ERISA: The Standard of Review When Determining if an Employee is Eligible for Pension Benefits, Disability Insurance, or Life Insurance

Section 502 of the Employee Retirement Income Security Act (ERISA) is a law that ensures that employees are given the work benefits that their employer provides.  (Section 502 of ERISA corresponds to 29 U.S.C. §1132).  If a company provides a benefit plan to employees, and the employee meets the standards to qualify for the benefits, the employer must provide the benefits to the employee.  Life insurance, disability insurance (both short term and long term benefits), and pension plans are types of plans that fall under ERISA. ERISA requires plans to provide participants with information about the plan and sets the minimum standards for participation in the plan, vesting, benefit accrual, and funding.   More specifically, ERISA is designed to help participants recover benefits due, enforce rights, and to clarify rights to future benefits under the terms of the plan.

Individuals participating in the plan are considered participants.  If a participant applies for benefits under the plan, and the plan administrator denies the participant’s claim for benefits the participant can ask the administrator to reconsider the claim.  (Appeals to the administrator are considered administrative appeals.)  A participant can bring their case to court once the opportunities for reconsideration at the administrative level are exhausted.  Often, ERISA claims are filed in federal court. 

If a participant chooses they can attempt to enforce their rights by bringing a lawsuit against the administrator.  In court, participants and administrators will often fight over the standard of review: de novo or abuse of discretion.  A brand new review is called a de novo review. Courts should conduct a brand new review to determine if a participant is eligible for benefits, unless the plan gives the administrator discretionary authority to award benefits.  If the judge proceeds with a de novo review he will review all records submitted to the administrator and potentially other records to reach a decision. 

Many plans incorporate language that give administrators discretionary authority to determine if a participant is eligible for benefits.   If the plan gives the administrator discretionary authority to decide if a participant is eligible for benefits, courts will review the claim by determining whether the administrator abused their discretion or made arbitrary and capricious decision. In abuse of discretion, the judge will only determine if the company came to a reasonable decision.   The abuse of discretion standard is not as favorable to the participant as a de novo review. 

Although plan administrators will often try to use language in their plan to ensure that courts use an abuse of discretion standard of review, sometimes the language the plan administrator uses is insufficient to permit courts to use the deferential abuse of discretion standard.  For example, an insurance company might not be able to rely on an abuse of discretion standard of review if they use language that states proof must be “satisfactory to us” to provide benefits.

If an employee is successful in court, they can be awarded the entirety of benefits due, court costs, and attorney fees. Hiring a knowledgeable attorney can help you in your ERISA claim.  

An Overview of Maryland's Unemployment Benefits Program

In Maryland, if an individual is terminated or performs less than full-time work that individual may be entitled to unemployment benefits.  Unemployment benefits are designed to protect individuals from involuntary unemployment.  To obtain unemployment benefits, an individual needs to apply for unemployment insurance benefits with the Maryland Department of Labor, Licensing and Regulation (DLLR).  (An individual applying for benefits is called a claimant.) From there, the DLLR will determine whether the claimant is eligible for benefits and the amount of benefits that the claimant is eligible to receive. 

Who Is Eligible

To be eligible for unemployment benefits, a claimant must have worked for someone else or a company.  (Independent contractors are not eligible for unemployment benefits.   Depending on the circumstances, even if there is a contract identifying someone as an independent contractor, by law that person may be considered an employee.  Thus, depending on the circumstances, that claimant may be eligible for benefits.  Checking with an attorney to determine if someone is considered a contractor can help your claim.)  If a claimant worked for an organization that operated primarily for religious purposes that claimant may not be eligible for benefits.  Furthermore, to qualify for benefits, a claimant must have worked at least two of the first four quarters within the last five quarters and must have earned sufficient wages.

To receive benefits, the claimant must be (1) able to work, (2) available for work, and (3) actively seeking work. “Able to work” means that a claimant is physically and mentally capable of working.  The claimant does not need to be physically and mentally capable of performing their last job, just capable of performing another job.  As for determining whether someone is available for work, a temporary medical impairment could delay the receipt of benefits if the impairment renders a claimant unable to work.   While receiving benefits, a claimant must apply for work, accept suitable work when offered, or return to self-employment when directed to do so.  An analysis of whether work is suitable focuses on a range of factors.  During the duration of the period that a claimant is obtaining benefits, the claimant needs to file proof that they continue to meet these three criteria and also that their claim for benefits is continuing.  Failure to properly file can result in the loss of benefits. 

