F ILED U.S. COURT O F APP EALS EL EV EN TH C IRC UIT Jun e 8, 20 05 T HOMA S K. KA HN CLERK [DO NOT PUBLISH]
IN THE UN ITED STATES COURT OF APPEALS FO R T HE EL EV EN TH CIRC UI T

____ ____ ____ ____ ____ ____ N o. 04- 1651 3 Non-A rgum ent Calendar

____ ____ ____ ____ ____ ____ D.C. Dock etNo. 0 4- 00 55 9- CV-J -NE KAYE F. L ANGFORD, P la int if f- Appe llant,
ve rs us UNUM LIFE INSURANCE COMP ANY OF AMERICA, TRWEMPLOYEE W ELFARE BENEFIT PLAN TRUST, Defen da nt s- App el le es .

____ ____ ____ ____ ____ ____ __ Appe al f ro m the U nit ed

S ta te s D istri ct

Co urt f or the M i d d l e D i s t r i c to f

A l ab a ma

____ ____ ____ ____ ____ ____ _ (June 8, 200 5)
Be fo re H U L L , MA RC U S, a nd W IL SO N , Ci rc uit Jud ge s. PE R CU RIA M:2

K ay e F. L an gf

or d, pr oc ee din g pr o se , appe al s th e dis tr ic t c ourt’ s or de r gr an tin g
sum m ar y j udgm en t, in favor

of the T RW

E m plo y ee W el far e Be ne fi t P la n T ru st (“ TRW Tr

ust”) and UN UM Life Insurance Com pany of Am erica (“ UN UM” ), on her cl ai m s al le gi ng im

pr op er d en ia l o f be ne fit s un de r a lo ng -te rm di sa bi li ty pla n (“ LTD Pl an ”) , in vio la tio n of

the E m plo y ee Re tir em en t I nc om e Se cu ri ty A ct ( “ E RI SA ”) , 29 U
. S. C. § 10 01, e t se q. On ap pe al , L an gf or d a rg ue s th at

the dis tr ic t c ourt e rr ed

by (1 ) fi ndi ng tha t the T RW T ru st h ad suf fi ci en t di sc re tio n, pur suant t o th e L T D P lan, to d ec ide he r cl ai m

so a s to w ar

rant a ppl ic at ionof

the ( m or e de fe re nti al ) ar

bitrary a nd
ca pr ic iou s st an da rd

of r ev ie w , a nd ( 2) by de ny ing he r cl ai m de spi te obs er

vin g, pr ior to a ppl y ing the a rb itr ar

y a nd c ap ri ci ous standard , t hat un de r a de nov o st an da rd , L an gf or d w oul d be e nti tl ed to c ont inu ed be ne fi ts. A ft er

tho ro ugh re vie w of

the
r e c o r d , a s w e l l a s c a r e f

u l c o n s i d e r a t i o n o f

t h e p a rt i e s ’ b r i e f

s , w e a f f i rm. W he n a ddr e ss i ng t he d i str i c tc ourt ’ s gr a nt o f s um m a ry j ud gm e nt , w e r e vi ew

“ the district court’ s ruling de novo , apply ing the sam e legal standards that gov erned the dis tr ic t c ourt’ s di sp os iti on. ” W ill ia m s v. Be lls outh T el ec om m s. , I nc . , 373 F
. 3d 1132 , 113 4 ( 11th C ir
. 200 4)
. In our re vie w , w e m ust vie w “ al l fa ct s an d r ea sona ble in fere nc es dra wn t he refr om in th e li gh t m os t fav or ab le to [ ] th e no n- m ov in g p art y .” John son v. Booker T. W ashingt on Broad. S erv. , I n c. , 2 3 4 F. 3d 50 1, 507 (11th Cir. 2000 ). Su mm ary

j udgm en t i s w ar

rante d if the e vid en ce sho w s “ tha t the re is no3

ge nui ne iss ue a s to any

m at er ia l fa ct

a nd tha t the m ovi ng p ar ty is en tit le d to a jud gm en t as a m at te r of

law.” Fe d. R. C iv . P. 56 (c). W e have de l i ne at e d the f

ol l ow i ng a

pp r oa c h f or review ing “ virtually

all” E RISA plan be ne fi t de nia ls: (1 ) Appl y

the de nov o st an da rd

to de te rm ine w he the r the c la im adm inistrator’ s benefits-denial decision is “ wr ong” (i.e ., t he court dis ag re es w iththe a dm ini strato r’ s de ci sio n) ; i f it is n ot, the n e nd the inquir y a nd a ff irm the de ci sio n. (2) If the adm inistrator’ s deci s i o n in fact is “ de novo wr ong,” then de te rm ine w he the r he w as ve ste d w ith dis cr et ion in re vie w ing cl ai m s; if not , e nd j udi ci al inquir

