No. 23-570

Jacqueline Avery v. Sedgwick Claims Management Services, Inc., et al.

Lower Court: Sixth Circuit
Docketed: 2023-11-28
Status: Denied
Type: Paid
Tags: administrative-regulations benefit-claims circuit-split claims-procedure erisa essential-purpose judicial-doctrine statutory-interpretation substantial-compliance
Key Terms:
Arbitration ERISA SocialSecurity Privacy
Latest Conference: 2024-02-16
Question Presented (AI Summary)

Whether the Sixth Circuit erred in holding — in conflict with the Second and Seventh Circuits — that violations of the claims procedure regulations, 29 C.F.R. § 2560.503-1, may be excused under the judicial 'substantial compliance' doctrine if a judge determines that plan procedures satisfy the 'essential purpose' of Section 503

Question Presented (from Petition)

QUESTION PRESENTED Under Section 503 of the Employee Retirement Income Security Act of 1974 (ERISA), 29 U.S.C. § 1133, employee benefit plans must, in accordance with the regulations of the Secretary of Labor: 1. provide adequate notice in writing to any participant or beneficiary whose claim for benefits under the plan has been denied, setting forth the specific reasons for such denial, written in a manner calculated to be understood by the participant, and 2. afford a reasonable opportunity to any participant whose claim for benefits has been denied for a full and fair review by the appropriate named fiduciary of the decision denying the claim. In turn, the Secretary of Labor’s claims procedure regulations, 29 C.F.R. § 2560.503-1, precisely detail the minimum performance standards necessary to comply with the statute. However, the Sixth Circuit has ruled that violations of the claims procedure regulations may be excused under the judicial “substantial compliance” doctrine if a judge determines that plan procedures satisfy the “essential purpose” of Section 503. App. 10-12. The question presented is: Whether the Sixth Circuit erred in holding — in conflict with the Second and Seventh Circuits — that violations of the claims procedure regulations, 29 C.F.R. § 2560.503-1, may be excused under the judicial “substantial compliance” doctrine if a judge determines that plan procedures satisfy the “essential purpose” of Section 503. li RELATED CASES Avery v. Sedgwick Claims Management Services, No. 20-11810, U.S. District Court for the Eastern District of Michigan. Judgment entered September 21, 2022. Avery v. Sedgwick Claims Management Services, No. 22-1960, U.S. Court of Appeals for the Sixth Circuit. Judgment entered July 24, 2023.

Docket Entries

2024-02-20
Petition DENIED.
2024-01-17
DISTRIBUTED for Conference of 2/16/2024.
2023-12-28
Brief of respondents Sedgwick Claims Management Services, Inc, et al. in opposition filed.
2023-11-22
Petition for a writ of certiorari filed. (Response due December 28, 2023)

Attorneys

Jacqueline Avery
Robert Brown JuneLaw Offices of Robert June, P.C., Petitioner
Robert Brown JuneLaw Offices of Robert June, P.C., Petitioner
Sedgwick Claims Management Services, Inc, et al.
J. Randall CoffeyFisher & Phillips, LLP, Respondent
J. Randall CoffeyFisher & Phillips, LLP, Respondent