To receive the full amount of benefits, a claimant must be terminated for a reason that does not constitute misconduct or have quit their job with good cause.  If the claimant is terminated from their job for simple misconduct or quits their job for valid circumstances, the claimant will still be eligible for benefits, but will subject to a penalty.  If a claimant quits their job without good cause and valid circumstances, or if the claimant is terminated for gross misconduct or aggravated misconduct, benefits will most likely be denied.  If an employee resigns in the face of being discharged, their resignation is treated as a discharge.  If the claimant received severance pay the receipt of benefits may be delayed.

Appeals

DLLR’s decision to award benefits will focus on the reason the claimant left their job and the claimant’s availability for work.  If a claimant is not awarded benefits at the initial level, the claimant may appeal the decision.  Similarly, if an employer believes that the claimant should not be awarded benefits, the employer can appeal the decision.  Appeals must be filed within 15 days of the date of delivery of the determination notice.  The first level of appeals is heard by a hearing examiner.  The decision by the hearing examiner can be appealed to the Board of Appeals.  Either party can appeal the Board of Appeals decision and have the matter heard by the circuit court.  

If a claimant is awarded benefits, the claimant will receive benefits during the course of their employer’s appeal.  Benefits will only cease if there is a finding in favor of an employer.  If an employer is successful in their appeal, a claimant may have to repay DLLR the benefits received.    Similarly, if a claimant is overpaid benefits, the claimant may have to pay those benefits back.  (If a claimant was overpaid because he or she provide of false statements, the claimant will have to pay DLLR back with interest and could be subject to other penalties).

Conclusion

There is an abundance of case law that can be used to strengthen a claimant’s or a company’s chance of success when applying for benefits.   This case law provides parameters as to whether or not a claimant should be awarded benefits and for how long those benefits should be awarded.  An attorney well versed in this sort of law can be a valuable asset in an unemployment hearing. 

The Outcome of an Administrative Hearing for a DUI/DWI

If you are charged with driving under the influence or driving while intoxicated, your license will be taken by the police and you will be issued a temporary license that lasts 45 days.  On the 46th day your license will be suspended.  To continue driving, you can fight your suspension in an administrative hearing or enter the ignition interlock system.  You can extend the length of your temporary license to the date of your administrative hearing, by asking for a hearing within 10 days of being charged. You have 30 days to request an administrative hearing, but the 45 day time limit of your temporary license will not be extended if you request your hearing after the 10th day.  

When a driver enters the ignition interlock program, he or she can only drive cars that are equipped with an ignition interlock system.  These systems prevent a car from starting until the driver has breathed into a device and the device has determined the driver is sober.  The driver will have to breathe into the device periodically while driving. Typically, there is an installation cost and a monthly service fee with the ignition interlock program.  The driver will need to breathe into the interlock system at least 50 times per month or explain to the Motor Vehicle Administration why he or she was unable to breathe into the device 50 times a month. Drivers in the interlock program, must file a monthly report with their interlock system provider so that providers can make sure that drivers are complying with the program. 

If having your license suspended or only being able to drive cars equipped with ignition interlock systems is not acceptable, you can request an administrative hearing.  In an administrative hearing, the judge does not have to allow you to participate in the ignition interlock program.  You are only guaranteed entry into the program if you enter into the program prior to the hearing. At the hearing, the administrative law judge can decide to suspend your license, allow you to enter into the ignition interlock program, enter the ignition interlock system and allow you to drive work vehicles that are not equipped with ignition interlock devices, or find that your license should not be suspended.  If you can show that the officer induced you into refusing the chemical test by providing misinformation you can beat the suspension. 

At the hearing, the only facts the administrative law judge will consider are:

1. Whether the police officer had reasonable grounds to believe you were driving or attempting to drive while under the influence of or impaired by alcohol or drugs;

2. Whether there is evidence that you used alcohol or drugs;

3. Whether the police officer advised you of administrative sanctions before requesting the in-station chemical breath test;

4. Whether you refused to take the test;

5. Whether you drove or attempted to drive while having a alcohol concentration of 0.08 or more;

6. Whether you drove or attempted to drive while having an alcohol concentration of 0.15 or more; and

7. If the hearing involves disqualification of a commercial driver’s license, whether you were operating a commercial motor vehicle or held a commercial driver’s license.