y a nd r ev er se the de ci sio n. (3) If the adm inistrator’ s decision is “ de novo wr ong” and he was vested with d iscretion in reviewing claim s, then determ ine whether
“ re as ona ble ” gr ound s su

ppor te d it ( he nc e, r ev ie w his de ci sio n un de r the m ore defe rential arbitrary and capricious standard). (4 ) If no reas ona

ble gr ound s e xis t, the n e nd the inquir y a nd r ev er se the adm ini str at or ’ s de ci sio n; if re as ona ble gr ound s do e xis t, the n de te rm ine if he op erat edun de r a co nf

li ctof i nt eres t. (5 ) If the re is no co nf

lic t, the n en d the inquir

y a nd a ff irm the de ci sio n. (6 ) If the re is a con fl ic t of inte re st, the n appl y he igh te ne d a rb itr ar

y a nd ca pr ic iou s r ev ie w to the de ci sio n to a ff irm or de ny it
. W il li am s, 3 73 F.3d at 1 13 7- 38 (em ph as is in ori gi na l) ( fo ot no te s o m it te d)
. H er e, the dis tr ic t c ourt f ir st f ound tha t the T RW

T ru st’ s decis ionto de ny benefits was “ de novo wr ong.” U nder the de novo st andard, w e have described4

“ ‘ [ w ] r on g’ [ a ] s t he l abe l u se d by o ur p r e c e de nt

t o de sc r i be t he c on c l us i onac ourt
re ac he s w he n, a ft er

r ev ie w ing the plan do cu m en ts and d isp ute d term s de no vo, the
co urt di sa gr ee s w iththe c la im s a dm ini str at or ’ s pl anint er pr et at ion
. ” H CAHeal th Servs. of G a. , I nc. v. Em

ploy ers H ealth Ins. C o., 240 F.3 d 9 8 2 , 9 94 n.23 (11th Cir. 2001 ). T he defendants relied prim arily on the opin ion of a doctor who wa s em ploy ed by U N U M but did not pe rs ona lly ex am ine L an gf or d. Whil e the de fe ndants w er e not obl iga te d to a cc or d sp ec ia l de fe re nc e to the opi nio ns o f L an gf or d’ s tr ea tin g phy sic ian s , th e d i s tr i c t

c ourt f ound the de fe ndants c om

ple te ly ign or ed se ve ra l of tho se opi nio ns. C f. Bl ac k & D ec ke r D isa bil ity Pl an v. N or d, 538 U
. S. 822, 825, 123 S
. Ct
. 1965 , 196 7, 155 L. E d. 2d 1 034 (2 003) ( hol din g th at “ plan a dm ini str at or s are not ob li ge d t o a cco rdsp eci al de fere nc e to th e o pi ni on s o f tr eat in g p hysic ia ns .” ). Af ter concludin g its de nov o reviewof the defendants’ decision, in accordance with t he test laid out in W illiam s, the district court then considered whether the T RW T ru st h ad dis cr et ionto de ci de he r cl ai m . S ee W ill ia m s, 373 F
. 3d a t 11 38. W e ha ve he ld tha t a de fe ndant ha s dis cr et ion to de ci de a cl ai m w he n “ the be ne fi t plan giv es the [d ef en da nt] dis cr et ion ar

y auth or ity to de te rm ine el igi bil ity fo r be ne fi ts or to c onstru e the te rm s of

the plan. ” Ca gle v. Br une r, 112 F
. 3d 1 510, 151 6 ( 11th C ir
. 199 7) (quotation om itted). T he LT D plan provided that the TRW Tr ust “ shall have the final
au tho ri ty to de te rm ine w he the r or not to pa y an y cl ai m s tha t U N U M r ec om

m en ds f or5

pa ym en t o r de ni al an d s ha ll ha ve th e fi na l au th or it y to au th or iz e p aym en t o f cl ai m s.” T hus, a s th e dis tr ic t c ourt f ound , the T RW

