Delay in providing denial letter does not alter standard of review
Steward v. Prudential Insurance Company of America, Civil Action No. 3: 12-CV-3844-B (N.D. Tex. Jan. 10, 2014) involved a claim for disability benefits. The Court first addressed Plaintiff's argument that Prudential's failure to provide the denial letter within 45 days of Plaintiff's appeal changed the standard of review from abuse of discretion to de novo. The Court noted that neither party informed the court of the date Prudential received the appeal. The Court found that Prudential was anywhere from 62 to 86 days late. However the Court determined that Prudential substantially complied with ERISA's procedural regulations. The Court further noted that even if it found that Prudential did not substantially comply with ERISA's procedures it would still not change the standard of review from abuse of discretion to de novo. (Lafleur v. Louisiana Health Serv. and Indemnity Co., 563 F.3d 148, 158 (5th Cir. 2009)). ("Although [defendant] failed to substantially comply with the procedural requirements of ERISA, these violations were not flagrant, so the de novo standard of review . . . is not implicated. Instead, we face the more ordinary situation in which a plan administrator has exercised discretion but, in doing so, has made procedural errors.").
Having decided that the standard of review would remain abuse of discretion the Court determined that Prudential did not abuse its discretion. The Court noted that it was to examine the record for substantial evidence to support Prudential's denial of the Plaintiff's claim. The Court found that the opinion of Prudential's medical experts coupled with Plaintiff's psychiatric records lacking evidence of a functional impairment was substantial evidence supporting Prudential's denial.