# U ni te d S ta te s Co ur t of A pp ea ls For the Eig hth Circu it

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No. 1 3- 12 10

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Tam ic a Sh aw

ll ll ll ll ll ll ll ll ll ll l Pla in ti

ff - App el la nt

v.

The Pru de nt ia l In su ran ce Co m pa ny of Am eri ca

ll ll ll ll ll ll ll ll ll ll l Defe nd

an t - Ap pe ll ee

__ __ __ __ __ __ App eal fro m

Uni te d S ta te s Di st ric t Co ur t fo r th e Weste rn Dis tri ct of M is so ur i - Sp rin gf ie ld

__ __ __ __ __ __
Su bm it te d: Nov em

be r 19 , 20 13 Fi le d: Ju ne 3, 3 01 4 [Un pu bl is he d]

__ __ __ __ __ __ Befo re BENTON, BEAM, an d S HEPHERD, Circ ui t J ud ge s.

__ __ __ __ __ __

PER CURI AM.In th is Em pl oyee Ret ire m en t In co m e Secu rit y Act (" ER I S A ") cas e, Tam ic a Sh aw ap pe al s fro m th e d i s t r i c t co ur t's gr an t of su m m ary jud gm en t in fav or of The 1
Pru de nt ia l In su ran ce Co m pa ny of Am eri ca (" Pru de nt ia l" ). W e aff irm.

I. BACKGRO UND

On Mar ch 4, 20 06
, Tam ic a's hu sb an d, Carl Sh aw, was ki ll ed in a si ng le -v eh ic le acci de nt in Sp rin gf

ie ld
, Mi ss ou ri. Acco rd in g to an in ve st ig at iv e rep or t, Carl 's ve hi cl e

wen t ai rb or ne aft er he cro ss ed ov er rai lro ad tra ck s at a hi gh rat e of sp eed
, ev en tu al ly

cau si ng hi m to care en in to a bu il di ng

. A su bs eq ue nt to xi co lo gy rep or t rev eal ed th at Carl ha d a bl oo d a lc oh ol lev el of 0 .12 6% a t t he ti m e o f hi s d eat h.

Tam ic a fil ed a cl ai m wit h Pru de nt ia l se ek in g be ne fit s fro m an acci de nt al de at h

an d di sm em

be rm en t po li cy ("AD&D" ) sh e ha d pu rch as ed fro m Pru de nt ia l th ro ug h he r em pl oyer, J PMo rg an Ch as e Ban k, N.A. (" Ch as e") , a s pa rt of a gr ou p i ns ur an ce

co nt ract

. The AD&D po li cy ex cl ud ed co ve rag e if a lo ss res ul te d fro m "[a ]n acci de nt th at oc cu rs whi le op erat in g a m ot or ve hi cl e in vo lv in g th e il le ga l us e of al co ho l."
Bas ed on th is ex cl us io n, on Ju ne 21
, 2 0 0 6
, P r u de nt ia l de ni ed th e cl ai m , in di cat in g th at , at th e ti m e of hi s de at h, Carl ha d a b l o o d a l c o h ol le ve l ex ceed in g th e li m it al lo wed to op erat e a m ot or ve hi cl e in Mi ss ou ri. Tam ic a ap pe al ed th e de ci si on in two

se pa rat e le tt ers to Pru de nt ia l da te d Octo be r 2, 20 06 , a nd Feb ru ary 7 , 2 00 7, arg ui ng th at ne it he r th e po li ce rep or t no r th e cert ifi cat e of de at h ci te d al co ho l as a co nt rib ut in g fact or in Carl 's d eat h.

On Mar ch 12
, 20 07
, Pru de nt ia l up he ld it s de ci si on to di sa ll ow th e cl ai m , ag ai n rel y in g on th e al co ho l ex cl us io n. On May 1 0, 20 07 , a fte r rec ei vi ng an d rev ie win g ad di ti on al reco rd s, Pru de nt ia l r e v i s e d it s de ni al le tt er, th is ti m e ci ti ng a fel on y

The Hon or ab le Dav id G r e go ry Kay s, Uni te d St at es Dis tri ct Ju dg e fo r th e 1 W es te rn Dis tri ct of M is so ur i.

