1. Invasion of Privacy Claim Preempted by ERISA. A Western District of Pennsylvania court granted the administrator’s Rule 12(b)(6) motion to dismiss the plaintiff’s invasion of privacy claim as preempted by ERISA. The plaintiff alleged that his attorney had advised Liberty Life of the plaintiff’s revocation of all releases previously given to Liberty Life to the extent they allowed verbal communication with third parties about the plaintiff’s long-term disability claim. Thereafter, according to the plaintiff, Liberty Life instructed its independent medical consultant to orally communicate with the plaintiff’s treating physician without informing him that the plaintiff’s authorization had been partially revoked in order to induce the plaintiff’s treating physician to breach his fiduciary relationship and violate his duty of confidentiality. In dismissing the privacy claim, the district court reasoned that the plaintiff did not allege any identified damages based on Liberty Life’s conduct in allegedly violating his right to privacy that is separate from damages directly caused by the denial of benefits. However, the district court recognized the possibility that the plaintiff could plead facts sufficient to support a state law claim that would not be preempted by ERISA. For example, a claim may survive preemption that is supported by allegations that the information obtained verbally from the plaintiff’s treating physician was insufficiently protected, used in a nefarious manner or disclosed to parties outside the administrative review process. Addington v. Senior Vice President – Human Resources, Consol Energy Inc., Civ. A. 17-444, 2017 WL 6398487 (W.D. Pa. Nov. 28, 2017).
  2. Administrator’s Interpretation of “Same Injury” Exclusion Was Arbitrary and Capricious. A Northern District of Illinois court held that the plan administrator’s interpretation of the “same injury” exclusion was arbitrary and capricious. The plaintiff slipped and fell and sustained injuries that required the removal of a spinal cord stimulator that was implanted following a car accident occurring two years prior. The plaintiff previously settled with third parties involved in the car accident for payment of her medical bills, and the plan excluded benefits for bills submitted with respect to the “same injury” that was the subject of the prior settlement. Following the slip and fall, the plaintiff sought payment of medical claims involving the removal of the spinal cord stimulator, and the plan administrator denied benefits under the “same injury” exclusion. In granting summary judgment in favor of the plaintiff, the district court reasoned that the administrator’s interpretation that the injuries caused by the slip and fall were the “same injury” as those caused by the car accident merely because the latter injury affected the spinal cord implant was broader than the plain language allowed. The plan’s “same injury” language necessarily excluded a separate, independent injury from the exclusion provision. Sadowski v. Tuckpointers Local 52 Health & Welfare Trust, Civ. A. 16-C-11014, 2017 WL 6549759 (N.D. Ill. Dec. 20, 2017).
  3. Dismissal of Section 1132(a)(3) Breach of Fiduciary Duty Claim/ Exhaustion of Administrative Remedies Without Submission of Formal Appeal. The District of New Jersey court dismissed the plaintiff’s breach of fiduciary duty claim under 29 U.S.C. § 1132(a)(3). The court recognized a circuit split in determining whether beneficiaries are precluded from simultaneously seeking relief under Sections 1132(a)(3) and 1132(a)(1)(B). In dismissing the plaintiff’s cause of action under Section 1132(a)(3), the district court reasoned that the relief sought was precisely the same relief as that sought by way of the plaintiff’s claim for benefits under Section 1132(a)(1)(B). The court further dismissed the plaintiff’s state law causes of action as preempted by ERISA. However, the court denied Reliance’s motion seeking to dismiss the plaintiff’s cause of action under Section 1132(a)(1)(B). The district court rejected Reliance’s position that the plaintiff did not exhaust her administrative remedies. Although the plaintiff did not submit a formal appeal, the court found sufficient evidence to conclude, at least on a motion to dismiss, that Reliance was aware of the plaintiff’s intent to contest the denial of the waiver of premium benefit. Specifically, following the denial there were subsequent communications between Reliance and the insured’s doctors. Rizzo v. First Reliance Standard Life Ins. Co., Civ. A. 17-cv-745 (PGS), 2017 WL 6626315 (D.N.J. Dec. 28, 2017).
  4. Discovery Beyond Administrative Record Not Permitted. A District of Maryland court held that the disability claimant was not permitted to conduct discovery outside of the administrative record because the claimant failed to identify any specific need for extra-record discovery. The court reasoned that the plaintiff failed to demonstrate that the administrative record did not contain enough information to allow the district court to weigh properly the alleged conflict of interest in reaching its conclusion. Rather the plaintiff made only generalized allegations of potential bias. Further, the record included evidence sufficient to determine whether any bias may have affected the defendant’s decision. Silverstone v. Reliance Standard Life Insurance Co., No. 17-0111, D. Md., 2017 U.S. Dist. LEXIS 189528 (D. Md. Nov. 16, 2017).
  5. Decision to Deny LTD Benefits Not Arbitrary and Capricious. An Eastern District of Pennsylvania court granted summary judgment in favor of the plan administrator finding that the denial of the plaintiff’s claim for long-term disability benefits was not arbitrary and capricious. The court reasoned that the plaintiff did not satisfy her burden of proving disability throughout the duration of the elimination period. Notably, the plaintiff did not seek treatment for her depression until after the elimination period and that her gastroenterologist characterized her Crohn’s Disease as dormant during the elimination period. Further, the district court repeatedly criticized the plaintiff’s “cherry-picking” and distortion of the evidence in the administrative record. Karen O'Conner v. The PNC Financial Services Group, Inc., Civ. A. 15-5051, 2017 WL 5352721 (E.D. Pa. Nov. 13, 2017)