• In Baldwin v Univ of Pittsburgh Med. Ctr., --- F.3d ---, 2011 WL 1126038 (3d Cir. Mar. 29, 2011), the Third Circuit held that an adoptive mother and her children had standing under ERISA to pursue benefits from the life insurance policies of the deceased biological mother. Relying on Pennsylvania law, the district court dismissed the complaint, finding that adoption severed all legal ties from the biological mother; thus, the minors were not “children” under the insurance policies’ default payment provisions. The Third Circuit reversed, holding that federal law governs interpretation of ERISA documents, and the term “children” was ambiguous because the court required extrinsic evidence to determine its meaning. Because the children presented a colorable claim that they qualified as beneficiaries under one interpretation of the insurance policies, the district court incorrectly dismissed the suit for lack of standing.
  • In Ramsay v. Mayer, No. 10-2447, 2011 WL 1097536 (7th Cir. Mar. 23, 2011), the Seventh Circuit rejected the claims of the children of a retirement plan participant that they were entitled to survivors’ annuity benefits because this was the choice their mother would have made had her employer adequately explained that she could elect that option. In so ruling, the court noted that plan documents are controlling, and “[a]rguments that something different should have been filed . . . do not change what was actually done,” and “[d]ocuments on file prevail over beliefs about participants’ mental states.”
  • In Salomaa v. Honda Long Term Disability Plan, --- F.3d ----, 2011 WL 768070 (9th Cir. Mar. 7, 2011), the Ninth Circuit held, in a split decision, that a plan administrator with a conflict of interest abused its discretion in denying a plaintiff’s claim for disability benefits by, among other things: requiring objective evidence of chronic fatigue syndrome; apparently disregarding the claimant’s disability benefits award from the Social Security Administration; and failing to meaningfully communicate with the claimant. In so ruling, the majority held, in accordance with dicta from a Ninth Circuit fibromyalgia case, that “conditioning an award [of disability benefits] on the existence of evidence that cannot exist is arbitrary and capricious.” The dissent criticized the majority’s finding that no objective evidence of chronic fatigue syndrome was available, because the claimant had submitted objective evidence – neuropsychological test results – after the deadline for his proof of claim had expired.
  • In Palmer v. Metropolitan Life Insurance Co., No. 10-3171, 2011 WL 892747 (10th Cir. Mar. 16, 2011), the Tenth Circuit upheld the district court’s conclusion that the defendant’s denial of the plaintiff’s long-term disability claim, based on a pre-existing condition, was not arbitrary and capricious even though the defendant had previously approved the claim, where evidence of the pre-existing condition was discovered in records that were in existence at the time the benefits were initially awarded, but not in the defendant’s possession. In so ruling, the Tenth Circuit reaffirmed its belief that a plan administrator could revisit disability claims and reach a different result, as long as the review was “principled,” in that it was authorized under ERISA and conducted in accordance with its principles.