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-ex cl us io n in ad di ti on to m ai nt ai ni ng de ni al ba se d on th e al co ho l ex cl us io n. On Ju ly

30
, 20 07
, Tam ic a ap pe al ed fro m th is de ci si on

. In he r ap pe al le tt er, Tam ic a in di cat ed th at he r le t t er "s erv [ed ] as an ap pe al to Pru de nt ia l's App eal Rev ie w Co m m it te e fo r

a fin al de ci si on rel at iv e to Pru de nt ia l's May 10
, 20 07
, le tt er de nyin g th e pa y m en t of li fe in su ran ce pr oc eed s." On Sep te m be r 28
, 20 07
, Pru de nt ia l is su ed it s fin al de ci si on de nyin g th e cl ai m

. Nearl y two y ears aft er th is de ni al
, Tam ic a ob ta in ed ne w co un se l

an d p res se d P ru de nt ia l fo r ad di ti on al rev ie w.

On Ju ly 27
, 20 10
, Tam ic a co m m en ced act io n in Mi ss ou ri st at e co ur t, al le gi ng Pru de nt ia l br each ed th e AD&D po li cy

. Pru de nt ia l rem ov ed th e cas e to fed eral co ur t

an d Tam ic a so ug ht a rem an d. Fi nd in g th at Tam ic a ha d al l eg ed ERISA cl ai m s, th e di st ric t co ur t de ni ed rem an d. Ta m ic a th en am en de d he r co m pl ai nt to in cl ud e on e
st at e la w cl ai m an d, in th e al te rn at iv e, an ERISA cl ai m

. Pru de nt ia l m ov ed fo r pa rti al

su m m ary jud gm en t on th e st at e la w cl ai m

. Aga in
, fin di ng th at ERISA go ve rn ed th e di sp ut e, t h e d i st ric t co ur t gr an te d pa rti al su m m ary jud gm en t in fav or of Pru de nt ia l, di sm is si ng Tam ic a's Mi ss ou ri st at e la w cl ai m

. Su bs eq ue nt ly, th e pa rti es fil ed cro ss

m ot io ns fo r su m

m ary jud gm en t on th e rem ai ni n g ERISA cl ai m

. Rev ie win g Pru de nt ia l's de ci si on fo r an ab us e of di sc ret io n, th e di st ric t co ur t de te rm in ed th at Pru de nt ia l's de ci si on was reas on ab le an d su pp or te d by su bs ta nt ia l ev id en ce an d, th us , gr an te d P ru de nt ia l's m ot io n. Tam ic a n ow ap pe al s.

II

. DISCUSS IO N

A. Sta nda rd o f Rev ie w

Tam ic a ch al le ng es th e di st ric t co ur t's de te rm in at io n th at an ab us e of di sc ret io n
st an da rd ap pl ie d to Pru de nt ia l's d e c i s i o n. W e rev ie w th e di st ric t co ur t's gr an t of

su m m ary jud gm en t de no vo , as well as it s de te rm in at io n th at Pru de nt ia l's de ci si on is

go ve rn ed by an ab us e of di s c r e t io n st an da rd

. Sah ul ka v. Luc en t Tech s., In c., 20 6
F.3 d 7 63 , 76 7 (8 th Cir . 20 00 ).

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-G en er al ly
, w he n an E RI SA pla n gr ants th e ad m in is tra to r di sc retiona ry au tho ri ty
to "m ak e el ig ib il it y de te rm in at io ns , th e ad m in is tra to r ' s d eci si on is rev ie wed fo r an ab us e of di sc ret io n." Trs. of Elec tr i c i a n s ' Sal ary Defer ral Pl an v. W rig ht , 6 88 F.3 d
92 2, 92 6 (8 th Ci r. 2 0 1 2 ) (q uo ta ti on om it te d)

. Howev er, if th e ERISA pl an fai ls to
gr an t su ch au th or it y , we rev ie w th e ad m in is tra to r' s d e c is io n de no vo

. Nich ol s v. Uni care Life a nd Heal th Ins . Co., 7 39 F.3d 11 76 , 11 81 (8t h C ir. 2 01 4)

.

