This disposit ion is not appropriate f or publication and is not pre cedent except as * provided by

Ninth Circuit Rul e 36-3.

* * The Honorable Da vid G. Trag er, Senior United States District Judg e for the Easter n District of New York, sitting by designation. NOT F OR P UB L I CAT I ON UN I TE D STATE S C OU RT OF APPE ALS FOR T HE NI NTH CI RC UI T S HA HL A MOB AY E N, P la in tif

f - A p p e lla n t, v. S T AN DA R D I NS UR AN C E C OMP AN Y; G A M BRO , I N C. LO N G TERM DI S AB I L I T Y I NS UR AN C E P L AN , D efen d an t s-A p p el l ees. N o. 07- 55430 D . C . N o. C V 06 -012 68 -R ME MOR AN DU M *

A pp ea l fr om the U ni t ed S t at es D i stri ctC ou rt f o rth e C e n tr a l D is tr ic t o f C a lif o rn ia M a nue l L . R e a l , D i s tr i c tJ udge , P r e s i di ng A r gue d a nd S ubm i tt e d O c t obe r6, 2009 *

P as adena, C al i forni a Be f o r e : K LEI N FELD a n d TA LLM A N , Ci r c u i tJ u d g e s , a n d TRA G ER, D i stri ct ** Judg e. 

# FI LED DE C 08 2009 M OLLY C. DW Y ER, CLERK U . S. C O U R T OF APPE ALS2

S ha hl aM oba y e n ( " M oba y e n" ) appe a l s the di s tr i c tc ourt ' s or de ruphol di ng the det erm i nat i on of S t andard Insurance C om pany (" S t andard") t o l i m i tre covery of her l on g t erm di sabi l i ty benef i tpaym ent s und erthe G am bro, Inc. L on g T erm D i sabi l i ty I nsurance Pl an, an em pl oyee benefi tpl an go verned by the E m pl oyee R e tir e m e n t I n c o m e S e c u r ityA c t o f 1 9 7 4 , 2 9 U .S .C . § 1 0 0 1 , e t s e q . ( " E R I S A " ) . W e have j uri sdi ct i on un der 28 U . S . C . § 1 29 1. "W e r evi ew de no vo the di stri ct c o u rt ' s c h o i c e a n d ap p l i c a t i o n o f th e s t a n d a r d o f

r e v i e w t o d e c i s i o n s b yERI SA fi d u ci ari es, an d w e rev i ew fo r cl ear erro r i t s u n d erl yi n g fi n d i n g s o f fact . " P annebecker v. L i berty L i fe A ss ur. C o. of B ost on , 54 2 F . 3d 12 13 , 12 17 (9th C i r. 20 08 ) ( ci t i ng A bat i e v. A l t a H ea l th & L i fe Ins. C o. , 45 8 F . 3d 95 5, 96 2 (9th C i r. 2 0 0 6 ) ( e n b a n c ) ) . W e a f f irm th e d is tr ic t c o u rt's d e c is io n f in d in g th a t S ta n d a r d d id notabus e i t s di s c r e t i on i n m a ki ng i t s di s abi l i tyde t e rm i na t i on. S ta n d a r d d e te rm in e d th a t M o b a y e n w a s d is ab le d d u e to f ib r o m y a lg ia , a c ondi t i on f

orw hi c h he rgr oup pol i c ypr ovi de d be ne f i tpa y m e nt s f

orup t o 18 m on ths because the po l i cydefi ned fi brom ya l gi a a s al i m i t ed cond i t i on . T he re cord dem on stra t es thatS t andard cond uct ed si x separ at e r evi ew s over athree -y ear peri od , gi vi ng M ob ay en nu m er ou s opp ortun i t i es t o sub m i taddi t i on al m edi ca l e v i d e n c e i n f

a v o ro f h e rd i s ab i l i ty c l a i m. D u r i n g th e f i n a l r e v i e w o f

