Ever since the Supreme Court's Firestone decision, ERISA plan administrators have been almost completely insulated from meaningful review in benefit denial cases. The new PPACA (sometimes referred to colloquially as "Obama Care" guarantees independent, external review in benefit denial cases to participants who want to pursue a claim prior to bringing an action in federal court. This paper evaluates the ongoing efforts of states to expand the availability of meaningful external review up until passage of the PPACA and examines the new statute's provisions for ensuring independent evaluation of claims. This article concludes that in spite of the Supreme Court's consistent attachment to the post-Firestone regime, the new regulations signal strong Congressional guidance in favor of meaningful independent review. If effective, and if insurers do not figure out how to game the review process, substantially fewer plan participants should feel compelled to seek help in the federal courts.
- ERISA preemption,
- plan administrator discretion,
- discretionary clauses,
- Firestone discretion
Available at: http://works.bepress.com/maria_hylton/1/