Table of contents for Lawyer law : comparing the ABA model rules of professional conduct with the ALI restatement (third) of the law governing lawyers / by Thomas Morgan.

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Contents
Foreword xxv
About the Editor xxvii
About the Authors xxix
CHAPTER 1 
First Circuit 1
Joseph M. Hamilton
William Kayatta
Brooks Magratten
	I.	What Constitutes an ERISA Plan? 1
A.	Determining the Existence of an Employee 
Welfare Benefit Plan 1
B.	Definition of "Employee" for ERISA Purposes 2
C.	Interpretation of Safe Harbor Regulation 2
D.	Amount of Employer Involvement Required to Sustain 
an Employee Welfare Benefit Plan 3
E.	Treatment of Multiple Employer Trusts 
and Welfare Agreements 3
	II.	Preemption 3
A.	Scope of ERISA Preemption 3
B.	Preemption of Managed-Care Claims 4
C.	Preemption of Malpractice Claims 4
D.	Other Preemption Issues 4
	III.	Exhaustion of Administrative Remedies 5
A.	Is Exhaustion an Absolute Requirement? 5
B.	Exceptions to the Exhaustion Requirement 5
C.	Consequences of Failure to Exhaust 6
D.	Minimum Number of Levels of Administrative 
Review 6
E.	Can a Defendant Waive a Failure-to-Exhaust 
Defense? 6
	IV.	Standard of Review 6
A.	Plan Language 6
B.	What Standard of Review Applies? 7
C.	Effect of Conflict of Interest or Procedural 
Irregularity 7
D.	Other Factors Affecting Standard of Review 9
	V.	Rules of Plan Interpretation 9
A.	Application of Federal Common Law 9
B.	Application of Contra Proferentem 9
C.	Deference Afforded to an Administrator's 
Interpretation of a Plan 10
D.	Other Rules of Plan or Contract Interpretation 10
	VI.	Discovery 10
A.	Limitations on Discovery 10
B.	Discovery and Conflict of Interest 11
	VII.	Evidence 11
A.	Scope of Evidence under Standards of Review 12
B.	Evidentiary Value of Social Security 
Determinations 12
C.	Other Evidence Issues 12
	VIII.	Procedural Aspects of ERISA Practice 13
A.	Methods of Adjudication 13
B.	Reported ERISA Trials 13
C.	Special Procedures for ERISA Benefit Cases 13
	IX.	Fiduciary Liability Claims 13
A.	Definition of Fiduciary 13 
B.	Definition of Fiduciary Duties 14
C.	Fiduciary Liability in the Context of Health 
and Disability Claims 14
D.	Remedies for Breach of Fiduciary Duty 14
E.	Contribution and Indemnity Claims 
among Fiduciaries 15
F.	ERISA Claims against Nonfiduciaries 15
	X.	Attorneys' Fees 15
A.	Criteria for Awarding Attorneys' Fees 15
B.	Fees Awarded to Plan Fiduciaries 16
C.	Calculation of Attorneys' Fees 16
	XI.	ERISA Regulations 17
	XII.	Cases Interpreting ERISA Statutes of Limitation 20
	XIII.	Subrogation Litigation after Great-West Life v. Knudson 22
	XIV.	Miscellaneous 22
A.	Unique Substantive or Procedural Rules 
for ERISA Cases 22
B.	Unique Approach to Common Policy-Based Defenses 22
C.	Other Miscellaneous Issues 22
CHAPTER 2 
Second Circuit 23
David J. Burke
Steven B. Getzoff
Helen M. Kemp
Randi F. Knepper
Michael J. Kolosky
Allan M. Marcus
Carl J. Schaerf
Jean E. Tomasco 
	I.	What Constitutes an ERISA Plan? 23
A.	Determining the Existence of an Employee 
Welfare Benefit Plan 23
B.	Definition of "Employee" 
for ERISA Purposes 24
C.	Interpretation of Safe Harbor Regulation 24
D.	Amount of Employer Involvement Required to Sustain 
an Employee Welfare Benefit Plan 24
E.	Treatment of Multiple Employer Trusts and Welfare 
Agreements 25
	II.	Preemption 25
A.	Scope of ERISA Preemption 25
B.	Preemption of Managed-Care Claims 26
C.	Preemption of Malpractice Claims 27
D.	Other Preemption Issues 28
	III.	Exhaustion of Administrative Remedies 29
A.	Is Exhaustion an Absolute Requirement? 29
B.	Exceptions to the Exhaustion Requirement 29
C.	Consequences of Failure to Exhaust 29
D.	Minimum Number of Levels of Administrative 
Review 30
E.	Can a Defendant Waive a Failure-to-Exhaust 
Defense? 30
	IV.	Standard of Review 30
A.	Plan Language 30
B.	What Standard of Review Applies? 31
C.	Effect of Conflict of Interest or Procedural 
Irregularity 31
D.	Other Factors Affecting Standard of Review 31
	V.	Rules of Plan Interpretation 31
A.	Application of Federal Common Law 31