h e rc l a i m, M o b a y e n s u b m itte d a n e le c tr o m y o g r a m d e m o n s tr a tin g " p r o b ab le r a d ic u lo p a th y ;"3

u n d e rth e p o lic y , r a d ic u lo p a th yis an o n - lim ite d c o n d itio n , m e a n in g th a t b e n e f it paym ent s w er e notre stri ct ed t o o nl y an 1 8-m on th p er i od . In S t andard' s f i nal de c i s i on, i tc onc e de d tha tthe r e w a s note nough e vi de nc e t o de f i ni t i ve l yrul e outthe pres ence of ra di cul op athy, bu tup hel d i t s pri or det erm i nat i on , re as on i ng thatthere w as n o ev i d en ce th atM o b ayen ' s d i sab i l i ty w as actu al l y cau sed b y rad i cu l o p ath y. M oba y e n a r gue s tha tc e rt a i n a c t i ons t a ke n byS t a nda r d dur i ng the adm i ni stra t i on proces s dem on stra t e thati t s dec i si on w as i nfl uenced by a structural confl i ctof i nt er es t . S uch a confl i ctexi st s w here , as here , "an i nsurer. . . ac t s a s both the pl a n a dm i ni s tr a t ora nd the f undi ng s our c e f

orbe ne f i t s . " A ba t i e , 458 F . 3d a t965. M oba y e n c l a i m s tha tS t a nda r d abus e d i t s di s c r e t i on by : ( 1) pr ovi di ng i n co n si st en treaso n s fo r d en yi n g h er cl ai m ; (2 ) i m p o si n g n ew p o l i cy req u i rem en t s; (3) arbi trari l y di sr egar di ng her m edi ca l evi dence; (4) f ai l i ng t o con si der her s ubj e c t i ve c om pl a i nt s of pa i n; ( 5) f

a i l i ng t o c ons i de rthe e f f e c t s of he rm e di c a t i on; an d (6 ) u n n ecessaril y d el ayi n g th e d eci si o n o n h er d i sab i l i ty cl ai m . E ssen t i al l y, M ob ay en ar gu es thatthere w as am pl e m edi ca l evi dence i n the re cord thatshe w as d is ab le d d u e to c h r o n ic p a in s y m p to m s c au s e d b yr a d ic u lo p a th y . H erar gu m ent s are w i tho utm er i t . S t andard do es no tdi sput e thatM ob ay en s uf f e r s f r om c hr oni c pa i n due t o f i br om y a l gi a . H ow e ve r , m os tc r i t i c a l l y , i tdi d not f in d e v id e n c e in th e r e c o r d d e m o n s tr a tin g th a t s h e is a ls o d is ab le d d u e to4

ra di cul op athy. D es pi t e M ob ay en' s argum ent s t o the contrary , i ti s c l ear that S ta n d a r d 's c o n d u c t d u r in g th e a d m in is tr a tio n o f h e rc la im d o e s n o t d e m o n s tr a te th a t it w a s in f

lu e n c e d b yits c o n f

lic te d n a tu r e . T h e u n d e r ly in g b a s is o f S ta n d a r d 's ori gi nal det erm i nat i on , thatM ob ay en w as no tdi sabl ed du e t o a no n-l i m i t ed cond i t i on , re m ai ned con si st entthrou gh ou tthe re vi ew proces s. S t andard' s f i nal d e te rm in a tio n s im p lyr e ite r a te d w h a t w a s e x p lic it f r o m th e p o lic yits e lf

