Norine Sylvia Cave v. Delta Dental of California, et al.
Arbitration ERISA HealthPrivacy Privacy
Whether a covered entity violates ERISA, by improperly denying beneficiaries' rights and further compounds such violations by approving unauthorized benefits while withholding medical records in its entirety, in order to avoid liability and to conceal its breaches of fiduciary duties?
Questions Presented 1. Whether a covered entity violates ERISA, by improperly denying beneficiaries’ rights and further compounds such violations by approving unauthorized benefits while withholding medical records in its entirety, in order to avoid liability and to conceal its breaches of fiduciary duties? 2. Where a Plan's fiduciary holds the authority and sole responsibility of adjudicating claims governed by ERISA and fails to follow the terms under the Plan, would a beneficiary have the equal right to challenge a fraudulent claim/determination under the same standard of review as a denied claim for relief pursuant to ERISA §§ 502(a), 502(a)(3)?