A co-worker referred Jane to a lawyer, Don Harris, in Billings, Mont. Under ERISA, Harris first had to file an appeal directly with MetLife, which the insurer ignored, Harris says. Pierce sued the company in federal court in Billings for breach of contract in May 2010.

'They had no facts . . .'

The insurer hired a Montana lawyer who rebuffed Pierce again, six weeks later. Harris says he then had a rational telephone call with the lawyer about the facts.

"Very quickly, he realized that they didn't have a leg to stand on," Harris says. After that, MetLife agreed to pay out the full policy amount. The case never went to trial.

Because ERISA prevents compensatory and punitive damages, Jane Pierce wasn't entitled to receive anything more. Harris, who was paid a fee of $4,500 for his seven months, estimates that a jury not bound by ERISA would have awarded punitive damages of more than $1 million -- five to 10 times the death benefit.

"They accused her husband of committing suicide, which is outrageous," he says. "They had no facts to support it. They just literally made it up."

'Nothing we can do'

Pierce never requested help from Montana's insurance department. If she had, she would have been turned away, says Amanda Roccabruna Eby, a spokeswoman. She says the agency can't assist people like Pierce because of ERISA's federal pre-emption.

"There's nothing we can do," she says. "We don't have any authority." The department does not even track ERISA complaints.

Prudential used the ERISA shield when it denied payment to the widower of a middle school teacher in Rochester, N.Y. Lois Brondon died of a heart attack at age 49 while refereeing a soccer game in May 2007.

The company refused to pay her husband, Christian, the $50,000 death benefit, saying the educator had failed to disclose her "heart trouble" when she applied for insurance.

Christian, who knew his wife had no history of a heart condition, sued Prudential in U.S. district court in Rochester.

"Mrs. Brondon had absolutely no symptoms referable to cardiac disease or heart trouble," Judge Michael Telesca ruled on Nov. 9, 2010. He said her records showed common and mild thickening of the aorta that required no medical treatment and didn't limit her activities in any way.

False grounds

The judge, finding that Lois Brondon had been truthful on her application for insurance, ordered Prudential to pay the full $50,000.

The judge said Prudential's reasoning created false grounds that the company could use to wrongfully deny death benefits to others.

"Indeed, under such a scenario, only Prudential would be allowed to define what constitutes 'heart trouble,' " the judge wrote.

Three weeks later, a judge in Lexington, Ky., ruled on a case that shows how inventive insurers can be in their denials -- even to the point of invoking drunk-driving laws when the person who died wasn't in a car.

U.S. District Court Judge Joseph Hood ruled that Prudential had wrongly denied a $300,000 accidental death benefit to the family of Ernest Loan.

Loan, a medical sales representative for Bayer AG, fell down a staircase in his house after drinking three glasses of wine on June 29, 2006, according to court records. Prudential told his wife, Mimi, in a Nov. 7, 2006, letter that 53-year-old Ernest was drunk by state standards used in DUI cases.

Court reversal

The Loan family sued Prudential in January 2008. Hood initially dismissed the case, saying Prudential's argument was sufficient under ERISA guidelines. The judge was reversed by the Sixth Circuit Court of Appeals, which said drunk-driving law doesn't outlaw performing chores around the house.

"A legal definition specifically intended to apply to someone who is driving a motor vehicle is not rational as applied to someone who is in his home and is not operating machinery," the court wrote.

On Nov. 30, 2010, Hood ordered Prudential to pay the family $300,000.

The threshold for what judges will accept as evidence in an ERISA case can be so low that an insurer can use Internet searches and not interview witnesses.

Acting on scant evidence

Brad Kellogg, an employee of Pfizer Inc., died in September 2004 when he crashed his Dodge Caravan into a tree in Merced, Calif. MetLife paid his widow, Cherilyn, $443,184 under Kellogg's term life policy. The insurer then received a letter from Stephen Morris, Merced County's deputy coroner.

"Mr. Kellogg died as a result of traumatic injuries sustained in a motor vehicle accident," Morris wrote. "His death is considered to be accidental."

MetLife refused in November 2005 to cover his $438,000 accidental death policy, saying Kellogg's death was caused by a seizure while driving. The insurer referred to a police report citing an eyewitness to the crash.

"It appears that Mr. Kellogg may have possibly had a seizure," police wrote.

Cherilyn wrote to MetLife, disputing its conclusion, on Jan. 13, 2006. MetLife again refused to pay.

She sued in U.S. District Court in Salt Lake City on July 26, 2006, for breach of contract. MetLife didn't provide medical evidence and didn't specify what kind of seizure supposedly occurred, court records show.

'The low end'

Judge Dale Kimball found that MetLife's medical research was limited to Internet searches. The company failed to interview witnesses, the coroner, the police or responding paramedics and didn't obtain Kellogg's medical records, the judge wrote.

Even with those findings, Kimball dismissed the case. He said the insurer met the standard of proof under ERISA.

"The court need only assure that the administrator's decision falls somewhere on the continuum of reasonableness -- even if on the low end," the judge wrote.

The U.S. Court of Appeals for the 10th Circuit reversed that decision in December 2008.