Carol Aschermann v. Aetna Life Insu
689 F.3d 726
7th Cir.2012Background
- Aschermann suffered chronic back pain with prior lumbar fusions and received ERISA disability benefits under Lumbermens administered by Aetna until 2009 when benefits were terminated as potentially capable of sedentary work.
- The plan delegates discretion to interpret and pay benefits to Lumbermens and its insurer; Aetna acted as Lumbermens' administrator under a delegation agreement.
- District court reviewed the denial under deferential review because the plan conferred discretion on the administrator; Aschermann contested the delegation and review standard.
- Aetna based its decision on multiple medical opinions (Mendelssohn, Blumberg, Riso) and a 2005–2009 evidentiary record including labor-market data.
- August 28, 2009 notice stated records were outdated and that a peer-review physician found sedentary work possible; later December 1, 2009 denial followed an appeal.
- This court affirmed, holding delegation valid, review deferential, and the record supported termination given conflicting medical opinions and procedural adequacy.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Was delegation to Aetna permissible? | Aschermann | Aetna | Yes, delegation allowed |
| Should ERISA reviewing court conduct de novo review? | Aschermann | Aetna | Deferential review applies |
| Was notice adequate under ERISA §1133? | Aschermann | Aetna | Notice adequate; afforded opportunity to appeal |
| Did the record support termination of benefits? | Aschermann | Aetna | Record supported termination; not arbitrary or capricious |
| Was do-over for new evidence required? | Aschermann | Aetna | No do-over needed; process adequate |
Key Cases Cited
- Firestone Tire & Rubber Co. v. Bruch, 489 U.S. 101 (1989) (established standard of review where plan grants discretion)
- Semien v. Life Insurance Co. of North America, 436 F.3d 805 (7th Cir. 2006) (reserved question of delegation/independent review)
- CIGNA Corp. v. Amara, 131 S. Ct. 1866 (2011) (plan documents, summary plan descriptions; interpretive scope)
- Metropolitan Life Insurance Co. v. Glenn, 554 U.S. 105 (2008) (conflicted-decision-makers; heightened review for conflicts)
- Diaz v. Prudential Insurance Co., 424 F.3d 635 (7th Cir. 2005) (baseline for deferential review in ERISA actions)