Timothy P. O'Leary v. Aetna Life Insurance Company
This petition presents one legal issue in two parts that have divided the courts of appeals regarding ERISA statute and regulations. Congress intended for fiduciaries to comply with ERISA statute and regulations to protect plan beneficiaries. Congress explicitly authorized the Department of Labor to police fiduciaries, implement regulations, authorize action for beneficiaries and courts upon fiduciary misconduct, all with the goal of protecting beneficiaries especially during benefit determinations.
O'Leary's questions are premised on an ERISA adverse benefits determination, when the fiduciary has discretionary authority over the plan and initially given deference by the court and the standard of review is deferential (arbitrary and capricious) but then it is revealed that the fiduciary failed to comply with ERISA statute and regulations claims-procedures textual requirements thus failing to provide a "full and fair review" of the claim which are codified in 29 C.F.R. § 2560.503-1.
The Questions Presented Are:
1. Does a fiduciary who is given deference "entitle" the fiduciary's decision priority over compliance with ERISA statute and regulations or does compliance have priority over fiduciary's decision and if found in violation of compliance with claims-procedures, is fiduciary's decision "arbitrary and capricious"?
2. Does a fiduciary lose its deference and the standard of review revert back to de novo, when claimsprocedures are violated as directed by the Department of Labor and held by the Second Circuit?
Does a fiduciary's decision take priority over compliance with ERISA statute and regulations?