Murray v. Andersen Bjornstad Kane Jacobs, Inc. (ABKJ, Inc.)
2:10-cv-00484
W.D. Wash.Feb 10, 2011Background
- Edward Murray, an ERISA plaintiff, seeks disability benefits and moves for partial summary judgment on the standard of review.
- Defendants denied Murray’s long-term disability claim initially in January 2009 and Murray exhausted administrative remedies, with a final denial in January 2010.
- The plan grants discretionary authority to the Plan Administrator and designees, including Unum as a claims fiduciary.
- Washington State regulation WAC 284-96-012 prohibits discretionary clauses in disability policies and purports to require de novo review.
- The question is whether de novo review applies under ERISA given the Washington regulation and its preemption/retroactivity effects.
- The court concludes the applicable standard of review is de novo.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether de novo review applies under ERISA. | Murray | Anderson/Kane | De novo review applies |
| Whether WAC 284-96-012 is saved from preemption as insurance regulation. | Murray | Anderson | Saved from preemption |
| Whether WAC 284-96-012 applies retroactively to the January 2010 denial. | Murray | Anderson | Not retroactive; prospective application |
| Whether the operative denial date for accrual is January 2010 and not January 2009. | Murray | Anderson | January 2010 accrual; final denial governs |
Key Cases Cited
- Firestone Tire & Rubber Co. v. Bruch, 489 U.S. 101 (Supreme Court 1989) (de novo vs. abuse-of-discretion standard under ERISA)
- Saffon v. Wells Fargo & Co. Long Term Disability Plan, 522 F.3d 863 (9th Cir. 2008) (preemption framework; savings clause)
- Kentucky Ass’n of Health Plans, Inc. v. Miller, 538 U.S. 329 (Supreme Court 2003) (two-part preemption test for savings clause)
- Rush Prudential HMO, Inc. v. Moran, 536 U.S. 355 (Supreme Court 2002) (risk-pooling and impact of insurance regulation)
- Metropolitan Life Insurance Co. v. Glenn, 554 U.S. 105 (Supreme Court 2008) (conflict-of-interest considerations in review)
- Aetna Health Ins. v. Davila, 542 U.S. 200 (Supreme Court 2004) (preemption of state statute claims ancillary to denial of benefits)
- Wise v. Verizon Communications Inc., 600 F.3d 1180 (9th Cir. 2010) (operational denial for accrual; final denial governs)
- Morrison v. Standard Ins. Co., 584 F.3d 837 (9th Cir. 2009) (ERISA preemption and insurance regulation interplay)
- Seattle-First National Bank v. Washington Insurance Guaranty Ass’n, 94 Wn. App. 744 (Wash. Ct. App. 1999) (contract provisions must comply with insurance statutes)