B.	Application of Contra Proferentem 31
C.	Deference Afforded to an Administrator's 
Interpretation of a Plan 32
D.	Other Rules of Plan or Contract Interpretation 32
	VI.	Discovery 32
A.	Limitations on Discovery 32
B.	Discovery and Conflict of Interest 32
	VII.	Evidence 32
A.	Scope of Evidence under Standards of Review 32
B.	Evidentiary Value of Social Security Determinations 34
C.	Other Evidence Issues 34
	VIII.	Procedural Aspects of ERISA Practice 34
A.	Methods of Adjudication 34
B.	Reported ERISA Trials 36
1.	Procedural Aspects of a De Novo Review 36
2.	Advisory Jury 37
C.	Special Procedures for ERISA Benefit Cases 38
	IX.	Fiduciary Liability Claims 38
A.	Definition of Fiduciary 38
B.	Definition of Fiduciary Duties 38
C.	Fiduciary Liability in the Context of Health 
and Disability Claims 39
D.	Remedies for Breach of Fiduciary Duty 39
E.	Contribution and Indemnity Claims among Fiduciaries 40
F.	ERISA Claims against Nonfiduciaries 40
	X.	Attorneys' Fees 41
A.	Criteria for Awarding Attorneys' Fees 41
B.	Fees Awarded to Plan Fiduciaries 41
C.	Calculation of Attorneys' Fees 42
	XI.	ERISA Regulations 43
	XII.	Cases Interpreting ERISA Statutes of Limitation 45
	XIII.	Subrogation Litigation after Great-West Life v. Knudson 45
	XIV.	Miscellaneous 46
A.	Unique Substantive or Procedural Rules for ERISA Cases 46
B.	Unique Approach to Common Policy-Based Defenses 47
C.	Other Miscellaneous Issues 47
CHAPTER 3 
Third Circuit 49
Joshua Bachrach
Randi F. Knepper 
	I.	What Constitutes an ERISA Plan? 49
A.	Determining the Existence of an Employee Welfare 
Benefit Plan 49
B.	Definition of "Employee" for ERISA Purposes 49
C.	Interpretation of Safe Harbor Regulation 50
D.	Amount of Employer Involvement Required 
to Sustain an Employee Welfare Benefit Plan 51
E.	Treatment of Multiple Employer Trusts and Welfare Agreements 51
	II.	Preemption 51
A.	Scope of ERISA Preemption 51
B.	Preemption of Managed-Care Claims 52
C.	Preemption of Malpractice Claims 52
D.	Other Preemption Issues 53
	III.	Exhaustion of Administrative Remedies 53
A.	Is Exhaustion an Absolute Requirement? 53
B.	Exceptions to the Exhaustion Requirement 54
C.	Consequences of Failure to Exhaust 54
D.	Minimum Number of Levels of Administrative Review 54
E.	Can a Defendant Waive a Failure-to-Exhaust Defense? 54
	IV.	Standard of Review 55
A.	Plan Language 55
B.	What Standard of Review Applies? 56
C.	Effect of Conflict of Interest or Procedural Irregularity 57
D.	Other Factors Affecting Standard of Review 58
	V.	Rules of Plan Interpretation 59
A.	Application of Federal Common Law 59
B.	Application of Contra Proferentem 59
C.	Deference Afforded to an Administrator's 
Interpretation of a Plan 59
D.	Other Rules of Plan or Contract Interpretation 59
	VI.	Discovery 60
A.	Limitations on Discovery 60
B.	Discovery and Conflict of Interest 60
	VII.	Evidence 62
A.	Scope of Evidence under Standards of Review 62
B.	Evidentiary Value of Social Security Determinations 62
C.	Other Evidence Issues 62
	VIII.	Procedural Aspects of ERISA Practice 63
A.	Methods of Adjudication 63
B.	Reported ERISA Trials 63
C.	Special Procedures for ERISA Benefit Cases 64
	IX.	Fiduciary Liability Claims 64
A.	Definition of Fiduciary 64
B.	Definition of Fiduciary Duties 65
C.	Fiduciary Liability in the Context 
of Health and Disability Claims 65
D.	Remedies for Breach of Fiduciary Duty 65
E.	Contribution and Indemnity Claims among Fiduciaries 65
F.	ERISA Claims against Nonfiduciaries 65
	X.	Attorneys' Fees 66
A.	Criteria for Awarding Attorneys' Fees 66
B.	Fees Awarded to Plan Fiduciaries 66
C.	Calculation of Attorneys' Fees 66
	XI.	ERISA Regulations 67
	XII.	Cases Interpreting ERISA Statutes of Limitation 67
	XIII.	Subrogation Litigation after Great-West Life v. Knudson 68
	XIV.	Miscellaneous 69
A.	Unique Substantive or Procedural Rules 
for ERISA Cases 69
B.	Unique Approach to Common Policy-Based Defenses 69
C.	Other Miscellaneous Issues 69
CHAPTER 4 71
Fourth Circuit 71
Bryan D. Bolton 
Stuart A. Brock 
Cheryl A. C. Brown 
George K. Evans, Jr. 