T ru st h ad

“ dis cr et ionary author ity to de te rm ine e lig ibi lity

f or be ne fi ts o r to c onstru e the te rm s of the plan. ” Id
. O n th e thi rd

pr ong of the W ill ia m s te st, the inquir y is “ w he the r [the c la im an t] ha s pr opos ed

asou nd i nte rp re ta tio n of t he plan to r iva l [ the de fe ndant’ s] interpretation.” L ee v. Blue Cross/Blue Shield of Ala. , 10 F. 3d 15 47, 1550 (11t h Cir. 1994 ). H ow ev er , “ [e ] ve n if the co urt de te rm ine s th at the c la im an t’ s in te rp re ta tio n is
re as o n ab l e, t h e c l ai m an td o es n o t n ec es s ar i l y p re v ai l
. . . . Th e r ea s o n t h e c l ai m an t ’s
re as ona ble int er pr et at iondoe s no t tru m p th e cl ai m s a dm ini str at or ’ s w rong int er pr et at ionis be ca

use the plan do cu m en ts ex pli ci tly gr an t the c la im s a dm ini str at or dis cr et ionto int er

pr et the plan. ” H CA , 240 F
. 3d at 994 (f ootnot e om itt ed ). W e al so ha ve no te d t ha t, [t ] o f ind ac la im s a dm ini str at or ’ s inte rp re ta tio n a rb itr ar y a nd c ap ri ci ous, the c ourt m

ust ove rc om e the pr inc ipl e of tr ust law w hic h st at es tha t a tr ust ee ’ s in te rp re ta tio n wi ll not be dis tur be d if it is re as ona

ble
. T hus, the n e x ts t e p r e q u i r e s t h e c o u rt t o d e t e rmi n e w h e t h e r t h e c l a i ms adm ini str at or ’ s w ro ng i nte rp re ta tio n is non ethe le ss r ea sona ble
. I f the co urt de te rm ine s th at

the c la im s adm ini str at or ’ s wr ong int er pr et at ionis re as ona ble , the n th is wro ng b ut re as ona ble int er pr et at ionis en tit le d to defere nce even thou gh the claim ant’ s interpretation is also reasonable. Id . (ci ta ti on an d fo ot no te om it te d)
.L ang ford did not ar g ue in the district cour t, and she doe s not claim here , that the 1 defe ndants had a conflict of interest or that their actions wer e mot ivated by self-inter est. Thus, eve n vie wi ngthe fa c ts i n a

lig ht m os t f

avo ra ble to L ang fo rd , s umm ary jud g me nt i s p ro pe r b e c a

us e sh e did not present a

ny “g enuine issue a s to a

ny materia l f

act” and the def

endants a re “ entitled to a judg ment as a matter of law .” See J ohnson, 234 F.3d at 507 (11th Cir. 2000); Fed. R. Civ. P. 56(c). More over, L ang fo rd a ba nd on e d a ny po ssi ble c la ims re g ard ingthe de fe nd ants ’ c on fl ic t of int e re st b y

fa ili ngto raise the se ar g uments in her brie f on appe al. See Gr eenbr iar, Ltd. v. Cit y of Alabaster, 881 F .2d 1570, 1573 n.6 (1989).
6 Inthe ins tant ca se , the dis tr ic t co urt fo und the de fe ndants ’ int er pr et at ion of

the L T D P lan w as r ea sona

ble in lig ht o f the m ed ic al doc um en ts i n th e re co rd a nd a UN UM doctor’ s conclusio ns. A lthou gh the UN UM doctor’ s con cl u s i o n s differe d fr om the opi nio ns o f som e of L an gf or d’ s tre at ing phy sic ia ns, the de fe ndants w er e not obl iga te d to a cc or d sp ec ia l de fe re nc e to the opi nions of L an gf or d’ s tr ea tin g phy sic ians. S ee Bl ac k & D ec ke r, 538 U
. S. at 825, 123 S. Ct
. a t 19 67. T hus, a lth ough the T RW T ru st’ s de ci sio n w as “ de nov o w ro ng, ” re as ona ble gr ound s e xis te d f

or it s d ec i s i o n , un d er t h e se co n d an d t h i rd p ro n g s o f W i l l i ams. Co n t ra ry t o L a n g f o r d ’s 1

ar gum en ts o n a

ppe al , it w as not er

ro r fo r the dis tr ic t c ourt t o pr oc ee d w ithit s ana ly sis be y ond the de nov o st an da rd r equir ed by the f ir st p ro ng o f W ill ia m s, nor w as it
re ve rs ibl e er

ro r fo r th e court t o c onc lud e tha t, on this r ec or d, the de fe ndants
reas on ab ly dis co nt in ue d p aym en t o f be ne fit s u nd er t he LTD Plan
. AFFIRMED.