Timothy P. O'Leary v. Aetna Life Insurance Company
AdministrativeLaw Arbitration ERISA SocialSecurity Securities JusticiabilityDoctri
Does a fiduciary's decision take priority over compliance with ERISA statute and regulations?
QUESTIONS PRESENTED 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 regula; tions 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”? ii QUESTIONS PRESENTED—Continued 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? Resolving the first question as petitioned by O’Leary will bring the Eleventh Circuit in uniformity with all the other Circuits. . Resolving the second question as petitioned by O’Leary will bring all Circuit Courts in. uniformity . with the Second Circuit, which is the first Circuit Court in over 40 years to fully comply with the directives of the Department of Labor regarding how to properly address fiduciary violations of claimsprocedures. If addressed, this will be the first time this issue will have come before the Supreme Court.