ERISA – Conflict Of Interest – Life Insurance

Employee Retirement Income Security Act (ERISA) cases are difficult at best.  But finally, here is a win in the courts.  The 5th Circuit issued a ruling on June 13, 2018, in favor of a claimant.  The case is styled, Ester Hill White v. Life Insurance Company of North America. Among other issues, the Court first addressed whether LINA had a conflict of interest.  This issue arises when the insurer of the plan also determines whether the claimant is entitled to benefits.  A conflict of interest, such as the one in this case, should prove more important where circumstances suggest a higher likelihood that it affected the benefits decision. The Court was concerned with LINA’s failure to address Dr. Fochtman’s report in its denial of life insurance benefits.  White argues that such failure amounts to procedural unreasonableness.  Procedural unreasonableness is important in its own right and also justifies the court in giving more weight…

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