In the case of Metropolitan Life Insurance Co. vs. Glenn, the high court justices were asked to decide whether a conflict of interest exists when the company that determines the validity of claims under a benefits plan also is responsible for paying benefits under the plan. "Yes," they said, and other courts should take this into account when adjudicating ERISA cases involving claims disputes.
Steven D. Spencer, an attorney with Morgan Lewis and Bockius, LLP, said that this decision has broad implications.
"In Glenn, the court concluded that such a [plan administration] structure creates an inherent conflict of interest that should be considered by courts in assessing whether the plan administrator abused its discretion in denying plan benefits. Employers must take note of this decision and consider whether a similar conflict in the administration and payment of claims under their benefit plans could diminish the protection usually afforded by the deferential standard of judicial review."
Of course, having a single administrator is not necessarily improper, and many insurers have procedures in place aimed at avoiding a conflict of interest, Spencer noted.
If after reviewing the plan structure, a sponsor decides to continue with it, Spencer recommended several steps to reduce potential bias and promote accuracy.
"Wall off the fiduciary from the financial," he suggested. This might include establishing an independent claims fiduciary whose decisions are subject to an independent auditor or including wording in a claim fiduciary committee's charter that makes it clear that the committee is free to make independent decisions without any repercussions from the plan sponsor.
This advice extends to self-insured employers as well, he added.
State pension plan does not discriminate
In Kentucky Retirement Systems v. Equal Employment Opportunity Commission, the high court ruled 5-4 that the state's pension plan for disabled workers, which treats employees differently based on pension status, does not violate the Age Discrimination in Employment Act.
Kentucky's retirement plan permits "hazardous position" workers, such as policemen, to receive normal retirement benefits after working either 20 years or five years and attaining age 55 and pays "disability retirement" benefits to workers meeting specified requirements. The plan calculates normal retirement benefits based on actual years of service. Disability benefits are calculated by adding to an employee's actual years of service the number of years that the employee would have had to continue working in order to become eligible for normal retirement benefits, adding no more than the number of years the employee had previously worked.
The employee in this case, Charles Lickteig, continued working after becoming eligible for retirement at age 55, became disabled and retired at age 61. He filed an age discrimination complaint with the Equal Employment Opportunity Commission after the plan based his pension on his actual years of service without imputing any additional years. The EEOC filed suit against Kentucky, arguing that the plan failed to impute years solely because Lickteig became disabled after age 55.
The justices sided – narrowly – with the employer. Harking back to the court's 1993 decision in Hazen Paper Co. v. Biggins, they said that a plaintiff must show that the differential treatment was actually motivated by age and not pension status to bring a disparate treatment claim under the ADEA.
"The court ruled that age and pension status are distinct concepts, and that decisions made under the plan are based on pension status rather than age," Spencer said. However, employers should be cautious about reading too much into this decision, he added.
"The court emphasized that this [decision] was a special case of differential treatment based on pension status, which lawfully turns, in part, on age, and that its decision 'in no way unsettles the rule that a statute or policy that facially discriminates based on age suffices to show disparate treatment under the ADEA."
