Pursuant to 5 T H C IR . R. 47.5, the court has determined that thi s opinion should not * be publishe d an d is not precedent except under the limited circu mstance s set forth in 5 T H C IR . R. 47.5 .4. 

### INTHE UNI TED S TATESCOU RT OFAPPEALS

FORTHE FIFTH CIRCU IT

N o. 08- 20658 Su m m ar y Cal endar

VI CENTE A. M ENCHACA , P la in tiff

–A p p e lla n t, v. C N AG R O U P L IF E A S S U R A N C E C O .; B A K E R H U G H E S IN C ., D efen da n t s–A pp el l ees .

A p p ea lf

rom the U n i tedS tates D i stri ct C ou rt f or t h e Sou t h ern D i st ri ctof T exas U SD C N o. 4: 07- C V

- 825

B ef ore K IN G , D E N N IS, an d O W E N , C i rcui tJu dg es . P E R C U R I A M: * Vi c e nt e M e nc hac a ap pe al s t he di s t r i c tc o ur t ’ s g r anto f s um m ar y j udg m e nt i n favor of

C N AG roup L i fe A ssuran ce C o. (C N A) a n d B ak er H u gh es, I n c. ( B ak er H u gh es) on h i s c l ai m f or l on g- t erm di sabi l i t y ben ef i t s un d e r E R ISAan d other
s t a t e - l a w c a u s e s o f

a c t i o n . We a f

f i r m. United States Court of App eals Fifth Circuit 

### F I L E D Aug ust18, 2009 Cha rl es R. F ulb ru g e II I ClerkN o. 08- 20658

2 I M en cha ca w orked f

or B ak er H u gh es as a m ach i n i stf or over t w en t y years
u n ti lh e d ev elop ed p a i n i n h i s h a n d s an dw ri sts. M en ch a ca f i l ed f or b en efi ts
u n d e rB a k e rH u g h e s ’ s L o n gT e r m D i s a b i l i t yP l a n (t h e P l a n ) , wh i c h a tt h e t i me
w as adm i n i st ered by IN G E m pl oyee B en ef i t s D i sabi l i t y M an agem en tServi ces ( I N G )

. The Pl an c o nt ai ne d t w o pr o vi s i o ns f o rl o ng- t e r m di s ab i l i t y be ne f i t s . The f i rst , ref erred t o as t h e “ ow n occupa t i on ” provi si on , provi des ben ef i t s f or t h e f i rst tw e lv e m o n th s o f d is a b ilityfo rp a r tic ip a n ts w h o a r e u n a b le to e n g a g e in th e ir regular occupa t i on . A f t er t h at i n i t i alt w elve- m on t h peri od, th e P l an t h en pr o vi de s c o ve r ag e und e rt he “ anyo c c upa t i o n” pr o vi s i o n, w hi c h r e qui r e s t hatt he pa r t i c i pa ntbe unabl e t o eng ag e i n “ anyoc c upa t i o n ore m pl o ym e ntf o rw hi c h he i s qua l i f

i e d , o rm a yr e a s o na b l yb e c o m e q ua l i f i e d , b a s e do n hi s t r a i ni ng, educ at i on o rex per i ence.” A s a c ondi t i on o f paym entof

be nef i t s, t he Pl an
r e q ui r e s t ha t “ e a c h Pa r t i c i p a nt
. . . p r o v i d e p r o o f o f c o nt i nued T ot al D i sa b i l i ty .
. . . ” T h e P l a n f u rth er g ra n ts t h e p l a n ad m i n i strato r “ab solu te d is c r e tio n to co n s tr u e a n din te r p r e t a n ya n da ll p r o v is io n s o f th e P la n ,” a s w e ll
a s t h e a u t h o r i t yt o “ [i] n i t s d i s c r e t i o n , . . . d e t e r mi n e e l i g ib i l i t y u n d e r t h e t e r ms o f th e P la n .” I NG i n i t i a l l ya p p r o v e dMe n c h a c a ’ s c l a i m f o rb e n e f

i t s u n d e rt h e “ o wn occu p a ti on ” pro visi on an d , after the f i rst tw elve m on th s elap sed , con ti n u ed to pay be nef

