Cook v. The New York Times LTD Plan, 2005 U.S. Dist. LEXIS 3262 (S.D.N.Y. 2005).

During the claims process of plaintiff's claim, MetLife, the plan administrator of the Plan, denied plaintiff's claim without adequately informing her of the reasons for denial and without telling her what she needed to submit to prove her claim. Every time plaintiff appealed MetLife's denial, MetLife came up with a new reason for denial. To plaintiff, it felt like MetLife was making her play a game with moving goal posts. No matter what she did, it was not good enough.

In a precedent setting decision, the Court held that the Plan did not furnish plaintiff with a full and fair review as required by ERISA. The case established that during the claims process the plan must engage in a meaningful dialogue with claimants; that the plan must adequately notify claimant of the reasons for denial; and that the plan must specify what the claimant must submit in order to be awarded benefits. When a plan does not satisfy these requirements, the Plan denies the claimant a full and fair review, and its determination is arbitrary and capricious.

As a result, the Court reversed MetLife's determination, ordered it to give an opportunity to plaintiff to provide additional evidence, and required the Plan to pay Riemer & Associates attorneys fees.