J. Carlyle Hearn, II 
E. Ford Stephens 
Erna A. P. Womble 
	I.	What Constitutes an ERISA Plan? 71
A.	Determining the Existence of an Employee Welfare 
Benefit Plan 71
B.	Definition of "Employee" for ERISA Purposes 72
C.	Interpretation of Safe Harbor Regulation 75
D.	Amount of Employer Involvement Required 
to Sustain an Employee Welfare Benefit Plan 76
E.	Treatment of Multiple Employer Trusts and Welfare 
Agreements 76
	II.	Preemption 78
A.	Scope of ERISA Preemption 78
B.	Preemption of Managed-Care Claims 80
C.	Preemption of Malpractice Claims 83
D.	Other Preemption Issues 86
	III.	Exhaustion of Administrative Remedies 90
A.	Is Exhaustion an Absolute Requirement? 90
B.	Exceptions to the Exhaustion Requirement 90
C.	Consequences of Failure to Exhaust 92
D.	Minimum Number of Levels of Administrative 
Review 93
E.	Can a Defendant Waive a Failure-to-Exhaust Defense? 93
	IV.	Standard of Review 93
A.	Plan Language 93
B.	What Standard of Review Applies? 94
C.	Effect of Conflict of Interest or Procedural 
Irregularity 95
D.	Other Factors Affecting Standard of Review 96
	V.	Rules of Plan Interpretation 97
A.	Application of Federal Common Law 97
B.	Application of Contra Proferentem 98
C.	Deference Afforded to an Administrator's 
Interpretation of a Plan 98
D.	Other Rules of Plan or Contract Interpretation 98
	VI.	Discovery 99
A.	Limitations on Discovery 99
B.	Discovery and Conflict of Interest 100
	VII.	Evidence 101
A.	Scope of Evidence under Standards of Review 101
1.	Abuse of Discretion Standard 101
2.	De Novo Standard 101
B.	Evidentiary Value of Social Security Determinations 102
C.	Other Evidence Issues 102
	VIII.	Procedural Aspects of ERISA Practice 103
A.	Methods of Adjudication 103
B.	Reported ERISA Trials 103
C.	Special Procedures for ERISA Benefit Cases 104
	IX.	Fiduciary Liability Claims 105
A.	Definition of Fiduciary 105
B.	Definition of Fiduciary Duties 106
C.	Fiduciary Liability in the Context of Health 
and Disability Claims 107
D.	Remedies for Breach of Fiduciary Duty 108
E.	Contribution and Indemnity Claims 
among Fiduciaries 108
F.	ERISA Claims against Nonfiduciaries 109
	X.	Attorneys' Fees 109
A.	Criteria for Awarding Attorneys' Fees 109
B.	Fees Awarded to Plan Fiduciaries 110
C.	Calculation of Attorneys' Fees 110
	XI.	ERISA Regulations 111
	XII.	Cases Interpreting ERISA Statutes of Limitation 113
	XIII.	Subrogation Litigation after Great-West Life v. Knudson 114
	XIV.	Miscellaneous 115
A.	Unique Substantive or Procedural Rules 
for ERISA Cases 115
B.	Unique Approach to Common Policy-Based 
Defenses 115
1.	Disability 115
2.	Mental Illness 116
C.	Other Miscellaneous Issues 116
1.	ERISA Class Actions 116
2.	Jurisdictional Removal 118
CHAPTER 5 
Fifth Circuit 123
Virginia N. Roddy 
Kelly D. Simpkins 
Stephen W. Smith 
	I.	What Constitutes an ERISA Plan? 123
A.	Determining the Existence of an Employee 
Welfare Benefit Plan 123
B.	Definition of "Employee" for ERISA Purposes 124
C.	Interpretation of Safe Harbor Regulation 124
D.	Amount of Employer Involvement Required 
to Sustain an Employee Welfare Benefit Plan 125
E.	Treatment of Multiple Employer Trusts 
and Welfare Agreements 125
	II.	Preemption 126
A.	Scope of ERISA Preemption 126
B.	Preemption of Managed-Care Claims 126
C.	Preemption of Malpractice Claims 127
D.	Other Preemption Issues 128
	III.	Exhaustion of Administrative Remedies 128
A.	Is Exhaustion an Absolute Requirement? 128
B.	Exceptions to the Exhaustion Requirement 129
C.	Consequences of Failure to Exhaust 129
D.	Minimum Number of Levels of Administrative Review 129
E.	Can a Defendant Waive a Failure-to-Exhaust 
Defense? 129
	IV.	Standard of Review 129
A.	Plan Language 129 
B.	What Standard of Review Applies? 130
C.	Effect of Conflict of Interest or Procedural Irregularity 130
D.	Other Factors Affecting 
Standard of Review 131
	V.	Rules of Plan Interpretation 131
A.	Application of Federal Common Law 131
B.	Application of Contra Proferentem 131
C.	Deference Afforded to an Administrator's 
Interpretation of a Plan 132
D.	Other Rules of Plan or Contract Interpretation 132
	VI.	Discovery 132
A.	Limitations on Discovery 132
B.	Discovery and Conflict of Interest 133
	VII.	Evidence 133
A.	Scope of Evidence under Standards of Review 133
B.	Evidentiary Value of Social Security Determinations 133
C.	Other Evidence Issues 133
	VIII.	Procedural Aspects of ERISA Practice 133
