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Supreme Court Presumes Conflict of Interest in "Dual Role" Benefits Denial Cases
07/02/2008

On June 19, 2008, the Supreme Court upheld the application of the deferential abuse of discretion standard of review for benefit decisions under ERISA-governed plans even in instances when the decision-maker on the claim also is responsible for paying benefits or is affiliated with the payer. This standard of review is very favorable to benefit decision-makers, as it generally requires a court to affirm the decision unless it is “downright unreasonable” in light of the record presented to the decision-maker. However, at the same time, the Supreme Court held that courts applying this standard of review must weigh the conflict of interest created by the dual payer/decision-maker role and must ascertain whether the conflict of interest has resulted in an unreasonable benefits determination. MetLife v. Glenn, 554 U.S. ___ (2008).

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