Lebau & Neuworth attorneys frequently represent claimants for short-term and long-term disability benefits under employer-sponsored benefit plans. These plans are governed under the Employee Retirement Income Security Act, also known, as ERISA. For employees denied disability benefits by private insurers, a recent Supreme Court case added conflict-of-interest as a factor for courts to take into account. As discussed in the most recent Maryland Bar Journal article by Lebau & Neuworth’s Richard Neuworth and Gregg Mosson, people denied disability benefits under an ERISA-regulated insurance plan can argue that a conflict of interest exists at the insurer. If true, this conflict of interest provides a court with more authority to overturn a denial. Metropolitan Life Ins. Co. v. Glenn, 514 U.S. 105 (2008). A conflict of interest exists if the insurer (1) decides claims and funds the insurance plan, (2) if the insurer has a history of one-sided decisions, or (3) acted in an obviously biased manner during the review process. See Glenn, supra. Glenn has expanded the right to look beyond the administrative record through the discovery process. E.g., Ferguson v. United of Omaha Life Ins. Co., 2012 U.S. Dist. LEXIS 179182, *7-8 (D. Md. Dec. 18, 2012). Examples of evidence outside of the record considered by courts include claims guidelines in determining whether there has been an abuse of discretion. Mullins v. AT&T Corp., 290 Fed. Appx. 642, 646-647 (4th Cir. Va. 2008) (unpublished opinion). In Brodish v. Federal Express Corp., the court permitted materials relating to the administrator’s refusal to reconsider the claim six months after the last denial of the appeal but prior to suit being filed because the Plan attorney invited additional evidence for consideration. 384 F. Supp. 2d 827 (D. Md. 2005). Maryland also has significantly changed the court review process for insurance plans issued after October 1, 2011, by banning the standard deferential “discretionary review.” HB 1085, Ch. 155 (Apr. 12, 2011), codified at Md. Ins. Code. Ann.§ 12-211 (2013). For more information, see our detailed article in the Nov./Dec. 2013 issue of the Maryland Bar Journal. If you think you may be entitled to disability benefits or need representation during the claims process or in contact us, contact as at www.lebauneuworth.com or call toll-free 1.888.456.2529.
