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The Wagner Law Group

The Wagner Law Group is a nationally recognized practice in the areas of ERISA and employee benefits, estate planning, employment, labor and human resources and investment management.


Established in 1996, The Wagner Law Group is dedicated to the highest standards of integrity, excellence and thought leadership and is considered to be amongst the nation's premier ERISA and employee benefits law firms. The firm has seven offices across the country, providing unparalleled legal advice to its clients, including large, small and nonprofit corporations as well as individuals and government entities worldwide. The Wagner Law Group's 32 attorneys, senior benefits consultant and five paralegals combine many years of experience in their fields of practice with a variety of backgrounds. Seven of the attorneys are AV-rated by Martindale-Hubbell and six are Fellows of the American College of Employee Benefits Counsel, an invitation-only organization of nationally recognized employee benefits lawyers.  Seven of the firm's attorneys have been named to the prestigious Super Lawyers list for 2017, which highlights outstanding lawyers based on a rigorous selection process.




Contact Info

The Wagner Law Group


  Integrity | Excellence



Tel: (617) 357-5200 

Fax: (617) 357-5250 

99 Summer Street 

13th Floor

Boston, MA 02110


Washington, D.C.

Tel: (202) 969-2800


Fax: (202) 969-2568

 800 Connecticut Avenue, N.W.

Suite 810

Washington, D.C. 20006



Tel: (847) 990-9034

Fax: (847) 557-1312

190 South LaSalle Street

Suite 2100

Chicago, IL 60603



Palm Beach Gardens 

Tel: (561) 293-3590
Fax: (561) 293-3591
7108 Fairway Drive
Suite 125
Palm Beach Gardens, FL 33418



Tel: (813) 603-2959

Fax: (813) 603-2961

101 East Kennedy Boulevard

Suite 2140
Tampa, FL  33602 


San Francisco

Tel: (415) 625-0002

Fax: (415) 358-8300

300 Montgomery Street

Suite 600

San Francisco, CA 94104


St. Louis

Tel: (314) 236-0065

Fax: (314) 236-5743
25 W. Moody Avenue
St. Louis, MO  63119 







 Fifth Circuit Adopts Standard of Review for ERISA Benefit Denial Claims


March 22, 2018




The Fifth Circuit Court of Appeals, in Ariana v. Humana Health Plan of Texas, has held that the "de novo" standard of review applies to ERISA denial of benefits claims involving challenges to a legal interpretation of plan provisions and factual determinations about benefit claims unless the plan administrator has been granted discretionary authority.


Law. In Firestone Tire & Rubber Co. v. Bruch, the Supreme Court held that if an ERISA plan does not delegate discretionary authority to the plan's administrator to interpret plan provisions, a denial of benefits claims based on these provisions is to be reviewed under a de novo standard. The Court further clarified that where a plan had delegated authority to the administrator, the decision must be reviewed under the heightened "arbitrary and capricious" standard.


Following Firestone, the majority of circuit courts of appeals have held that, in cases where a plan has not delegated discretionary authority to its plan administrator, the de novo standard of review applies to both challenges to the legal interpretation of a plan and the administrator's factual conclusions.


An arbitrary and capricious standard of review means that the plan's decision will only be overturned by the court if it is "without reason, unsupported by substantial evidence or erroneous as a matter of law." By contrast, a de novo review means that a court will independently review a claim and not defer to the plan administrator's, or insurer's, decision.


Background. In Ariana, the plaintiff filed a lawsuit against the defendant to challenge its decision to discontinue coverage of inpatient treatment for an eating disorder after two experts said she was no longer a danger to herself. After reviewing the claim using the abuse of discretion standard, the district court ruled in favor of the defendant. In turn, the plaintiff appealed the decision to the Fifth Circuit.


Fifth Circuit. The Fifth Circuit first reviewed the Firestone holding and, this time, determined that the decision provided a general standard of review for both legal interpretations of plan language and factual findings. It further acknowledged that subsequent Supreme Court decisions did not limit the de novo standard of review to legal interpretations of plan terms. Finally, the court observed that its past reasoning for declining to apply the de novo standard when reviewing a plan administrator's factual determination (i.e., doing so would deplete plan funds and overrun courts) had not come to fruition in the other circuits that applied a uniform standard of review. Accordingly, the Fifth Circuit reversed its long-standing precedent of using the abuse of discretion standard to review a plan administrator's factual determination and ruled that the de novo standard of review should be used when discretionary authority is not granted.


Employer takeaway. In the wake of Ariana, all circuit courts of appeals now apply the de novo standard of review, in the context of ERISA benefit denial claims, to both legal interpretation of plan documents and factual determinations made by a plan administrator when discretionary authority is not granted through plan provisions.








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