Standard of Review – Long Term Disability (ERISA)

The first step in reviewing a claim for wrongful denial of long term disability benefits under ERISA is to determine whether the plan vested the insurance company with discretion to determine eligibility for benefits.  Such a determination is made de novo by the court.  If the plan confers discretionary authority to the plan administrator, the court reviews the decision under the abuse of discretion standard. Under the abuse of discretion standard, the Court is limited to the evidence that was before the plan administrator at the time the decision to deny benefits was made.

Next, a conflict of interest analysis must take place.  If the plan administrator’s decision to award or deny benefits impacts its own financial interests, that would be a conflict of interest.  Such a conflict must be considered by the court in determining the reasonableness of the decision.


About tngainjurylawyer
Serious Injury Lawyer in Tennessee and Georgia.

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