The Ninth Circuit held that a plan administrator’s failure to render a decision on a long-term disability benefits claim within the period mandated by the plan and ERISA did not alter the standard of review that the court should apply to the plan fiduciary’s decision concerning the claim.  Plaintiff Isela Dimery received long-term disability benefits until Reliance Standard Life Insurance, the plan administrator and fiduciary, declined to continue paying the benefits. 

Although the summary plan description and ERISA regulations required Reliance to render a decision on Dimery’s appeal within forty-five days, or notify her that it needed additional time, Reliance only notified Dimery that it was seeking an independent medical evaluation, not that it would need additional time to decide her claim.  Reliance affirmed its initial decision on the sixty-fourth day.  The district court, using the abuse of discretion standard, granted summary judgment in favor of Reliance.  On appeal, Dimery argued that the district court should have applied a de novo standard of review. 

As relevant here, the Ninth Circuit held that Dimery’s argument failed because procedural violations of the ERISA regulations do not alter the standard of review unless the violations cause substantive harm and Dimery had not identified any substantive harm.  The case is Dimery v. Reliance Standard Life Ins. Co., No. 12–17550, 2015 WL 1044047 (9th Cir. Mar. 11, 2015)

Sam Margolis contributed content for this article.