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The Conflict of Interest Inherit in Administrative Review

tion in favor of allowing an award for attorney’s fees to a prevailing plaintiff. III.What is the Appropriate Standard of Review for a U.S. District Court?Prior to Firestone Tire & Rubber Co. v. Brunch, the Supreme Court had held that an arbitrary and capricious standard of review was to be given to all administrative reviews appealed to the U.S. District Court under ERISA. ERISA has always contained an enforcement clause that grants plan participants the explicit right to file suit to recover benefits that have been wrongfully withheld. 29 U.S.C. 1132(a)(1)(B). However, the statute itself does not contain any guidance or standard regarding the proper standard of review for denial of a benefit. Early ERISA decisions applied the “arbitrary and caprious standard,” which strongly favored the plan administers. The arbitrary and caprious standard was imported from the Labor Management Relations Act of 1947 (LMRA). This standard had worked in the LMRA, and was thought to be appropriate for ERISA. However, no one noticed the fundamental differences between LMRA trusts and ERISA. 51 Alabama L. Rev. 733. One important difference between ERISA governed health plans and LMRA trusts, is that LMRA trusts were to be administered by joint employer-employee trustee. Id. This safeguard allowed the conflicting interests of administers and beneficiaries to decide together on the appropriate course of action. Then, if the employer and employees could not decide a course of action, the dispute was turned over to a disinterested arbitrator for a ruling. Id. This safeguard, embedded in the procedural administration, prevented a conflict of interest from affecting the decision. ERISA, on the other hand, contains no safeguards. Once the courts realized that a conflict of interest could affect benefit approvals and that ERISA should not be treated like the LMRA, many differing opinions began to arise. In 1989, the United ...

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