Life Health & Disability Case Law Update

Abena v. Metropolitan Life Insurance Company,

— F.3d — , 2008 WL 4210938 (7th Cir. (Wis.) Sept. 16, 2008)

In Abena, the 7th Circuit held that a three-year contractual limitations period in an ERISA regulated long term disability plan running from the date proof of loss is due, and not from the date of a final denial following exhaustion of administrative remedies, is enforceable. The key point in Abena is that the 7th Circuit continues to dispute the position taken by the 4th Circuit, as well as several district courts in the 2d and 6th Circuits in cases decided during the past year or so, holding that regardless of what an ERISA-governed policy states in its clear and unambiguous language and regardless of mandated insurance policy language in 49 states, a benefit suit accrues only when the claim is denied, and not when the proof of loss is due

Doyle v. Liberty Life Insurance Company of Boston,

— F.3d — , 2008 WL _______(11th Cir. (Fla.) Sept. 18, 2008)

On September 18, 2008, the Circuit Court granted the Plan’s motion for panel rehearing, having waited until after the U.S. Supreme Court issued its decision in Metropolitan Life v. Glenn, — U.S. –, 128 S. Ct. 2343 (2008). The 11th Circuit held that Glenn implicitly overrules its prior precedent 1) requiring district courts to review benefit decisions made by conflicted administrators under a heightened standard of review; and 2) requiring the burden of proof to shift to the conflicted administrator to show that its decision was not influenced by a conflict.  The 11th Circuit also held that, consistent with the teachings of Glenn, conflict of interest is merely a factor for the district court to consider when determining whether an administrator’s decision was arbitrary and capricious and that the burden of proving that the decision was arbitrary remains with the plaintiff.

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