Refusing to Take a Chemical Test When Pulled Over for a DUI/DWI

In Maryland, if an officer pulls over a vehicle and suspects that the driver was driving while impaired or under the influence of drugs or alcohol, the officer will ask the driver to take a variety of tests.  Drivers can refuse all of these tests.  Except for the chemical breath test in the police station, drivers will not be penalized for refusing to take these tests. 

Maryland is an implied consent state.  This means that if a driver was lawfully stopped and detained by an officer, and the officer had probable cause to believe the driver was impaired, at the request of the officer, the driver must either take a chemical breath test at the police station or have their license suspended. 

The suspension is an administrative penalty that is not related to any criminal penalties that a driver may face.  The suspension will begin 45 days after the incident, unless the driver requested an administrative hearing within 10 days of being charged.  If the driver requests an administrative hearing within 10 days of being charged, their license will be suspended on the day of their administrative hearing.  (A driver can choose to have their license suspended earlier.)   Drivers have up to 30 days to request an administrative hearing, but their license will still be suspended after day 45 if they did not request the administrative hearing by day 10.   Rather than facing a suspension,  drivers that refuse to take a breath test can keep their license if they enter into the ignition interlock program.  However, except for a potential exception for work provided vehicles, the driver will only be able to drive vehicles equipped with an ignition interlock system.  (For more information on the ignition interlock system, click here.)

When a driver refuses to take the in-station breath test, an officer should inform the driver that their license will be suspended for refusing to take the test.  The officer should also tell the driver what happens if the driver takes a chemical test and has above a 0.08 or above a 0.15 blood alcohol content.   Prior to suspending a driver’s license, the officer will have the driver sign a DR-15 form.  This form advises drivers of their administrative rights.  The police officer should read the DR-15 to the driver or play a recording of someone reading the DR-15.  An officer’s failure to follow these steps might be considered misleading. 

If a driver can prove in an administrative hearing that the officer gave misleading information or induced the driver into refusing the test, the driver will only be without his or license for a short time – the period between the administrative hearing and going to the Motor Vehicle Administration to get a new driver’s license.  Licenses are confiscated at the administrative hearing, so drivers leave without their license.

High Stakes in Maryland Administrative Hearings

At the Maryland state level, administrative hearings are extremely important and are used to decide appeals of administrative agency decisions.  For example, these agency decisions might preclude someone from collecting insurance, result in a suspended driver’s license, or require someone to pay a fine. Generally, before appealing an agency’s decision to a court, a party has to exhaust all administrative remedies, including having an administrative hearing.   

In Maryland, administrative hearings are presided over by Administrative Law Judge (ALJ) and are commonly held by the Office of Administrative Hearings, an executive branch agency.  (Almost half of the administrative hearings are related to issues concerning the Motor Vehicle Administration.) Depending on the matter, after the hearing, the ALJ either makes a decision on the appeal or makes a recommendation to the agency with jurisdiction over the matter.  The agency can choose whether it follows the recommendation. 

Once all administrative remedies are exhausted, a party typically has 30 days to appeal to a court an agency decision by filing a petition for judicial review.  (Filing a petition for agency review does not automatically stop an agency action.  The petitioner has to file a motion with the court to delay the agency action until the court has ruled on the matter.) An appeal can be filed in any county where a party resides or has a principal place of business.  In order to overturn an ALJ’s decision, a reviewing court needs to find that the ALJ’s opinion was arbitrary.  In most instances in Maryland, courts review the administrative decision in the light most favorable to the administrative court.  A court will not reverse an ALJ’s decision simply because it would have ruled differently.  The ALJ’s decision will stand as long as it is legally sufficient and reasonable given the evidence.  (In worker’s compensation cases, the reviewing court will hear the case de novo, meaning the court will issue a new decision and not rely on the Administrative Law Judge’s decision.)  If a party wants to admit additional evidence at the circuit court level, they must provide the court with a good reason why the evidence was not offered at the administrative level.  At the conclusion of the case, the reviewing court can then remand the decision for additional consideration by the ALJ or uphold or reverse the ALJ’s decision.