Holding an insurer to its explanation for denying benefits articulated during its internal claims review process.

“In Glista, we held an insurer to its internal claims review process.”   Dutkewych v. Standard, 781 F.3d 623 (1st Cir. 2015)(citing Glista v. Unum Life Insurance Co. of America, 378, F.3d 113, 132 (1st Cir. 2004). 

 

The court has a range of options available to it in such circumstances.  Glista v. Unum Life Insurance Co. of America, 378, F.3d 113, 116 (1st Cir. 2004). 

 

The court reasoned in Dutkewych v. Standard, 781 F.3d 623 (1st Cir. 2015) that the insurer’s reliance on the limited conditions provision in the plan took place before there was any litigation and that plaintiff had adequate notice during the administration process, in declining to find the insurer’s use of the provision during litigation to be a post hoc rationalization.

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