A.	Methods of Adjudication 133
B.	Reported ERISA Trials 133
C.	Special Procedures for ERISA Benefit Cases 134
	IX.	Fiduciary Liability Claims 134
A.	Definition of Fiduciary 134
B.	Definition of Fiduciary Duties 134
C.	Fiduciary Liability in the Context of Health 
and Disability Claims 135
D.	Remedies for Breach of Fiduciary Duty 135
E.	Contribution and Indemnity Claims among Fiduciaries 135
F.	ERISA Claims against Nonfiduciaries 135
	X.	Attorneys' Fees 136
A.	Criteria for Awarding Attorneys' Fees 136
B.	Fees Awarded to Plan Fiduciaries 136
C.	Calculation of Attorneys' Fees 137
	XI.	ERISA Regulations 137
	XII.	Cases Interpreting ERISA Statutes of Limitation 138
	XIII.	Subrogation Litigation after Great-West Life v. Knudson 140
	XIV.	Miscellaneous 142
A.	Unique Substantive or Procedural Rules for ERISA Cases 142 
B.	Unique Approach to Common Policy-Based Defenses 143
C.	Other Miscellaneous Issues 143
CHAPTER 6 
Sixth Circuit 145
Robert D. Anderle 
Michael Shpiece 
	I.	What Constitutes an ERISA Plan? 145
A.	Determining the Existence of an Employee 
Welfare Benefit Plan 145 
B.	Definition of "Employee" for ERISA Purposes 145
C.	Interpretation of Safe Harbor Regulation 146
D.	Amount of Employer Involvement Required 
to Sustain an Employee Welfare Benefit Plan 147
E.	Treatment of Multiple Employer Trusts 
and Welfare Agreements 147
	II.	Preemption 147
A.	Scope of ERISA Preemption 147
B.	Preemption of Managed-Care Claims 148
C.	Preemption of Malpractice Claims 148
D.	Other Preemption Issues 149
	III.	Exhaustion of Administrative Remedies 149
A.	Is Exhaustion an Absolute Requirement? 149
B.	Exceptions to the Exhaustion Requirement 149
C.	Consequences of Failure to Exhaust 150
D.	Minimum Number of Levels of Administrative Review 150
E.	Can a Defendant Waive a Failure-to-Exhaust Defense? 150
	IV.	Standard of Review 150
A.	Plan Language 150
B.	What Standard of Review Applies? 150
C.	Effect of Conflict of Interest or Procedural Irregularity 151
D.	Other Factors Affecting Standard of Review 151
	V.	Rules of Plan Interpretation 152
A.	Application of Federal Common Law 152
B.	Application of Contra Proferentem 152
C.	Deference Afforded to an Administrator's 
Interpretation of a Plan 153
D.	Other Rules of Plan or Contract Interpretation 153
	VI.	Discovery 153
A.	Limitations on Discovery 153
B.	Discovery and Conflict of Interest 154
	VII.	Evidence 155
A.	Scope of Evidence under Standards of Review 155
B.	Evidentiary Value of Social Security Determinations 155
C.	Other Evidence Issues 155
	VIII.	Procedural Aspects of ERISA Practice 156
A.	Methods of Adjudication 156
B.	Reported ERISA Trials 156
C.	Special Procedures for ERISA Benefit Cases 156
	IX.	Fiduciary Liability Claims 157
A.	Definition of Fiduciary 157
B.	Definition of Fiduciary Duties 158
C.	Fiduciary Liability in the Context of Health 
and Disability Claims 158
D.	Remedies for Breach of Fiduciary Duty 158
E.	Contribution and Indemnity Claims among Fiduciaries 158
F.	ERISA Claims against Nonfiduciaries 159
	X.	Attorneys' Fees 159
A.	Criteria for Awarding Attorneys' Fees 159
B.	Fees Awarded to Plan Fiduciaries 159
C.	Calculation of Attorneys' Fees 159
	XI.	ERISA Regulations 160
	XII.	Cases Interpreting ERISA Statutes of Limitation 161
	XIII.	Subrogation Litigation after Great-West Life v. Knudson 161
	XIV.	Miscellaneous 162
A.	Unique Substantive or Procedural Rules 
for ERISA Cases 162
B.	Unique Approach to Common Policy-Based Defenses 162
C.	Other Miscellaneous Issues 163
CHAPTER 7 
Seventh Circuit 165
Mark D. DeBofsky 
Mark E. Schmidtke 
	I.	What Constitutes an ERISA Plan? 165
A.	Determining the Existence of an Employee Welfare 
Benefit Plan 165
B.	Definition of "Employee" 
for ERISA Purposes 166
C.	Interpretation of Safe Harbor Regulation 166
D.	Amount of "Employer Involvement" Required 
to Sustain an Employee Welfare Benefit Plan 166
E.	Treatment of Multiple Employer Trusts 
and Welfare Agreements 166
	II.	Preemption 167
A.	Scope of ERISA Preemption 167
B.	Preemption of Managed-Care Claims 167
C.	Preemption of Malpractice Claims 167
D.	Other Preemption Issues 167
	III.	Exhaustion of Administrative Remedies 167
A.	Is Exhaustion an Absolute Requirement? 167
B.	Exceptions to the Exhaustion Requirement 168
C.	Consequences of Failure to Exhaust 168
D.	Minimum Number of Levels of Administrative 
Review 168
E.	Can a Defendant Waive a Failure-to-Exhaust Defense? 168
