The Plan Strikes Out
A recent decision from the Fourth Circuit indicates that, even under an abuse of discretion standard, one flawed medical report can taint the entire “deliberate, principled reasoning process” that is required under ERISA. Further, a claimant cannot be required to exhaust conservative treatment options before undergoing surgery if that is not an explicit term in the applicable plan. Finally, a plan that continuously errs in its decision-making process may be denied remand, even where there is no evidence of bad faith. In short, three strikes and you’re out.