glenn, 128 S. Ct. 2343, 2354 (2008) that the Court’s opinion “leaves the law more uncertain, more unpredictable than it found it.” The Ninth Circuit has now conjured Glenn to transmogrify the abuse of discretion standard of review in ERISA cases to de novo review. Montour v. Hartford Life & Accident Ins. Co., 2009 WL 2914516 (9th Cir. Sept. 14, 2009).

Montour reifies Chief Justice Roberts’ concern that in “[s]aying that courts should consider the mere existence of a conflict in every case, without focusing that consideration in any way, invites the substitution of judicial discretion for the discretion of the…

Jesuitical – ERISA, Complete Preemption, Federal Question Jurisdiction, and Removal

Michael Cessna — Fri, 11 Sep 2009 20:03:10 +0000

ERISA preemption presents a vexed question. And such preemption approaches the metaphysical where invoked as a basis for removal. Marin General Hospital v. Modesto & Empire Traction Co., 2009 WL 2882832 (9th Cir. Sep. 10, 2009), limns the issue.

The case arises out of prosaic circumstances. On April 8, 2004, Marin General Hospital telephoned the Medical Benefits Administrators of M.D., Inc. (“MBAMD”) to confirm that a prospective patient had health insurance through an ERISA plan provided by his employer, Modesto & Empire Traction Co. MBAMD was the administrator of Modesto’s plan. MBAMD orally verified the patient’s coverage, authorized treatment, and agreed to cover 90% of the patient’s medical expenses at the hospital.

Between April 19 and April 24, 2004, the hospital performed…

ERISA, Glenn, and Legal Realism

Michael Cessna — Wed, 26 Aug 2009 20:37:44 +0000

In Metropolitan Life Insurance Co. v. Glenn, 128 S.Ct. 2343 (2008), the Supreme Court held that a conflict of interest inheres in a plan administrator’s dual role as insurer and administrator and that the conflict is one factor to be considered in determining the reasonableness of a decision to deny a claim for benefits. A year later, the import of the decision in ERISA litigation continues to the subject of contention. Chief Justice Roberts’ concurring opinion has proved to be prescient: “The Court leaves the law more uncertain, more unpredictable than it found it.” Id. at 2354 (Roberts, J., concurring).

We now have the benefit of Judge Posner’s exegesis of Glenn. In Marrs v. Motorola, Inc., No. 08-2451, 2009 WL 2477650 (7th Cir. August 14,…