Court: LINA Form Not Part of Plan Doc, Applies De Novo Review to Claim Denial

De novo judicial review applies to Life Insurance Co. of North America’s decision denying long-term disability benefits, because the insurer failed to demonstrate that its “Appointment of Claim Fiduciary” form (ACF)—which included a grant of discretionary authority—was part of the operative plan document, the U.S. District Court for the Eastern District of New York held (Barbu v. Life Ins. Co. of N. Am., 2013 BL 351317, E.D.N.Y., 2:12-cv-01629-JFB-WDW, 12/19/13).

According to the court, the ACF was executed on the same day as the relevant insurance policy, and it included language granting LINA discretionary authority to review and determine ...