i t s und ert he “ any oc c upat i on” pr ovi si on unt i lO c t obe r2001. At t hat poi n t , ben ef

i t s w ere t erm i n ated becau se M en cha ca fai l ed to provi de ea rn in gsr e la te dd o c u m e n ta tio n a n dp e r io d ic m e d ic a l u p d a te s to s u b s ta n tia te h is conti n u ed en t i t l em en tt o ben ef i t s. I n J ul y 20 02 , CN A r e pl ac e d I N G a s t he a dm i ni s t r at o ro f t he Pl an, b ut M e nc hac a’ s c l ai m w as no tt r ans fe r r e d t o C N A. I ns t e ad , Bake rH ugh e s ke ptt he cl ai m i n - h ou se. I n res pon se t o l et t ers f rom M e n cha ca regardi n g h i s benefi t s, B a k e rH u gh es d ecide dto ask C N Ato reop en an dev a l u a te M en ch a ca ’ s cl a im

.N o. 08- 20658

3 B ak er H u gh es al so di rect ed C N At o i ssue a “good fai t h ” l u m p-s u m pay m en tf or ben ef i t s s pa n n i n g f

rom N o vem ber 200 1 to D ecem ber 200 2, bu tw arn ed M e n c h a c a t h a t s u c h a p a y m e n t d id“ n o t c o n s tit u te a d e te r m in a tio n th a t y o u , in fac t , had a qual i f

yi ng di sa bl i ng c ondi t i on duri ng t he per i od f r om N ove m ber1, 2 0 0 1 th r o u g h D e c e m b e r1 , 2 0 0 2 th a t e n tit le dy o u to p a y m e n t.” C N Ar evi ew ed M enc haca’ s f i l e a nd co ndu c t ed an i nves t i gat i on t hat in c lu d e dre v ie w o f M e n c h a c a ’ s m e d ic a l re c o r d s ; a n in te r v ie w o f M e n c h a c a in
w h i c h he a dm i t t e d t hathe w as w o r ki ng pa r t

- t i m e r unni ng e r r and s a nd t r ansl at i ng f

oran at t or ney; vi deo surveil l ance t hats how ed M enc haca w al ki ng, en t eri n g an d exi t i n g veh i cl es, an d drivi n g; an i n dep en den tm edi caleval u ati on i n w hi c h t he doc t orc onc l uded t hatM enc haca had no l i m i t at i ons as t o s i t t i ng, st an di n g, or w al king; a fun ct i on alcap aci t y evaluati on t h at dem on st rat ed good t o l e r anc e f

o rs i t t i ng, w al ki ng, s t and i ng, a nd l i f t i n g l i ght w e i ghto bj e c t s ; a nd a
vo c at i o nala s s e s s m e nti ndi cat i ng t hatM e nc hac a w as c ap ab l e o f pe r f o r m i ng al t erna t ive gainf

u lem pl oym en t
. D u ri n g t h i s i n vest i gati on , C N Aal so r equ est ed upd at e d m e di c ali nf o r m at i o n f

r o m M e nc haca s ho w i ng t hathe w as und e rt he care of a ph ysi ci an an d w as st i l ldi sabl ed, as r equ i red b yth e P l an . M en cha ca refu sed to com p l y. A s a re su l t of this i n ve sti ga ti on an dM en ch a ca ’ s fa i l u re to pro vi de updat ed m edi ca lin f or m at i on s ubst ant i at i ng hi s c ont i nued di sa bi l i t y, CN A f o und M e nc hac a i ne l i gibl e f o rb e nef

i t s a nd d e ni e d p ay m e ntb e yo nd D ece m b er 2 0 0 2
. M en ch a ca req u ested reco n sider a ti on of th e den i a l p u rsu a n t t o hi s a ppe alr i ght s und e rER I SA and CN A af f i r m e d i t s de c i s i o n. M en ch a ca f

i l ed a claim i n the distri ct cou rt f or lon g-term disa b i l i ty ben ef i t s u n d e r E R IS A , as w el las st ate- l aw causes of act i on f

or breach of
c o n tr a c t, s ta tu to r ya n dco m m o n la w b r e a c h o f th e d u tyo f g o o dfa ith a n dfa ir dea l i n g, breach of f

i du ci ary du t y, n egl i gen ce, an d vi ol ati on s of T exas Insu ran ce C ode §§ 21. 21 a n d 21

