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ERISA Rulings by the DC Circuit

The DC Circuit requires that grants of discretion be clear and will not construe a requirement of "proof of eligibility" to confer discretion.

Additionally, the DC Circuit has found that when a plan term is ambiguous, it is construed against the plan. In an important DC Circuit case, the term "mental illness" was not defined and was therefore held to be ambiguous. The court construed the term against the plan and in favor of the claimant, concluding that bipolar disorder was not a mental illness as defined by the plan documents. Obviously, bipolar disorder is a mental illness, but it has a physical cause. The court's ruling underscores the importance of clear and explicit definitions of policy terms and the need for claimants to evaluate their policies carefully when its terms are not explicitly defined.

The DC Circuit also permits a grant of discretion to be found in documents other than the actual policy, reasoning that all plan documents must be examined together to determine the appropriate standard review. This makes it easier to prove a grant of discretion.

Choose an Experienced ERISA Lawyer

ERISA Law Center serves the DC Circuit by representing claimants in Washington, D.C. If you are ready to discuss your claim with an experienced ERISA lawyer, please do not hesitate to call our offices at (844) 710-2993. We are available 24 hours a day, 7 days a week and offer a free consultation to help you get started.