Tam ic a as se rts th ree reas on s why a d e n ov o s ta nd ard ap pl ie d i n th is cas e: (1 ) th e sp eci fic AD&D po li cy f a il ed to pr ov id e di sc ret io na ry au th or it y to th e Pl an ad m in is tra to r; (2 ) th e su m m ary pl an de sc rip ti on (SPD) an d ot he r do cu m en ts gr an ti ng di sc ret io na ry

au th or it y are n ot pa rt of th e AD&D po li cy ; an d (3 ) Pru de nt ia l d id no t
pr op erl y am en d th e AD&D po li cy to in cl ud e di sc ret io na ry au th or it y

. W e fin d th es e rel at ed co nt en ti on s u np ers ua si ve un de r pr es en t ci rcu m st an ces

.

Our cas es es ta bl is h a few pr i n c i p le s to di sc ern th e ap pr op ria te st an da rd of

rev ie w i n th e type of s i t ua ti on we no w c on fro nt

. W e ha ve reco gn iz ed th at "a gr an t of di sc ret io n t o t he pl an ad m in is tra to r, ap pe ari ng on ly in a [S PD], do es no t v es t t he ad m in is tra to r wit h di sc ret io n whe re th e po li cy pr ov id es a m ech an is m fo r am en dm en t

an d di sc la im s th e po wer of th e su m m ary pl an de sc rip ti on to al te r th e pl an ." Ri ng wald

v. Pru de nt ia l In s. Co

. of Am
., 60 9 F.3 d 94 6, 94 8 (8 th Ci r. 20 10 ) (q uo ta ti on om it te d)

. Yet, at th e sa m e ti m e, we ha ve ne ve r he ld th at th e di sc ret io n- gr an ti ng la ng ua ge m us t
ap pe ar on ly in th e in di vi du al welf are po li cy or SPD to ha ve effe ct

. See McKeeh an 2

v. Ci gn a Life In s. Co
., 34 4 F.3 d 78 9, 79 3 (8 th Ci r

. 2 0 0 3 ) ("[ W ]e req ui re ex pl ic it di sc ret io n- gr an ti ng lan gu ag e in th e p ol ic y or in ot he r p la n d

oc ume nt s to tri gg er t he
ERISA de fere nt ia l st an da rd of rev ie w.") (em ph as is ad de d) (in te rn al qu ot at io n

om it te d) ); Ri tt en ho us e v. Uni te dHe al th Gr p. L ong T er

m D isab il it y In s. Pl an , 47 6 F.3 d
62 6, 62 9 (8 th Ci r. 20 07 ) ("Th e tri gg eri ng la ng ua ge m ay ap pe ar in a pl an do cu men t

On th is po in t, we fu nd am en ta ll y di sa gr ee wit h Tam ic a's r e a d i n g o f Jo be v. 2 Med ic al Life I ns . Co., 5 98 F.3d 47 8 (8 th Cir . 20 10 ), an d R in gwa ld

.
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-ot he r th an th e SPD.")

. In de ed
, " a n ER I SA pl an m us t be in ferr ed fro m a se rie s of do cu m en ts ," Adm in is tra ti ve Co m m it te e of W al -Ma rt St or es , In c. v. Gam bo a, 47 9
F.3 d 53 8, 54 2 (8 th Ci r. 20 07 ), an d in in te rp ret in g th e te rm s of th e pl an , li ke al l

co nt ract s, "[c ]our ts m

us t lo ok at th e ERISA pl an as a who le ," Jo hn so n v. Am eri can Uni te d Life In su ran ce Co
., 71 6 F.3 d 81 3, 82 0 (4 th Ci r. 20 13 ). To th is en d, al th ou gh in a sl ig ht ly di ffer en t co nt ex t, in Gam bo a, we ack no wled ge d th e co nt ro ll in g effe ct of
"wra p- pl an " do cu m en ts th at "p ro vi de [] th e gove rn ing stru ct ur e of th e ov eral l Pl an an d de sc rib e[] th e ge ne ral pr oc ed ur es fo r de te rm in in g pa rti ci pa ti on , fu nd in g, ad m in is tra ti on , an d cl ai m s un de r each in di vi du al welf are pr og ram ." 47 9 F.3 d at 54 2.