. 55. C N Afi l ed a R u l e 1 2(b) ( 6) m ot i on t o di sm i ss t h e st atela w ca u s e s o f a c tio n , w h ic h th e d is tr ic t co u r t g r a n te d

. M e n c h a c a a m e n d e dh isN o. 08- 20658

Wade v. Hewlett -Packard Dev. Co. LP ShortTerm Disabilit y Plan , 49 3 F .3d 5 33, 537 1 (5 thC ir

. 2 0 0 7). Id

. 2 Id

. 3 Corry v. Lib ert

y L ife Assu rance Co. of Boston , 4 9 9F .3 d 3 8 9 , 3 9 7( 5 thC ir

. 2 0 0 7). 4 4 com pl ai n tbu tconti n u ed to assertt h e st ate- l aw causes of act ion . T h e di st ri ct court aga i n gran t ed a m ot i on t o di sm i ss t h e st ate- l aw cl ai m s, causi n g M en cha ca t o f i l e a se c ond am ended c om pl ai nt t hat agai n at t em pt ed t o as sert state- l aw cl ai m s. C N At h e n m o v ed f or s u m m ary j u dg m en t , w h i ch the di st ri ctcourt gr ant e d. II W e revi ew a d i st ri ctcou rt ’ s gran tof sum m ary j u dg m en ti n E R ISAcases de no vo , a pplyi ng t h e sam e leg als t and ar d a s t he di s t r i c tc o ur t
. H e r e , t he 1 di s t r i c tc o ur tr e vi e w e d CN A ’ s de ni alo f b e ne f i t s f o ra bus e o f

di s c r e t i o n. M en cha ca argu es t h at t h e di st ri ctcourtshou l d hav e ap pl i ed a d e nov o st an da rd
o f r e v ie w b e c a u s e o f a p o t e n t i a l c o n fl ic to f i n t e r e s tin th e p la n a d m in is t r a t o r ’s decisi on m ak i n g. W h et h er t h e di st ri ctcourtapp l i ed the corr ectst an da rd of revi ew i s a questi on of l aw t h at w e revi ew de n ovo. 2 Apl an a d m in istr ator ’ s fact u aldeter m i n ati on s are revi ew ed f or abu se of di scr etion

. W e al so r evi ew an adm i n i st rat or’ s den i alof E R ISAben ef

i t s f or 3 abu se of

di scr et i on w h ere t h e pl an gran t s t h e adm i n i st rat or di scr etion ary aut ho r i t y t o de t e r m i ne el i gibi l i t y f o rb e ne f

i t s a nd t o c o ns t r ue t he t e r m s o f t he pl an . Evi de nc e o f

ac o nf l i c to f i nt e r e s tdo e s no ta l t e rt he a bus e - o f

- di s c r e t i on 4 st andard, bu trat heri s “ w ei ghed as a fac t ori n det er m i ni ng w het herther e i s anN o. 08- 20658

Metro. L ife I

ns. Co. v. Glenn , 128 S. Ct. 2343, 2350 (2008) (quoting Fires to ne Tire & 5 Rub ber Co. v. Bruch , 4 8 9U .S

. 1 0 1 , 1 1 5( 1 9 8 9))