	IV.	Standard of Review 168
A.	Plan Language 168 
B.	What Standard of Review Applies? 168
C.	Effect of Conflict of Interest or Procedural 
Irregularity 169
D.	Other Factors Affecting Standard of Review 170
	V.	Rules of Plan Interpretation 170
A.	Application of Federal Common Law 170
B.	Application of Contra Proferentem 170
C.	Deference Afforded to an Administrator's 
Interpretation of a Plan 170
D.	Other Rules of Plan or Contract Interpretation 170
	VI.	Discovery 170
A.	Limitations on Discovery 170
B.	Discovery and Conflict of Interest 171
	VII.	Evidence 171
A.	Scope of Evidence under Standards of Review 171
B.	Evidentiary Value of Social Security Determinations 171
C.	Other Evidence Issues 171
	VIII.	Procedural Aspects of ERISA Practice 171
A.	Methods of Adjudication 171
B.	Reported ERISA Trials 172
C.	Special Procedures for ERISA Benefit Cases 172
	IX.	Fiduciary Liability Claims 172
A.	Definition of Fiduciary 172
B.	Definition of Fiduciary Duties 172
C.	Fiduciary Liability in the Context 
of Health and Disability Claims 172
D.	Remedies for Breach of Fiduciary Duty 172
E.	Contribution and Indemnity Claims among Fiduciaries 172
F.	ERISA Claims against Nonfiduciaries 172
	X.	Attorneys' Fees 173
A.	Criteria for Awarding Attorneys' Fees 173
B.	Fees Awarded to Plan Fiduciaries 173
C.	Calculation of Attorneys' Fees 173
	XI.	ERISA Regulations 173
	XII.	Cases Interpreting ERISA Statutes of Limitation 173
	XII.	Subrogation Litigation after Great-West Life v. Knudson 174
	XIV.	Miscellaneous 174
A.	Unique Substantive or Procedural Rules 
for ERISA Cases 174
B.	Unique Approach to Common Policy-Based Defenses 174
C.	Other Miscellaneous Issues 175
CHAPTER 8 
Eighth Circuit 177
Clark H. Cole
Terrance J. Wagener 
	I.	What Constitutes an ERISA Plan? 177
A.	Determining the Existence of an Employee Welfare 
Benefit Plan 177
B.	Definition of "Employee" for ERISA Purposes 178
C.	Interpretation of Safe Harbor Regulation 179
D.	Amount of Employer Involvement Required 
to Sustain an Employee Welfare Benefit Plan 180
E.	Treatment of Multiple Employer Trusts and Welfare 
Agreements 180
	II.	Preemption 181
A.	Scope of ERISA Preemption 181
1.	State-Law Claims 181
2.	Savings Clause 181
B.	Preemption of Managed-Care Claims 182
C.	Preemption of Malpractice Claims 182
D.	Other Preemption Issues 182
	III.	Exhaustion of Administrative Remedies 183
A.	Is Exhaustion an Absolute Requirement? 183
B.	Exceptions to the Exhaustion Requirement 183
1.	Futility Exception 183
2.	Denial of Meaningful Access to Procedures 183
3.	Rapid and Life-Threatening Illness 183
C.	Consequences of Failure to Exhaust 183
D.	Minimum Number of Levels of Administrative Review 184
E.	Can a Defendant Waive a Failure-to-Exhaust Defense? 184
	IV.	Standard of Review 184
A.	Plan Language 184
B.	What Standard of Review Applies? 185
1.	Abuse of Discretion 185
2.	De Novo 185
3.	Sliding Scale 185
C.	Effect of Conflict of Interest or Procedural Irregularity 186
1.	Conflict of Interest 186
2.	Procedural Irregularity 186
D.	Other Factors Affecting Standard of Review 187
	V.	Rules of Plan Interpretation 189
A.	Application of Federal Common Law 189
B.	Application of Contra Proferentem 189
C.	Deference Afforded to an Administrator's 
Interpretation of a Plan 189
D.	Other Rules of Plan or Contract Interpretation 189
1.	Ordinary Meaning 189
2.	Vesting of Benefits 190
	VI.	Discovery 190
A.	Limitations on Discovery 190
1.	Abuse of Discretion Standard of Review 190
2.	De Novo Standard of Review 191
B.	Discovery and Conflict of Interest 191
	VII.	Evidence 192
A.	Scope of Evidence under Standards of Review 192
B.	Evidentiary Value of Social Security Determinations 193
C.	Other Evidence Issues 193
	VIII.	Procedural Aspects of ERISA Practice 194
A.	Methods of Adjudication 194
B.	Reported ERISA Trials 194
C.	Special Procedures for ERISA Benefit Cases 194
	IX.	Fiduciary Liability Claims 194
A.	Definition of Fiduciary 194
B.	Definition of Fiduciary Duties 194
C.	Fiduciary Liability in the Context 
of Health and Disability Claims 195
D.	Remedies for Breach of Fiduciary Duty 195
E.	Contribution and Indemnity Claims among Fiduciaries 195
F.	ERISA Claims against Nonfiduciaries 195
	X.	Attorneys' Fees 195
A.	Criteria for Awarding Attorneys' Fees 195
B.	Fees Awarded to Plan Fiduciaries 196
C.	Calculation of Attorneys' Fees 196
	XI.	ERISA Regulations 197
	XII.	Cases Interpreting ERISA Statutes of Limitation 197