P r e s en tl y , al th ou gh th e in di vi du al AD&D po li cy at is su e do es no t co n t a i n di sc ret io n- gr an ti ng la ng ua ge , ot he r Pl an d o cu m en ts un am bi gu ou sl y gr an t su ch

au th or it y

. In ad di ti on to th e in di vi du al we l f a r e p o l ic ie s, Tam ic a's ERISA Pl an

co nt ai ns a gl ob al do cu m en t en ti tl ed "Hea lt h an d In co m e Pro te ct io n Pro gr am fo r J P Mo rg an Ch as e Ban k an d Cert ai n Affi li at ed Co m pa ni es ." Thi s wra p

- p l a n do cu m en t, li ke in Gam

bo a , "p ro vi de s th e go ve rn in g st ru ct ur e of th e ov eral l Pl an an d de sc rib es th e g e ne ral pr oc ed ur es fo r de te rm in in g pa rti ci pa ti on , fu nd in g, ad m in is tra ti on , an d cl ai m s un de r each in di vi du al welf are pr og ram ." Id

. Fu rth erm or e, th e wrap -p la n do cu m en t in fo rm s th e em pl oyee th at th e ERISA Pl an is ev id en ced by th e wrap -p la n do cu m en t it se lf, as well as th e SPDs an d t h e in di vi du al in su ran ce
po li ci es , am on g ot he r na m ed do cu m en ts

. Sect io n 4.2 of th is do cu m en t de cl ares th at "[b ]enefi ts un de r th e Pro gr am or a Pl an wil l b e pa id on ly if th e Pro gr am [ 3 ]
Adm in is tra to r or it s de le ga te s de ci de s in it s di sc ret io n th at a Part ic ip an t is en ti tl ed to th em ." Giv en th at th is Pl an do cu m en t pr ov id es su ch a cl ear an d ex pl ic it gr an t of

The wrap do cu m en t de fin es "Pl an " as "an y on e of th e em pl oyee be ne fit pl an s 3

. . . whi ch is m ai nt ai ne d fo r th e be ne fit of Eli gi bl e Em pl oyees an d th ei r Dep en da nt s." "Pr og ram " is de fin ed as th e "Hea lt h an d In co m e Pro te ct io n Pro gr am fo r JP Mo rg an Ch as e Ban k and Cert ai n Affi li at ed Co m pa ni es ," and "re fere nc es

. . . to th e Pro gr am sh al l in cl ud e each in di vi du al Pl an ." Unl ik e Tam ic a, gi ve n th es e de fin it io ns , we fin d it in si gn ifi can t t ha t t he wrap do cu m en t i s en ti tl ed "Pro gr am " i ns te ad of " Pl an ."

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-di sc ret io n, we fin d it un ne ces sa ry to ad dr es s Tam ic a's arg um en ts co nc ern in g whe th er

th e di sc ret io n- gr an ti ng la ng ua ge in th e SPDs –i nc or po rat ed b y r e f

e r en ce in to th e
wrap -p la n do cu m en t– ha s an y co nt r o l l i n g effe ct

. The di st ric t co ur t di d no t err in de te rm in in g a n a bu se of d is cret io n s ta nd ard ap pl ie d.