. Ellis v. L ibert

y L ife Assu rance Co. , 3 9 4F .3 d 2 6 2 , 2 7 0n .1 8( 5 thC ir

. 2 0 0 4). 6 Corry , 499 F.3dat 397 (quoting Ell is , 39 4 F .3d at 2 73) (alteration and quotation 7 mark s o mitted). Ell is , 39 4 F .3d at 2 73. 8 BellaireGen. Hosp. v. Blue Cross Bl ueShield of Mich. , 97F .3d 8 22, 828(5th Cir. 9 1 9 9 6). 5 a b u se o f d i scre ti on . ” T h e p l a i n ti ff h a s th e b u rd en to pro d u c e e v id e n c e tha t a 5 confl i ctexi st s. 6 H er e , M e nc hac a do e s no tdi s put e t hatt he Pl an gr ant s di s c r e t i o n ary au t h ori t y t o C N At o deter m i n e el i gibi l i t y f or ben ef i t s an d constr u e t h e t erm s of t h e P la n . T h o u g h M e n c h a c a a s s e r t s t h a t a c o n fl ic t o f in t e r e s t e x is t s in C N A ’s ad m i ni s t r at i o n o f

t he Pl an, he ha s fai l e d t o pr o duc e a ny e vi denc e t hats uc h a
c o nf l i c te xi s t s o rt o w hat e xt e nt i t m i ght af fe c t CN A’ s de c i s i o nm ak i ng. Thus , t he d i s t r i c tc o u r tc o r r e c t l ya p p l i e da n a b u s e o f d i s c r e t i o n s t a n d a r do f r e v i e w. III “U n d e rth e a b u s e o f d is c r e tio n s ta n d a r d , if th e p la n fid u c ia r y ’ s d e c is io n is sup ported by sub st an t i alevi den ce and i s not arbi t rary an d cap ricious, i tm u st pr e va i l

. ” “ Subs t ant i ale vi de nc e i s m o r e t han a sci n t i l l a, l e s s t han a

7 pr e po nde r anc e , a nd i s s uc h r e l e va nte vi de nc e a s a r e as o nab l e m i nd m i ghta c c e pt
as a de qua t e t o s upporta con c l us i o n. ” A de c i s i o n i s a rbi t r ar y i f i ti s “ m ad e 8
w i t h ou ta rat i on alco n n e ct i on betw een t h e kn ow n fact s and t h e deci si on or b e tw e e n th e fo u n dfa c ts a n dth e e v id e n c e .” 9 M en cha ca a rg u es t h at C N Aabu sed i t s di scr et i on by “r e- open [i n g] [h i s] i n d ivid u a lcas e a n drev ers[i n g] the p ri or d ecisi on s gra n ti n g lon g-term disa b i l i ty ben ef i t s” to M en cha ca. H ow ever, t h e evi den ce i n t h e adm i n i st rat ive recor d d oes noti ndi c at e t hatC N A ’ s dec i si on rev ersed t he dec i si on o f t he pr i orpl anN o. 08- 20658

Duhonv. T

exaco, Inc. , 1 5F .3 d 1 3 0 2 , 1 3 0 9( 5 thC ir

. 1 9 9 4). 10 See Duhon , 15F .3d at 1 30 8 (ho ld in g that aplan administrator did not abuseit s 11 discretion in denying disab ility benefits to a sixty -five-year-old man where medical evi dence 6 ad m i ni s t r at or. ING s t o ppe d p r o vi di ng be ne f i t s t o M e nc hac a unde rt he “ any o c c upa t i o n” pr o vi s i o n a s o f O c t o be r2 00 1 due t o M e nc hac a’ s fai l ur e t o pr o vi de
earn i n gs- rel ated docu m en t ati on an d m edi calup da t es. Th ou g h B ak er H u gh es d i r e c t e dC NA t o i s s u e a “ g o o d

- fa i t h ” l u mp s u m p a y me n tt o Me n c h a c a wh e n C NA
r e o pe ne d M e nc hac a’ s c l ai m , Bake r H ugh e s s pe c i f i c al l y no t e d t hatt he pa ym e nt d i d n otc ons t i t ut e adet er m i nat i on t hatM enc haca w as el i gibl e f orbe nef

i ts d u ri n g th i s ti m e. C N A ’ s l a ter d en i a lba sed , i n pa rt, on M en ch a ca ’ s fa ilu re to provi de earn i n gs i n f

orm ati on an d m edi calup da t es i s c on si st en tw i t h I N G ’ s pri or de c i s i o n. M enc haca a l so ar gues t hatt he di st r i c tc our ter r ed i n co nsi der i ng an opi ni on i n t he adm i ni st r at ive r ec or d r ender ed byJul i e Byrd, C N A ’ s voc at i onal
case m an ager, w h ose qua li ficati on s as an exp ertM en cha ca asser t s w ere not est abli she d b y t he a dm i ni s t r at ive r e c o r d. Byr d s t at e d t hatM e nc hac a hadt he abil i t y t o perf

o rm w ork as an i n f orm ati on rec epti on i st , survei l l an ce c am era
m o n ito r , co n tr o l a c c e s s g u a r da n dg a te g u a r d