	XIII.	Subrogation Litigation after Great-West Life v. Knudson 198
	XIV.	Miscellaneous 198
A.	Unique Substantive or Procedural Rules 
for ERISA Benefit Cases 198
B.	Unique Approach to Common Policy-Based Defenses 198
1.	Mental/Nervous Limitation 198
2.	Total Disability versus Residual Disability 198
3.	Preexisting-Condition Exclusion 199
4.	Burden of Proof 199
5.	Basis for Denial Not Considered by Administrator 199
C.	Other Miscellaneous Issues 200
CHAPTER 9 
Ninth Circuit 201
Linda M. Lawson 
Robert Miller 
Katherine Somervell
	I.	What Constitutes an ERISA Plan? 201
A.	Determining the Existence of an Employee Welfare 
Benefit Plan 201
B.	Definition of "Employee" for ERISA Purposes 202
C.	Interpretation of Safe Harbor Regulation 202
D.	Amount of Employer Involvement Required 
to Sustain an Employee Welfare Benefit Plan 203
E.	Treatment of Multiple Employer Trusts and Welfare 
Agreements 203
	II.	Preemption 203
A.	Scope of ERISA Preemption 203
B.	Preemption of Managed-Care Claims 205
C.	Preemption of Malpractice Claims 206
D.	Other Preemption Issues 207
1.	State Independent Review Statutes 207
2.	Bad-Faith Claims 208
	III.	Exhaustion of Administrative Remedies 208
A.	Is Exhaustion an Absolute Requirement? 208
B.	Exceptions to the Exhaustion Requirement 208
C.	Consequences of Failure to Exhaust 209
D.	Minimum Number of Levels of Administrative 
Review 209
E.	Can a Defendant Waive a Failure-to-Exhaust Defense? 209
	IV.	Standard of Review 209
A.	Plan Language 209
B.	What Standard of Review Applies? 209
C.	Effect of Conflict of Interest or Procedural 
Irregularity 210
D.	Other Factors Affecting Standard of Review 210
1.	Timeliness 210
2.	Discretionary Clauses 210
	V.	Rules of Plan Interpretation 211
A.	Application of Federal Common Law 211
B.	Application of Contra Proferentem 211
C.	Deference Afforded to an Administrator's Interpretation 
of a Plan 211
D.	Other Rules of Plan or Contract Interpretation 211
	VI.	Discovery 212
A.	Limitations on Discovery 212 
B.	Discovery and Conflict of Interest 212
	VII.	Evidence 213
A.	Scope of Evidence under Standards of Review 213 
B.	Evidentiary Value of Social Security Determinations 213
C.	Other Evidence Issues 213
	VIII.	Procedural Aspects of ERISA Practice 214
A.	Methods of Adjudication 214
B.	Reported ERISA Trials 214
C.	Special Procedures for ERISA Benefit Cases 214
	IX.	Fiduciary Liability Claims 214
A.	Definition of Fiduciary 214
B.	Definition of Fiduciary Duties 214
C.	Fiduciary Liability in the Context of Health 
and Disability Claims 215
D.	Remedies for Breach of Fiduciary Duty 215
E.	Contribution and Indemnity Claims 
among Fiduciaries 215
F.	ERISA Claims against Nonfiduciaries 215
	X.	Attorneys' Fees 215
A.	Criteria for Awarding Attorneys' Fees 215
B.	Fees Awarded to Plan Fiduciaries 217
C.	Calculation of Attorneys' Fees 218
	XI.	ERISA Regulations 220
	XII.	Cases Interpreting ERISA Statutes of Limitation 220
	XIII.	Subrogation Litigation after Great-West Life v. Knudson 222
	XIV.	Miscellaneous 222
A.	Unique Substantive or Procedural Rules 
for ERISA Cases 222
B.	Unique Approach to Common Policy-Based Defenses 222
C.	Other Miscellaneous Issues 222
CHAPTER 10 
Tenth Circuit 223
Michael S. Beaver
Trent A. Howell
David N. Kelley 
	I.	What Constitutes an ERISA Plan? 223
A.	Determining the Existence of an Employee Welfare 
Benefit Plan 223
B.	Definition of "Employee" for ERISA Purposes 224
C.	Interpretation of Safe Harbor Regulation 224
D.	Amount of Employer Involvement Required 
to Sustain an Employee Welfare Benefit Plan 224
E.	Treatment of Multiple Employer Trusts and Welfare 
Agreements 225
	II.	Preemption 225
A.	Scope of ERISA Preemption 225
B.	Preemption of Managed-Care Claims 225
C.	Preemption of Malpractice Claims 226
D.	Other Preemption Issues 226
1.	Bad-Faith Breach of Insurance Contract 226
2.	State Claims-Handling Statutes 227
3.	State Laws Construing Insurance Contracts 227
4.	Other State-Law Claims by Participants 227
5.	Claims by Health Care Providers Based 
upon Precertification 227
6.	Claims by Employers against Insurers 
and Service Providers 228
	III.	Exhaustion of Administrative Remedies 228
A.	Is Exhaustion an Absolute Requirement? 228
B.	Exceptions to the Exhaustion Requirement 228
C.	Consequences of Failure to Exhaust 228
D.	Minimum Number of Levels of Administrative Review 229
