In a recent decision the Employee Retirement Income Security Act ("ERISA"), was given some spunk under a standard of de novo or brand-new review in Download Wein_v. Prudential Insurance Co. of America (E.D.N.Y. Case No. 03-CV-6526 Opinion Filed October 2, 2006).pdf. The Claimant in that case is Ms. Judy Wein. She filed a lawsuit to recover partial long term disability benefits which were denied under a group policy issued to her Employer, Aon Risk Services, where she worked as an Assistant Director for more than 25 years.
The Federal Judge denied Prudential Insurance Company's Motion for Summary Judgment, granted Judy Wein's Motion for Summary Judgment, and also granted Ms. Wein's request for reasonable attorney's fees and costs under ERISA in that case. The key was the Federal Court's standard of review.
The Prudential insurance policy was part of a long-term disability group coverage Insurance Plan that Aon makes available to its employees like Ms. Wein. "[T]he policy does not clearly grant discretion to Prudential," said the Federal Court, so that under existing Federal precedent in New York, the Federal Judge was entitled to review even all fact issues involved in the denial of an ERISA claim like Ms. Wein's. The Federal Judge proceeded to address numerous issues involved in that denial including issues of fact, concluding that "on the basis of the evidence before this court, no reasonable juror would find for Prudential on the limited issue of whether Plaintiff's injuries permit her to perform her job duties full time. Prudential has not submitted admissible, competent evidence in support of its administrative denial, and has failed to raise any significant doubt about the opinions of [certain stated physicians] on the issue of Plaintiff's physical limitations, or of [other stated physicians] on the issue of Plaintiff's inability to use a computer full time."
The Federal Judge then reversed Prudential's administrative denial of disability benefits in that case, denied Prudential's Motion for Summary Judgment, and granted the Claimant's Ms. Wein's Motion for Summary Judgment. Although the Federal Judge also granted Plaintiff's motion for attorney's fees and costs at that time, later, on October 20, 2006, the same Court granted a "letter application" filed by Prudential such that Ms. Wein's fee application was "adjourned" to November 3, 2006 "on account of ongoing settlement negotiations" according to the Court's Docket Entry. We would appreciate a Comment from the Attorneys involved in that case to let us know the outcome.
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