Plan to allow Ms. Wolf’s benefits to be terminated. These actions are violations of
arbitrary and capricious. In addition, the interpretations were
unreasonable under any standard of review and especially unreasonable given Delta’s
conflict of interest.
Delta had an affirmative duty to ensure that it is in possession of all necessary and
obtainable information before it makes a claims decision. Motor Vehicle Mfrs. Ass'n v.
State Farm Mutual Auto Ins. Co., 463 U.S. 29, 43, 103 S.Ct. 2856, 77 L.Ed. 2d 443
(1983) (a decision is arbitrary and capricious if the decision-maker "entirely failed to
consider an important aspect of the problem, offered an explanation for its decision that
runs counter to the evidence before [it], or is so implausible that it could not be ascribed
to a difference in view or the product of agency expertise"). ERISA does not allow a
fiduciary to sit back and wait for information to be submitted. At the very least, Delta
must obtain all the medical records from the treating physicians. A failure to investigate
is deemed arbitrary and capricious36.
"Good faith requires an honest effort to ascertain the facts upon which its exercise must rest and an honest determination from such ascertained facts. . . . If [the fiduciary] knew of matters concerning which honesty would require investigation, and failed to act, or if it knew of matters which would honestly compel a given determination and it announced to the contrary, it cannot, in law be regarded as having exercised good faith, and its action would be arbitrary. Thus, an improper motive sufficient to set aside a fiduciary's decision may be inferred from the fiduciary's failure to investigate or to interpret honestly evidence that greatly preponderates in one direction."
Brown, 898 F.2d at1566. Accord, Shannon v. Jack Eckerd Corp., 113 F.3d 208, 210 (11th Cir. 1997)("obligation to make a reasonably relevant inquiry"); Kunin v. Benefit
Delta has admitted that it failed to obtain all the medical records. See, Request for Admissions, Exhibit
Q, numbers 28, 36, 37, 38 and 39,
. This fact alone is enough to conclude that Delta’s decision
was arbitrary and capricious under any standard of review.