In plaintiff’s claim for disability benefits, the insurance company changed its basis for denial after an administrative appeal. While reviewing the denial of benefits under the arbitrary and capricious standard, the court of appeal reviewed de novo the legal question of whether the defendant complied with the notice requirements of ERISA. “Assuming arguendo that Sun Life complied with ERISA Section 503(1), it violated Section 503(2) by failing to ‘afford a reasonable opportunity to plaintiff for a full and fair review by the appropriate named fiduciary of the decision denying the claim.’ Such language cannot encompass Sun Life telling Wenner it was denying his claim for one reason, and then turning around and terminating his benefits for an entirely different and theretofore unmentioned reason, without affording him the opportunity to respond to the second, determinative reason for the termination.” While a procedural violation does not necessarily require a substantive remedy – where, for example, there are two independent bases for denial, only one of which is procedurally deficient – “under these circumstances, it is appropriate to reinstate all benefits beginning from the invalid termination…. When an initial grant of benefits has been terminated in violation of Section 503, the benefits have ‘never been properly revoked. Thus the procedural violation is not the reason that the benefits commenced, but it is the reason that they should continue until a decision regarding the potential revocation of … benefits has been properly determined in compliance with the plan’s provisions.'” See Wenner v. Sun Life, 482 F.3d 878 (6th Cir. 2007).
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