What is the 11th Circuit’s Standard of Review?
Did you know that when an ERISA law suit is filed, the court employs a state methods overview. These include:
1. A denovo review if the plan doesn’t grant the Administrator discretion to make the determination;
2. Arbitrary and capricious where the plan grants the Administrator discretion;
3. Heightened arbitrary and capricious where the plan grants Administrator discretion and the Administrator has a conflict of interest.
The 11th Circuit has it’s own six step framework to guide courts in evaluating the plan administrator’s decision and ERISA action. The 11th Circuit test is found in Blankenship vs. Metro Life Insurance Company 644f3d1350 (11th Circuit, circ denied, 132 S. Court 849 (2001)):
(1) “applied the denovo standard to determine whether the claim’s administrators benefits denial decision is wrong” (i.e. the Court disagrees with the Administrators decision); if it is not, it ends the inquiry and affirm the decision)
(2) if the Administrators decision in fact was “denovo wrong”, then determine whether he was vested with discretion in reviewing claims; if not end the judicial inquiry and end the decision
(3) the Administrator’s decision is “de novo wrong” and he was vested with discretion in reviewing claims, then determine whether “reasonable” grounds supported it (hence review his decisions under the more deferential arbitrary and capricious standards)
(4) If no reasonable ground existed then end the inquiry and reserve the Administrators decision; if reasonable grounds do exist then determine if he operated under a conflict of interest
(5) if there is no conflict then end the inquiry and affirm the decision
(6) if there is a conflict, the conflict should merely be a factor for the court to take in account whether determining whether an administrators decision was arbitrary and capricious.
It’s as complex as it sounds! If you live in Florida and your long term disability claim has been denied you have only 180 days in which to perfect an appeal. Filing that appeal can make the difference between getting your benefits and having to file lawsuit and going through the 11th Circuit standard of review.
To learn more about your rights to long term disability benefits, contact long term disability benefits denial attorney Nancy Cavey for a complimentary consultation.