Cultrona v. Nationwide Life Ins. Co., 748 F.3d 698 (6th Cir. 2014), involved the denial of benefits under an accidental death policy on the ground that the plaintiff’s husband’s death was excluded due to his intoxication. The court found that determination to be reasonable.
But the court also affirmed the district court’s determination that the plan administrator had to pay plaintiff a statutory penalty for its failure to provide a copy of the original policy in a timely manner. The administrator argued that the court should adopt the “clear-notice” standard, which requires a claimant to “provide clear notice to the plan administrator of the information they desire.” The court, as an issue of first impression, adopted that standard, and stated that the key question was whether the administrator knew or should have known which documents were being requested. The claimant’s attorney’s request for “all documents comprising the administrative record and/or supporting [the administrator’s] decision” gave clear notice that the original policy was being requested. This was further evidenced by the fact that an employee of the claim administrator proposed sending a copy of the original policy in response to the request.