B. The Admini st ra tiv e Reco rd

Tam ic a ta ke s is su e wit h m at eri al s th e di st ric t co ur t refu se d to co ns id er as pa rt of th e ad m in is tra ti ve reco rd

. Sp eci fic al ly, b ecau se th e di st ric t co ur t was rev ie win g Pru de nt ia l's fin al de ci si on d a t e d S e pt em be r 28
, 20 07
, th e co ur t refu se d to co ns id er

an y m at eri al s Tam ic a su bm it te d to Pru de nt ia l aft er th at da te

. Tam ic a arg ue s th at sh e

su bm it te d ev id en ce to Pru de nt ia l aft er Sep te m be r 28
, 20 07
, in cl ud in g a req ue st fo r

reco ns id erat io n; th at Pru de nt ia l co ns id ered th e ev id en ce in res po nd in g to he r req ue st fo r reco ns id erat io n be fo re sh e fil ed su it ; th at P r ud en ti al su bm it te d th es e ad di ti on al

m at eri al s to th e di st ric t co ur t as pa rt of th e cert ifi ed reco rd ; an d th at Pru de nt ia l ci te d

so m e of th es e m at eri al s in it s m ot io n fo r su m m ary jud gm en t. Thu s, in Tam ic a's vi ew, th e di st ric t co ur t erre d in refu si ng to co ns id er ev id en ce su bm it te d to Pru de nt ia l aft er Sep te m be r 28 , 20 07

.

In rev ie win g a pl an ad m in is tra to r's de ni al of be ne fit s, co ur ts "co ns id er on ly th e

ev id en ce th at was be fo re th e ad m in is tra to r whe n th e cl ai m was de ni ed ." Sah ul ka
, 20 6
F.3 d at 76 9. In Ri tt en ho us e, we reject ed arg um en ts si m il ar to th os e Tam ic a no w

as se rts

. 47 6 F.3 d at 63 0- 31

. The re, m uc h li ke th e pr es en t cas e, aft er th e pl an

a d mini st rat or is su ed it s fin al de ci si on , th e em pl oyee pr es se d th e ad m in is tra to r t o

reco ns id er it s po si ti on an d su bm it te d ad di ti on al ev id en ce. Id

. at 63 0. W e co nc lu de d

t he di st ric t co ur t ab us ed it s di sc ret io n in co ns id eri ng th e em pl oyee's ad di ti o n a l

ev id en ce su bm it te d to th e pl an ad m in is tra to r, as th e em pl oyee of fere d no ex pl an at io n why th e rel ev an t ev id en ce co ul d no t ha ve be en su bm it te d be fo re a fi na l ad m in is tra ti ve de ci si on was re nd ered . Id. at 63 1.

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-W e fin d Ri tt en ho us e co nt ro ls he re a n d a n y sl ig ht di st in ct io ns are wit ho ut a

di ffer en ce. Tam ic a ha s of fere d no ex pl an at io n as to why sh e co ul d no t su bm it al l he r

ev id en ce du rin g th e ad m in is tra ti ve ap pe al s pr oc es s an d wait ed ne arl y two y ears aft er Pru de nt ia l is su ed i t s f

i n a l de ci si on to fin al ly su bm it th e ev id en ce to Pru de nt ia l.
Tam ic a is no t en ti t l ed to li m it le ss rev ie w m erel y be cau se sh e de ci de d to swi tc h

co un se l aft er he r fin al ad m in is t r a t i v e a pp eal ha d be en de ni ed

. See Dav id so n v. Pru de nt ia l In s. Co

. of Am
., 95 3 F.2 d 10 93
, 10 96 (8 th Ci r. 19 92 ) ( " [ T] he ad m in is tra t i v e [ r e vi ew] pr oc es s m us t en d at so m e po in t." (s eco nd al te rat io n in

or ig in al ) (q uo ta ti on om it te d) ). The re f o r e , t he di st ric t co ur t di d no t ab us e it s di sc ret io n in refu si ng to co ns id er ev id en ce th at Tam ic a fai le d to ti m el y su bm it du rin g th e ad m in is tra ti ve ap pe al s p ro ces s.

