Court Rules Discretionary Language in SPD was Insufficient

April 7, 2017

A more stringent standard of review was applied by the District Court of Arizona where discretionary authority language was contained only the Summary Plan Description and not in the Plan Document itself. Plaintiff brought suit against Prudential Insurance Company for denying his claim for short-term and long-term disability benefits. Prudential maintained that language such as “when Prudential determines” and requiring proof that a disability was “satisfactory to Prudential” was a sufficient grant from the plan to Prudential of discretionary authority. The court disagreed and reviewed the disability claim de novo, ultimately finding for the plaintiff. This an important reminder to plans to make sure that when the SPD and plan documents are separate documents, discretionary language is either both in the SPD and plan document or that the SPD is incorporated into the plan document.

 

Nieves v. Prudential Ins. Co. of Am., No. CV-16-00768-PHX-DGC, _ F. Supp. 3d _, 2017 WL 168039 (D. Ariz. Jan 17, 2017).

Please reload

Featured Posts

HIPAA Fines--Not Going Away!

January 15, 2016

The Office of Civil Rights (OCR) of the U.S. Department of Health and Human Services recently announced a resolution agreement with Triple-S Managemen...

1/3
Please reload

Recent Posts
Please reload

Archive
Please reload

© 2019 by Ledbetter Parisi LLC.