. W e n e e dn o t a d d r e s s th is
ar gum e nt , ho w e ve r , b e c aus e e ve n wi t ho utByr d’ s o pi ni o n, t he r e w as s uf f i c i e nt evi den ce t o sup port C N A ’ s deci si on . V ocat i on al t est i m on y i s not requ i red f or a pl an adm i ni st r at ort o de t er m i ne di sa bi l i t y. The fac tt hatM enc haca w as 10
ac t ual l y pe r f

or m i ng par t

- t i m e w or k f ora l aw f

i r m i s st r ong e vi d en c e t hat M en cha ca w as n ot di sabl ed f rom perf

orm i n g “ an y occupa t i on . ” M oreover, vi deo survei l l an ce and m edicalt est i m on y est abli shed t h at M en cha ca w as capab l e of per f or m i ng s ede nt ar y o rl i ght

- c apac i t y w or k. A ddi t i onal l y, M enc haca’ s r ef usal t o pr ovi de e ar ni ngs i nf or m at i on and m edi c alupdat es as r equi r ed byt he pl an pro vi ded a suf

f i c i entr eas on t o de ny benef i t s. G iven t hes e fac t s, w e c annots ay t h at C N Aabu sed i t s di scr et i on i n den yi n g M en cha ca’ s l on g- t erm ben ef i t s. 11N o. 08- 20658

showed he was capable of performing “sedentary to light work,” despite being unable to squat , stoop, b en d, or liftmoreth antwe nty -f ive poun ds). See 200 3 Tex

. Sess. Law Serv

. 127 4 (West) (renu mbering and reorganizingthe Texas 12 I n suranceC ode, inclu din g§ § 2 1 .2 1 an d 2 1 .5 5). 7 F i n al l y, M en cha ca argu es t h at t h e P l an ’ s “ an y occupa t i on ” l an gu age m u st be r e adt o i nc l ude a n i m pl i c i tre qui r e m e ntt hatM e nc hac a be a bl e t o w o r k a tt he
oc c upat i on o n a f

ul l

- t i m e b as i s, and t hatnone o f t he e vi denc e e st abl i she s t hat h e w a s a b l e t o w o r k fu llti m e . T h is a r g u m e n tis n o ts u p p o r t e db yth e P la n ’s de f i ni t i o n o f

To t alD i s ab i l i t y w hi c h r e qui r e s t hatM e nc hac a “ no teng ag e i n a ny oc c upat i on o rper f

or m any w or k f

orc om pensa t i on or pr of i tot hert han R e h abil i t ative E m pl oym en t
. ” Th i s def i n i t i on does not r equ i re t h at w ork p e r fo r m e dfo rco m p e n s a t i o n ( s u c h a s th e p a r t-t im e w o r k h e w a s d o in g) b e fu ll t i me . T h e r e f

o r e , C N A d i d n o ta b u s e i t s d i s c r e t i o n b yfa i l i n gt o r e a daf u l l