C. Con fli ct o f In tere st an d Pro cedu ra l I rreg ul ar iti es

Eve n if th e pl an do cu m en ts ve st P r u d e nt ia l wit h di sc ret io n, Tam ic a su gg es ts th at th e di st ric t cou rt fail ed to co ns id er Prud en ti al 's con fli ct of in te res t. Se e Kho ur y

v

. G r p

. H e a l t h Pl an , In c., 61 5 F.3 d 94 6, 95 3 (8 th Ci r. 20 10 ) ("Th e ex is te nc e of a

co nf li ct of in te res t is on e fact or am on g m an y th at a rev ie win g jud ge mu s t t a k e in to

acco un t when de te rm in in g whe th er a pl an ad m in is tra to r ha s ab us ed it s di sc ret io n in de nyin g be ne fit s." ( i n te rn al qu ot at io n om it te d) ). The reco rd be li es Tam ic a's

co nt en ti on

. In it s or de r de n yi n g he r m ot io n fo r reco ns id erat io n, th e di st ric t co ur t

no te d t ha t i t had co ns id ered th e co nf li ct of i nt eres t b ut co nc lu de d t ha t an y po te nt ia l

co nf l i c t "d id no t in flu en ce or ot he rwis e ov erri de th e ot he r fact or s Pru de nt ia l

co ns id ered in de nyin g P l a i n ti ff be ne fit s." W e ag ree wit h th e di st ric t co ur t's

as se ss m en t.

Ta mi c a a l s o c o mp l a i n s th at Pru de nt ia l ab us ed it s di sc ret io n by fa i l i n g t o

en ga ge in a fu ll an d fai r rev ie w of he r cl ai m be cau se it s cl ai m ha nd li ng pr oc es s was rid dl ed wit h pr oc ed ur al ir reg ul ari ti es

. Sev eral of Tam ic a's pe rcei ve d pr oc ed ur al

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-irr eg ul ari ti es se em to st em fro m he r m is ch arac te riz at io n of th e r e c or d an d ou tri gh t

m is st at em en ts of la w. Fo r ex am pl e, in on e of he r m an y as se rti on s, Tam ic a cl ai m s th at "Pr ud en ti al di d no t gi ve [Tam ic a's ] co nt en ti on s fai r co ns id erat io n, an d fai le d to gi ve
sp eci fic reas on s fo r de nyin g th e cl ai m an d fo r no t co ns id eri ng cri ti cal ev id en ce." A

rev ie w of th e reco rd rev eal s a di ffer en t s t o r y. I n each of it s cl ai m de ni al le tt ers , Pru de nt ia l ga ve sp eci fic reas on s fo r th e de ni al
, ci te d ev id en ce, an d res po nd ed to each of Tam ic a's arg um en ts

. In it s fin al de ci si on , Pru de nt ia l no te d th at Tam ic a ap pe al ed b u t f a i le d to pr ov id e an y ad di ti on al in fo rm at io n fo r Pru de nt ia l to rev ie w. A f t e r th or ou gh ly rev ie win g th e reco rd
, we se e no ab us e of di sc ret io n ba se d on pr oc ed ur al irr eg ul ari ti es

.

D. Alco ho l Ex cl us io n

As to th e m eri ts of th e un de rlyin g de ni al
, Tam ic a arg ue s th at th e di st ric t co ur t

erre d in co nc lu di ng th e al co ho l e x c l us io n pr ecl ud ed co ve rag e un de r th e AD&D

po li cy

. Bec au se we ha ve de te rm in ed th at an ab us e of di sc ret io n st an da rd ap pl ie s, th e "ad m in is tra to r's de ci si on to de ny be ne fit s wil l st an d if a reas on ab le pe rs on co ul d ha ve

reac he d a si m il ar de ci si on ." Rat li ff v. Je ffer so n Pi lo t Fi n. In s. Co
., 48 9 F.3 d 34 3, 34 6 (8 th Ci r. 20 07 ) (q uo ta ti on om it te d)

. A de ci si on is no t un reas on ab le m erel y be cau se th e pl an is su sc ep ti bl e to di ffer in g in te rp ret at io ns

. Ri ve r v. Edwar d D. Jo ne s Co
., 64 6
F.3 d 10 29
, 10 32 (8 th Ci r. 20 11 ). "Ra th er, a co ur t wil l rev ers e a cl ai m s ad m in is tra to r's de te rm in at io n o nl y

if i t i s ar bi tra ry

an d c ap ric io us ." Id . Accor di ng ly, whe re a p la n ad m in is tra to r of

fers a reas on ab le ex pl an at io n fo r a d eci si on th at is su pp or te d by

su bs ta nt ia l ev id en ce– su ch ev id en ce th at a re a s o n a b l e m in d m ig ht fin d ad eq ua te to

su pp or t t he co nc lu si on –we wil l n ot di st ur b t he de ci si on . Id. at 10 33

.

