Jay C. Richmond v. Life Insurance Company of North America

Whether, in this denial of benefits case under the Employee Retirement Income Security Act of 1974 (ERISA), 29 U.S.C. §§ 1001 et seq., the court of appeals applied the wrong standard of judicial review under Firestone Tire and Rubber Co. v. Bruch, 489 U.S. 101

in view of Conkright v. Frommert, 559 U.S. 506 (2010), and deepened an established circuit split, when the court: a. extended the plan’s grant of interpretive authority beyond plan terms that are “clear and accurate” to even ambiguous terms that are not ERISA-compliant, and concluded—by virtue of the presumed grant—that the plan administrator’s interpretation of an ambiguous exclusionary provision was entitled to Firestone deference; and b. did not invoke the doctrine of contra proferentem to resolve the ambiguous exclusionary provision.

Does ERISA’s “full and fair review” mandate apply to each ground asserted in a plan administrator’s final denial, such that a plan administrator abuses its discretion in barring benefit recovery based on a procedurally defective ground?