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