E.	Can a Defendant Waive a Failure-to-Exhaust Defense? 229
	IV.	Standard of Review 229
A.	Plan Language 229
B.	What Standard of Review Applies? 231
1.	Abuse of Discretion or Arbitrary and 
Capricious Standard 231
2.	De Novo Standard 232
C.	Effect of Conflict of Interest or Procedural Irregularity 232
D.	Other Factors Affecting Standard of Review 233
	V.	Rules of Plan Interpretation 233
A.	Application of Federal Common Law 233
B.	Application of Contra Proferentem 234
C.	Deference Afforded to an Administrator's 
Interpretation of a Plan 234
D.	Other Rules of Plan or Contract Interpretation 235
1.	Summary Plan Descriptions 235
2.	Effect of Plan Amendments 236
	VI.	Discovery 236
A.	Limitations on Discovery 236
B.	Discovery and Conflict of Interest 237
	VII.	Evidence 237
A.	Scope of Evidence under Standards of Review 237
1.	Arbitrary and Capricious Review 237
2.	De Novo Review and Evidence 
beyond the Administrative Record 238
B.	Evidentiary Value of Social Security Determinations 239
C.	Other Evidence Issues 239
	VIII.	Procedural Aspects of ERISA Practice 240
A.	Methods of Adjudication 240
B.	Reported ERISA Trials 240
C.	Special Procedures for ERISA Benefit Cases 241
	IX.	Fiduciary Liability Claims 241
A.	Definition of Fiduciary 241
B.	Definition of Fiduciary Duties 242
C.	Fiduciary Liability in the Context 
of Health and Disability Claims 242
D.	Remedies for Breach of Fiduciary Duty 242
E.	Contribution and Indemnity Claims 
among Fiduciaries 243
F.	ERISA Claims against Nonfiduciaries 243
	X.	Attorneys' Fees 244
A.	Criteria for Awarding Attorneys' Fees 244
B.	Fees Awarded to Plan Fiduciaries 244
C.	Calculation of Attorneys' Fees 244
	XI.	ERISA Regulations 244
	XII.	Cases Interpreting ERISA Statutes of Limitation 245
	XIII.	Subrogation Litigation after Great-West Life v. Knudson 246
	XIV.	Miscellaneous 246
A.	Unique Substantive or Procedural Rules 
for ERISA Cases 246
B.	Unique Approach to Common Policy-Based Defenses 246
C.	Other Miscellaneous Issues 247
CHAPTER 11 
Eleventh Circuit 249
Russell Buhite 
H. Sanders Carter 
Maggie Marrero-Ladik 
Anthony Pelle 
	I.	What Constitutes an ERISA Plan? 249
A.	Determining the Existence of an Employee Welfare 
Benefit Plan 249
B.	Definition of "Employee" for ERISA Purposes 250
C.	Interpretation of Safe Harbor Regulation 250
D.	Amount of Employer Involvement Required 
to Sustain an Employee Welfare Benefit Plan 250
E.	Treatment of Multiple Employer Trusts and Welfare 
Agreements 251
	II.	Preemption 251
A.	Scope of ERISA Preemption 251
B.	Preemption of Managed-Care Claims 253
C.	Preemption of Malpractice Claims 253
D.	Other Preemption Issues 253
	III.	Exhaustion of Administrative Remedies 254
A.	Is Exhaustion an Absolute Requirement? 254
B.	Exceptions to the Exhaustion Requirement 254
C.	Consequences of Failure to Exhaust 255
D.	Minimum Number of Levels of Administrative Review 255
E.	Can a Defendant Waive a Failure-to-Exhaust Defense? 255
	IV.	Standard of Review 255
A.	Plan Language 255 
B.	What Standard of Review Applies? 256
C.	Effect of Conflict of Interest or Procedural Irregularity 256
D.	Other Factors Affecting Standard of Review 257
	V.	Rules of Plan Interpretation 257
A.	Application of Federal Common Law 257
B.	Application of Contra Proferentem 257
C.	Deference Afforded to an Administrator's 
Interpretation of a Plan 258
D.	Other Rules of Plan or Contract Interpretation 259
	VI.	Discovery 259
A.	Limitations on Discovery 259
B.	Discovery and Conflict of Interest 260
	VII.	Evidence 261
A.	Scope of Evidence under Standards of Review 261
B.	Evidentiary Value of Social Security Determinations 262
C.	Other Evidence Issues 262
1.	Evidence beyond the Administrative Record 262
2.	Treating-Physician Rule 262
	VIII.	Procedural Aspects of ERISA Practice 262
A.	Methods of Adjudication 262
B.	Reported ERISA Trials 263
C.	Special Procedures for ERISA Benefit Cases 264
	IX.	Fiduciary Liability Claims 264
A.	Definition of Fiduciary 264
1.	Employers 264
2.	Corporate Officers 266
3.	Insurers 266
4.	Third-Party Plan Administrators 267
5.	Banks 267
6.	Legal Counsel 268
7.	Investment Advisors 268
8.	Plan Participants 269
B.	Definition of Fiduciary Duties 269
1.	Misrepresentations 270
2.	Disclosure of Rights 270
3.	Amendments to the Plan 271
4.	Blocking an ERISA Action 271
5.	Noncompliance with Arbitration Award 271
6.	Serving in Dual Capacity 272
7.	Sale of a Business 272
8.	Investment Advice 272
