This case involved a claim for accidental death benefits following a fatal motor vehicle accident. LINA denied benefits, asserting that the death was not accidental due to alleged foreseeability and risk-taking conduct.
During litigation, LINA attempted to defend the denial using arguments and theories that were not raised during the administrative claims process. Kantor & Kantor challenged the insurer’s effort to reshape its rationale after the fact.
The Ninth Circuit barred LINA from introducing new justifications on appeal and emphasized that ERISA benefit determinations must stand or fall based on the reasons given at the time of denial. The decision curtailed insurers’ ability to retrofit defenses once litigation begins.
