Florida ERISA Blog

This is a weblog devoted to recent developments in ERISA and employee benefits law in Florida.

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Location: Clearwater, Florida

Marcus Castillo is a Florida Bar board certified labor and employment lawyer with substantial experience handling ERISA and related employee benefit cases. Mr. Castillo has extensively lectured on ERISA and, for a number of years, was the instructor for the ERISA component of the labor and employment law board certification review course sponsored by the Florida Bar. Mr. Castillo has handled a variety of ERISA and related claims including group short and long term disability insurance cases, accidental death and dismemberment and life insurance claims, group health insurance cases, disability pension and other pension benefit cases. To learn more about his practice visit www.haas-castillo.com

Wednesday, January 26, 2005

Standards of Review 101

The standard of review in a benefits case often drives the outcome. This was illustrated in a recent Middle District opinion: Dowling v. Metropolitan Life Insurance Co. Courts recognize three standards of review. The “pure arbitrary and capricious” standard of review is highly deferential to the Plan. The “heightened arbitrary and capricious” standard of review governs where the claims decision maker operated under a conflict of interest. Under Eleventh Circuit precedent, it is presumed that this conflict infected the decision unless the decision maker can show otherwise. Thus, less deference is given to the Plan under this standard. Finally, the “de novo” standard of review gives no deference to the Plan. Which standard governs depends on whether the Plan included adequate protective language in plan documents, as well as the afore-mentioned presence (or not) of a conflict of interest. More on this in a later post.

In Dowling, Judge Moody noted that the plaintiff’s own treating physicians were equivocal and that the defendant’s consultants found that he could perform sedentary work. The Court held that the pure arbitrary and capricious standard of review applied. Not surprisingly, the Court upheld the benefits denial.

Plaintiffs can win “pure arbitrary and capricious” cases but seldom if ever without the unequivocal help of the treating physicians.