Roehr v. Sun Life Assur. Co.

In this 2021 ERISA case, the Court found that the district court did not err by evaluating the claimant’s claims under the well-known abuse of discretion standard. The court had consistently rejected the notion that the mere presence of a potential conflict of interest is sufficient to warrant a less deferential standard, and here, the plan administrator actively sought to reduce any potential conflict of interest or bias by consulting with two independent physicians who reviewed the claimant’s medical records.

The plan administrator relied on virtually the same medical records for a decade and pointed to no information available to it that altered in some significant way its previous decision to pay benefits. There was not substantial evidence in the joint administrative record to support the plan administrator’s termination decision.

The court reversed the district court’s grant of the plan administrator’s motion for judgment on the record. The court remanded to the district court with directions to order the reinstatement of benefits.

If you need assistance navigating your claim for short term or long term disability benefits under ERISA, or it is time to sue the insurance company, please do not hesitate to give Cody Allison & Associates, PLLC a call (844) LTD-CODY, (615) 234-6000. or send us an e-mail Cody@codyallison.com.  We provide representation nationwide and have successfully sued all the major insurance companies in many states. Our headquarters are located in Nashville, Tennessee.  We offer a free consultation and would love to speak with you.