No. 20-1106

Jane Doe v. Harvard Pilgrim Health Care, Inc., et al.

Lower Court: First Circuit
Docketed: 2021-02-11
Status: Denied
Type: Paid
Experienced Counsel
Tags: administrative-record circuit-split de-novo-review erisa-benefits evidence material-dispute standard-of-review summary-judgment
Key Terms:
AdministrativeLaw Arbitration ERISA JusticiabilityDoctri
Latest Conference: 2021-05-20
Question Presented (AI Summary)

Whether, on de novo consideration of an ERISA benefits claim, summary judgment must be denied if there is a genuine dispute of material fact

Question Presented (from Petition)

QUESTIONS PRESENTED This case presents two acknowledged circuit conflicts regarding how district courts adjudicate benefits claims under the Employee Retirement Income Security Act, 29 U.S.C. 1132(a)(1)(B), when those claims are considered de novo under Firestone Tire & Rubber Co. v. Bruch, 489 USS. 101 (1989). Here, despite recognizing that the expert medical evidence conflicted, the district court granted respondents summary judgment and denied petitioner’s request to examine the experts. The First Circuit affirmed. First, the court held that “{iJn the ERISA context, ‘the burdens and presumptions normally attendant to summary judgment practice do not apply,” so the district court can resolve fact conflicts. That holding aligns with the Sixth Circuit, but ten other circuits apply Rule 56 the usual way: “If a paper record contains a material dispute, atrial is essential.” Krolnik v. Prudential Ins. Co. of Am., 570 F.3d 841, 844 (7th Cir. 2009) (Easterbrook, J.). Second, the court held that, absent a challenge to the plan’s administrative process, district courts are confined to the record before the administrator. That holding entrenches an eleven-circuit, four-way split about the scope of the record for de novo ERISA benefits claims. The questions presented are: 1. Whether, on de novo consideration of an ERISA benefits claim, summary judgment must be denied if there is a genuine dispute of material fact. 2. Whether, on de novo consideration of an ERISA benefits claim and absent a challenge to the plan’s procedures, a district court has discretion to consider evidence that was not part of the record before the plan administrator. (1)

Docket Entries

2021-05-24
Petition DENIED.
2021-05-04
DISTRIBUTED for Conference of 5/20/2021.
2021-05-03
Reply of petitioner Jane Doe filed. (Distributed)
2021-04-14
Brief of respondents Harvard Pilgrim Health Care, Inc. and the Harvard Pilgrim PPO Plan Massachusetts, Group Policy Number 0588660000 in opposition filed.
2021-02-25
Motion to extend the time to file a response is granted and the time is extended to and including April 14, 2021.
2021-02-24
Motion to extend the time to file a response from March 15, 2021 to April 14, 2021, submitted to The Clerk.
2021-02-05
Petition for a writ of certiorari filed. (Response due March 15, 2021)

Attorneys

Harvard Pilgrim Health Care, Inc. and the Harvard Pilgrim PPO Plan Massachusetts, Group Policy Number 0588660000
Steven Lewis SchreckingerAnderson & Kreiger, 21st Floor, Respondent
Steven Lewis SchreckingerAnderson & Kreiger, 21st Floor, Respondent
Harvard Pilgrim Health Care, Inc., et al.
Scott P. LewisAnderson & Kreiger LLP, Respondent
Scott P. LewisAnderson & Kreiger LLP, Respondent
Jane Doe
Peter K. StrisStris and Maher LLP, Petitioner
Peter K. StrisStris and Maher LLP, Petitioner