Rec al l, th e al co ho l ex cl us io n pr ov id es th at "[a ] lo ss is no t co ve red if it res ul ts fro m

. . . [a]n acci de nt t ha t oc cu rs whi le op erat in g a m ot or ve hi cl e in vo lv in g th e il le ga l us e of al co ho l." Tam ic a fin ds s ev eral as pe ct s of th is pr ov is io n am bi gu ou s,

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-na m el y , th e "re su lt s fro m " la ng ua ge , th e "i ll eg al us e of al co ho l" la ng ua ge , an d th e

la ck of a na m ed ve hi cl e op erat or

. Afte r rev ie win g th e reco rd an d ou r pr eced en t, we

co nc lu de th at th e pl an ad m in is tra to r of fere d a reas on ab l e i n te rp ret at io n an d

ap pl ic at io n of th e ex cl us io n to th e fact s of thi s case

. See id

. at 10 33 ("We co nc lu de th a t , b as ed on [th e in to xi cat io n] ex cl us io n al on e, [th e pl an ad m in is tra to r] di d no t ab us e it s d is cret io n a s p la n a dm in is tra to r whe n i t d en ie d b en efi ts .").

E. Subs ta nti al Ev id ence

Tam ic a al so as se rts th at Pru de nt ia l's de ci si on is no t su pp or te d by su bs ta nt ia l

ev id en ce b ecau se "t he gre at weig ht of th e ev id en ce in th e reco rd

. . . es ta bl is he s th e bl oo d te st res ul ts are no t rel ia bl e an d th at Carl Sh aw di d no t dr in k al co ho l on th e ni gh t he di ed ." W e reject ed si m il ar as se rti on s in Ri ve r. The re, we de te rm in ed th at th e pl an ad m in is tra to r act ed reas on ab ly b y rel y in g on a "ce rti fie d to xi co lo gy re po rt is su ed by th e Mi ss ou ri St at e Hig hwa y Pat ro l Cri m e Lab or at or y Div is io n an d si gn ed by o ne of it s te ch ni ci a n s ," whi ch sh owe d th e de ced en t ha d a bl oo d al co ho l le ve l of
0.1 28 %, no twi th st an di ng ev id en ce i nd ic at in g t he de ced en t was no t in to xi cat ed

. Id

. at 10 33 & n.2

. Here, th e Mi ss ou ri St at e Hig hwa y Pat ro l Cri m e Lab or at or y Div is io n is su ed a rep or t in di cat in g Carl 's bl oo d al co ho l le ve l was 0.1 26 % at th e t i m e of th e acci de nt

. Thi s to xi co lo gy rep or t sa ti sf ie s th e su bs ta n t i a l ev id en ce st an da rd ev en if

co nt rary evi de nc e ex is te d. Id . at 1 03 4.

F. To xi co lo gy Repo rt

Fi na ll y , Tam ic a ch al l e n ge s th e rel ia bi li ty an d ev id en ti ary va lu e of th e
to xi co lo gy rep or t be cau se pr op er pr oc ed ur e was no t fo ll owe d in dr awin g an d te st in g Carl 's bl oo d. Afte r th or ou gh ly rev ie win g th e reco rd
, we are sa ti sf ie d th at Pru de nt ia l

act ed reas on ab ly in re lying on th e to xi co lo gy repo rt.

-9

-II I. CONCLUSI ON

W e aff irm th e jud gm en t o f th e d is tri ct co ur t.

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