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Unpublished Paper
Post-Firestone Skirmishes: "Obama Care", Discretionary Clauses and Judicial Review of ERISA Plan Administrator Decisions
ExpressO (2010)
  • Maria Hylton, Boston University
Abstract

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.

Keywords
  • ERISA,
  • ERISA preemption,
  • PPACA,
  • plan administrator discretion,
  • discretionary clauses,
  • Firestone discretion
Disciplines
Publication Date
August 30, 2010
Citation Information
Maria Hylton. "Post-Firestone Skirmishes: "Obama Care", Discretionary Clauses and Judicial Review of ERISA Plan Administrator Decisions" ExpressO (2010)
Available at: http://works.bepress.com/maria_hylton/1/