Orzechowski v. Boeing Co. Non-Union Long-Term Disability Plan

District court should review ERISA plan administrator’s eligibility determination de novo since a California statute, which is not preempted by ERISA, bans clauses granting an insurer discretion to determine eligibility for policy benefits.  A court reviews an ERISA plan administrator’s decision to deny benefits de novo unless the plan gives the administrator discretion to determine eligibility.  Here, the plan granted the administrator discretion, but that provision was rendered void by Ins. Code 10110.6 which voids provisions granting insurers discretion to determine eligibility for benefits. ERISA did not preempt that state law because it exempts from preemption state laws regulating insurance.  So the district court should have determined de novo whether plaintiff was eligible for disability benefits under the plan’s terms.

Ninth Circuit Court of Appeals (Bybee, J.); May 11, 2017; 2017 WL 1947883

Advertisements

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Google photo

You are commenting using your Google account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s