Failing To Heed ERISA's Claims Procedure: A Fast-Track to Court and De Novo Review
This article explores the situations in which a plaintiff can shorten the process to challenge a denial of ERISA benefits and, at the same time, switch the court's standard of review from arbitrary and capricious to de novo.
November 04, 2021 at 10:00 AM
8 minute read
InsuranceIndividuals denied benefits under an ERISA-governed plan must exhaust the plan's administrative remedies before going to court. However, in limited instances, a plaintiff can forego the claims procedure process, thereby obtaining a fast-track to litigation. In so doing, the plaintiff will cause a critical shift in the standard a court will apply to assess an administrator's decision to deny benefits.
This article explores those situations in which a plaintiff can shorten the process to challenge a denial of benefits and, at the same time, switch the court's standard of review from arbitrary and capricious to de novo.
What Are Claims Procedures and What Happens if the Plan Fails To Adopt One? To protect the interests of participants and beneficiaries, ERISA requires every employee benefit plan to adopt a claims procedure that provides for (a) written notice setting forth the basis for any decision to deny benefits, and (b) a reasonable opportunity for a full and fair review of any benefits denial. ERISA §503.
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