C.	Fiduciary Liability in the Context of Health 
and Disability Claims 272
1.	Delay in the Provision or Forwarding of Benefit Materials 272
2.	Breaches of Cofiduciaries 273
3.	Coverage Determinations 273
4.	Failure to Comply with COBRA Provisions 274
5.	Assistance to Participants with Benefit Claims 274
6.	Notification of Plan's Financial Problems 274
7.	Delay in the Claim Process 275
8.	Advance Warning of Termination of Benefits 275
D.	Remedies for Breach of Fiduciary Duty 275
1.	Restitution under §1132(a)(2) 275
2.	Restitution under §1132(a)(3) 275
3.	Disgorgement of Profits 276
4.	Reinstatement 276
5.	Extracontractual Damages 276
6.	Punitive and Compensatory Damages 277
7.	Interest 277
E.	Contribution and Indemnity Claims among Fiduciaries 277
F.	ERISA Claims against Nonfiduciaries 277
	X.	Attorneys' Fees 278
A.	Criteria for Awarding Attorneys' Fees 278
1.	Bad Faith of Nonmovant 278
2.	Ability to Pay Award 279
3.	Deterrence 279
4.	Benefit to All Participants 280
5.	Relative Merits of Parties' Positions 280
B.	Fees Awarded to Plan Fiduciaries 280
C.	Calculation of Attorneys' Fees 281
	XI.	ERISA Regulations 281
	XII.	Cases Interpreting ERISA Statutes of Limitation 283
	XIII.	Subrogation Litigation after Great-West Life v. Knudson 284
	XIV.	Miscellaneous 285
A.	Unique Substantive or Procedural Rules for ERISA Cases 285
B.	Unique Approach to Common Policy-Based Defenses 285
C.	Other Miscellaneous Issues 285
1.	ERISA Class Actions 285
2.	Removal of ERISA Cases 287
CHAPTER 12 
D.C. Circuit 289
Jerome V. Bolkcom
James Marketos
Glenn Merten
Mary Ellen Noonan
Robin Sanders
Ben Tompkins
	I.	What Constitutes an ERISA Plan? 289
A.	Determining the Existence of an Employee 
Welfare Benefit Plan 289
B.	Definition of "Employee" for ERISA Purposes 290
C.	Interpretation of Safe Harbor Regulation 290
D.	Amount of Employer Involvement Required 
to Sustain an Employee Welfare Benefit Plan 290
E.	Treatment of Multiple Employer Trusts and Welfare 
Agreements 290
	II.	Preemption 290
A.	Scope of ERISA Preemption 290
B.	Preemption of Managed-Care Claims 292
C.	Preemption of Malpractice Claims 292
D.	Other Preemption Issues 292
	III.	Exhaustion of Administrative Remedies 293
A.	Is Exhaustion an Absolute Requirement? 293
B.	Exceptions to the Exhaustion Requirement 294
C.	Consequences of Failure to Exhaust 294
D.	Minimum Number of Levels of Administrative Review 295
E.	Can a Defendant Waive a Failure-to-Exhaust Defense? 295
	IV.	Standard of Review 295
A.	Plan Language 295
B.	What Standard of Review Applies? 297
C.	Effect of Conflict of Interest or Procedural Irregularity 297
D.	Other Factors Affecting Standard of Review 299
	V.	Rules of Plan Interpretation 299
A.	Application of Federal Common Law 299
B.	Application of Contra Proferentem 300
C.	Deference Afforded to an Administrator's 
Interpretation of a Plan 300
D.	Other Rules of Plan or Contract Interpretation 300
	VI.	Discovery 300
A.	Limitations on Discovery 300
B.	Discovery and Conflict of Interest 302
	VII.	Evidence 303
A.	Scope of Evidence under Standards of Review 303
B.	Evidentiary Value of Social Security Determinations 304
C.	Other Evidence Issues 304
1.	Denial Notices 304
2.	Federal Common Law; Remedies 304
	VIII.	Procedural Aspects of ERISA Practice 305
A.	Methods of Adjudication 305
B.	Reported ERISA Trials 306
C.	Special Procedures for ERISA Benefit Cases 306
	IX.	Fiduciary Liability Claims 306
A.	Definition of Fiduciary 306
B.	Definition of Fiduciary Duties 307
C.	Fiduciary Liability in the Context 
of Health and Disability Claims 307
D.	Remedies for Breach of Fiduciary Duty 307
E.	Contribution and Indemnity Claims among Fiduciaries 308
F.	ERISA Claims against Nonfiduciaries 308
	X.	Attorneys' Fees 308
A.	Criteria for Awarding Attorneys' Fees 308
B.	Fees Awarded to Plan Fiduciaries 309
C.	Calculation of Attorneys' Fees 309
	XI.	ERISA Regulations 309
	XII.	Cases Interpreting ERISA Statutes of Limitation 311
	XIII.	Subrogation Litigation after Great-West Life v. Knudson 312
	XIV.	Miscellaneous 313
A.	Unique Substantive or Procedural Rules for ERISA Cases 313
B.	Unique Approach to Common Policy-Based Defenses 313
C.	Other Miscellaneous Issues 313
Table of Cases 315
Index 

Library of Congress Subject Headings for this publication:

Legal ethics -- United States.
Lawyers -- United States.
Attorney and client -- United States.
Practice of law -- United States.