What happens when an ERISA LTD case goes to federal court?

ERISA federal court litigation is unlike any other civil proceeding. There is typically no discovery in the conventional sense, no depositions of treating physicians, and no jury. The judge decides the case on briefs and the administrative record — the same claim file the insurer reviewed when it denied your claim.

This is why building the administrative record during the 180-day appeal window is so consequential. Courts in the S.D.N.Y. and E.D.N.Y. apply the principle that evidence not in the administrative record is generally not considered on judicial review. A claimant who submits new treating-physician reports for the first time in federal court will almost always find that evidence excluded.

The standard of review is the other defining feature. Under Firestone Tire & Rubber Co. v. Bruch, 489 U.S. 101 (1989), if the plan document grants the administrator or insurer discretionary authority, the court reviews only for “abuse of discretion” — was the decision arbitrary and capricious? The Supreme Court in Metropolitan Life Insurance Co. v. Glenn (2008) held that a structural conflict of interest (the insurer both funds and decides claims) is a factor the court must weigh, but it does not change the deferential standard.

If the plan does not grant discretion, the court reviews de novo — a far more favorable standard. Reviewing your plan document for the discretionary-authority clause is one of the first things an ERISA attorney will do. We handle ERISA litigation on contingency. No fee unless we win.