- t i me
r equi r em enti nt o t he pol i c y. IV M en cha ca al so app eal s t h e di st ri ctc o ur t ’ s di s m i s s alof hi s s t ate- l aw causes of act i on forb reach of

con t ract , stat u t ory a n d com m on l aw breach of t h e du t y of go o d fai t h and fai r de al i ng, br e ac h o f f i duc i ar y dut y, ne gl i ge nc e , andv i o l at i o ns o f Te xa s I ns ur anc e Cod e § § 21
. 21 and 21
. 55
. CN A f i l e d t w o s e pa r at e m o t i o ns 12 t o di sm i ss t h e st ate- l aw causes of act i on s on t h e gro u n ds t h at t h ey w ere p r e e m p t e db yE R I S A , a n dth e d is t r ic tc o u r tg r a n t e db o t h m o t io n s . M e n c h a c a ’s S econd A m en ded C om pl ai n tagain al l eged fact s t h at, accor d ing to t h e di st ri ct
c o u r t, “m a yre p r e s e n t a n a tt e m p t t o a s s e r t cla im s b a s e d o n s ta te la w .” T h u s , in t h e di st ri ctcourt ’ s grant of sum m ary j u dg m en t , i tagain st ated tha ta n y st atel aw c l ai m s w e r e pr e e m pt e d b y ER I SA. M e nc hac a ar gue s t hathe ha d t he r i ght t o pl e adt he s t at e - l aw c aus e s o f a c t i o n i n t he al t e r nat ive t o hi s E RI SA c l ai m s a ndN o. 08- 20658

Pro viden t Life & Acciden t Ins. C o. v. Sharpless , 3 6 4F .3 d 6 3 4 , 6 4 0( 5 thC ir

. 2 0 0 4). 132 9U .S .C

. § 1 1 4 4 (a); Pro viden t Life & Acciden t Ins. C o. , 36 4 F .3d at 6 40. 14 Ae t na HealthI

n c. v . Dav ila , 5 4 2U .S

. 2 0 0 , 2 0 9(2 0 0 4). 15 Ell isv . L ib ert

y L if e Assu ran ceC

o. , 3 9 4F .3 d 2 6 2 , 2 7 6 -7 8( 5 thC ir

. 2 0 0 4). 16 8 th a t p reem pti on of

t h ose c l ai m s vi ol ated his const i t u t i on alri gh t s. W e revi ew E R ISApreem pti on of st ate l aw de n ovo. 13 E R ISApreem pts al lst ate l aw s t h at “rel ate” t o em pl oyee b e n e f i tpl an s. 14 A ccor d in g ly, “ an y st ate- l aw cause of act i on t h at dup l i cat es, sup pl em en t s, or suppl ant s t he E R I SAc ivi lenf orc em entr em edy c onf l i c t s w i t h t he c l ear congressi on ali n t en tt o m ak e t h e E R ISArem edyexcl u sive an d i s t h erefore preem pted. ” T h ou gh E R ISA al so h as a savi n gs cl au se excepti n g f rom preem pti on 15 any s t at e l aw s “w h i c h re gul at e i nsur ance , banki ng, ors ec uri t i es , ” w e have pre vi ous l y hel d t hatc l ai m s und erTexas I nsur ance C ode § 21. 21 and 21. 25, as
w e ll a s th e T e x a s co m m o n la w d u tie s o f g o o dfa ith a n dfa ird e a lin g , d o n o t fa ll wi t h i n t h a te x c e p t i o n a n da r e p r e e m p t e db yERI S A. 16 In d ee d , M en ch a ca ack n ow l ed ge s th a t E R IS A p ree m p ts “ a pa rty’ s ab i l i ty t o o bt ai n m ul t i pl e rel i e f v i a c o nc ur r e nts t at e - l aw c aus e s o f a c t i o n. ” I ns t e ad , M e nc hac a ar gue s t hat hi s s t at e - l aw c l ai m s ar e pl e d i n t he a l t e r nat ive pur s uant to F e d e r a l R u le o f C iv il P r o c e d u r e 8 a n dth u s n o t s u bje c t t o p r e e m p tio n . T h is
a rg u m en t ha s n o m erit. W h eth er M en ch a ca refers to h i s cl a i m s as an “alt ern a te t h eory of

rec overy” or a “c on current s t ate- l aw cause of act i on ” ha s no ef

fecton E R ISA ’ s preem pti on of t h ose c l ai m s. T h u s, t h e di st ri ct court properl y di sm i ssed M en cha ca’ s s t ate- l aw cl ai m s. * * * T h e d i s t r i c tc o u r t ’ s g r a n to f s u mm a r yj u d g me n ti s A F F I RMED.