Zall v. Standard Ins. Co.

Dist. Ct. erred in granting defendant-insurance company’s motion for summary judgment in plaintiff-employee’s ERISA action, alleging that defendant arbitrarily stopped making payments on long-term disability benefits provided by defendant's policy, and that defendant violated 29 USC section 1133 by failing to tender to plaintiff all documents used by defendant to make determination to stop said benefits prior to making said determination. While plaintiff made initial claim in 2013 for long-term disability benefits that were paid by defendant for six years prior to decision in 2019 to stop said benefits, 2018 Amendment to procedural regulations issued under section 1133 required that defendant provide claimants with any information sufficiently in advance of any adverse determination so as to give claimants reasonable opportunity to respond to said information. Moreover, record showed that defendant based stoppage of benefits on physician report that was not given to plaintiff prior to defendant stopping said benefits. As such, plaintiff was entitled to new determination after he has been given physician’s report and any other information used by defendant to stop his benefits. Ct. also raised possibility that defendant could make same decision after giving plaintiff opportunity to respond to information used to stop plaintiff’s benefits.