The Issue: Conflict of interest exists when a party is entitled to both determine whether a claim is eligible (or not) and also pay the claim. In such case how much weightage should be given to the conflict of interest to justify if the company has abused this dual power
Wanda Glenn started working as sales manager for Sears, Roebuck & Company (chain of American department stores) in 1986. Around 1989, she was diagnosed for cardiomyopathy and doctors surgically implanted a defibrillator. However, in 2000 her medical condition worsened again and doctors diagnosed her with an enlarged and weakened heart that necessitated a surgery involving heart transplantation. Additionally doctors suggested her to quit her job, observing the fact that psychological and physical stress involved with her job was complicating her illness.
Glenn filed a disability benefits with Sear’s Long Term Disability Plan, which was both administered and funded by Metropolitan Life Insurance Company. According to the Plan, employees diagnosed with “total disability” received sixty percent of their salary. …show more content…
decide whether the claim is legitimate or not) (SupremeCourt, Metropolitan Life Ins. Co. v. Glenn, 2008) and the conflict must be weighted to determine if there was an actual abuse of this discretion. There is enough evidence to judge the weightage of this abuse. MetLife has asked Glenn to apply for benefits under Social Security Administration (SSA), and the report provided by SSA claims that Glenn satisfies the criteria required under ERISA (CarryPaine, 2008). But MetLife has failed to consider this before it has denied the benefits. While having a second opinion on the reports provided by Glenn is understandable, but ignoring the reports provided by SSA shows some sort of abuse in the decision taken by
Wanda Glenn started working as sales manager for Sears, Roebuck & Company (chain of American department stores) in 1986. Around 1989, she was diagnosed for cardiomyopathy and doctors surgically implanted a defibrillator. However, in 2000 her medical condition worsened again and doctors diagnosed her with an enlarged and weakened heart that necessitated a surgery involving heart transplantation. Additionally doctors suggested her to quit her job, observing the fact that psychological and physical stress involved with her job was complicating her illness.
Glenn filed a disability benefits with Sear’s Long Term Disability Plan, which was both administered and funded by Metropolitan Life Insurance Company. According to the Plan, employees diagnosed with “total disability” received sixty percent of their salary. …show more content…
decide whether the claim is legitimate or not) (SupremeCourt, Metropolitan Life Ins. Co. v. Glenn, 2008) and the conflict must be weighted to determine if there was an actual abuse of this discretion. There is enough evidence to judge the weightage of this abuse. MetLife has asked Glenn to apply for benefits under Social Security Administration (SSA), and the report provided by SSA claims that Glenn satisfies the criteria required under ERISA (CarryPaine, 2008). But MetLife has failed to consider this before it has denied the benefits. While having a second opinion on the reports provided by Glenn is understandable, but ignoring the reports provided by SSA shows some sort of abuse in the decision taken by