Martinez-Claib v. Business Men’s Assurance Company of America

Issue: (1) Whether ERISA’s statutory and regulatory requirements limit the grounds on which an administrator may defend a benefits action to the reasons it timely communicated to the claimant; (2) whether a contractual provision imposing like requirements limits the grounds on which an administrator may defend a benefits action to the reasons it timely communicated to the claimant; and (3) whether, when a plan administrator, having knowledge of grounds for claim denial, fails to communicate them to a claimant when it denies a claim, waiver principles preclude it from defending a benefits action based on those undisclosed grounds.