, th a t a cl ai m antm ustdem on stra t e both thatthe cl ai m antsuff er s f rom a non -l i m i t ed cond i t i on and thatthe cl ai m anti s di sabl ed as a r es ul tof thatcond i t i on . S t andard consi dere d al l of the m edi ca l evi dence s ub m i tt ed by M ob ay en and credi t ed her c om pl a i nt s of

pa i n. I tr i ght f

ul l ydi s r e ga r de d c e rt a i n uns ubs t a nt i a t e d di a gnos e s of r a d ic u lo p a th y . S ta n d a r d h a d n o r e a s o n to c o n s id e rth e s id e - e f f e c t o f M o b a y e n 's m e d ic a tio n r e g im e n b e c au s e th e r e c o r d w a s d e v o id o f a n ys u c h in f

o rm a tio n . T h e r e is a ls o n o e v id e n c e th a t M o b a y e n w a s in ju r e d b yS ta n d a r d 's f

a ilu r e to i s s ue af i na l de c i s i on w i thi n the t i m e l i m i t s pr e s c r i be d byE R I S A . S e e G a tt i v. R el i ance S t andard L i fe Ins. C o. , 41 5 F . 3d 97 8, 98 5 (9th C i r. 20 05 ) ( ho l di ng that "p ro ced u ral v i o l at i o n s o f E R IS A d o n o tal t er th e st an d ard o f rev i ew u n l ess th o se vi ol a t i ons a r e s o f

l a gr a nta s t o a l t e rthe s ubs t a nt i ve r e l a t i ons hi p be tw e e n the e m pl oy e ra nd e m pl oy e e , the r e byc aus i ng the be ne f i c i a rys ubs t a nt i ve ha rm " ) . T he e x tr in s ic e v id e n c e th a t M o b a y e n a tte m p te d to a d m it d o e s n o t u n d e rm in e S ta n d a r d 's5

de t e rm i na t i on tha tthe r e w a s no e vi de nc e tha the rdi s abi l i tyw a s c aus e d by r a di c ul opa thyorde m ons tr a t e tha tS t a nda r d w a s i nf l ue nc e d byi t s c onf

l i c tof in te r e s t. T he di s tr i c tc ourtdi d c i t e t o a n i nc orr e c tl e ga l s t a nda r d i n i t s di s c us s i on of the st andard of revi ew . T he st andard se tforth i n Jordan v . N orthrop G rum m an C orp. W e l f

a r e B e ne f

i tP l a n, 370 F . 3d 869, 875 ( 9th C i r . 2004) , a nd c i t e d bythe di stri ctcourtw as ov erturned i n A bat i e, 45 8 F . 3d at96 9. S ee M on t ou r v. H art ford L i f e & A c c . I ns . C o. , 582 F . 3d 933 ( 9th C i r . 2009) , a s a m e nde d by2009 W L 3 8 5 6 9 3 3 , a t* 7 ( 9 th C i r . No v . 1 9 , 2 0 0 9 ) ( “ I n c l a r i f y i n g th e s t a n d a r d o f

r e v i e w, A bat i e abrog at ed a l i ne of cas es , i ncl ud i ng Jordan. . . . t o the ext entthatthe ca se s di re ct ed re vi ew i ng court s t o d i sr egar d structural confl i ct s of i nt er es tand aff i rm an a dm i ni s tr a t i ve de c i s i on ‘ gr ounde d on anyr e a s o n ab le b a s is ,’ u n le s s ap la in tif f c o u ld p r o d u c e s u f

f ic ie n t e v id e n c e th a t th e c o n f lic t w a s ‘s e r io u s .’” ) ( e m p h a s is in o r ig in a l) ( c ita tio n s o m itte d ) . A lth o u g h th e d is tr ic t c o u rt c ite d to th e o ld te s t, it s p e c if ic a lly co n sid er ed h o w th e s tru ctu ra l co n flict o f in tere st m ig h t h av e a ff ec ted S tan d ar d ’s de t e rm i na t i on. W e a r e s a t i s f i e d f r om i t s r e vi e w of

the r e c or d on thi s i s s ue tha tthe di stri ctcourtcorr ec t l y app l i ed the A bat i e anal ys i s. A ny error i n ci t at i on t o Jordan w a s th u s h a rm le s s . AF F I RME D.