FI LED U.S. COURT OF APPEALS ELEV ENT H CI RCUI T OCT OBER 21, 2011 J OHN LEY CLERK [DO NOT PUBLISH] IN THE UN ITED STATES COURT OF APPEALS FOR THE ELE VENTH CIRCUIT

__ __ __ __ __ __ __ __ __ __ __ __ No. 1 0- 14 69 3 Non -Arg um en t Ca le nd ar

__ __ __ __ __ __ __ __ __ __ __ __ D.C. Dock etNo. 4 :0 9- cv -0 02 38 -KOB MYRA RAY, Pl ai nt iff - Co un te r-Defe nd an t -

App el la nt , ve rs us SUN LIFE & HEALTH INSURANCE COM PANY, Defen da nt- Co un te r-Cl ai m an t - App el le e.

__ __ __ __ __ __ __ __ __ __ __ __ App eal fro m

th e Uni te d S ta te s Di st ric t Co urt forth e North ernDis tri ctof Al ab am a

__ __ __ __ __ __ __ __ __ __ __ __ (Oct ob er 2 1, 2 01 1) Befo re EDMONDSON, HULL, an d M ARTIN, Cir cu itJu dg es . PER CURI AM:Pl ai nt iff -Ap pe ll an t M yra Ra y

ap pe al s t he di st ric t co urt’s d eci si on affi rm in g th e te rm in at io n o f he r lo ng -te rm di sabi li ty ben efi ts . No rev ers ib le erro r ha s b een sh own ; we af

firm . Thro ug h h er em

pl oyer, Ray

was c ov eredun de r a l on g- te rm gro up di sabi li ty pl anin su redby D efen dant -Ap pe ll ee Su n Li fe an d Hea lt h In su ran ce Co m pa ny (“ Su n Li fe”) . The ERIS A pl ando cu m en t p ro vi de d t ha t GE Gro up Life As su ran ce Co m pa ny was t he cla im s fi du ci ary an d b ro ad ly gran te d t he cla im s fi du ci ary 1 di sc ret io na ry

au th or it y to m ak e al l cl ai m , eli gi bi li ty andot he r admin is tra ti ve de ci si on s. Th e cl ai m s fi du ci ary was gra nt edso le an d e xc lu si ve di sc ret io n and
au th or it y to carry ou t al l ac ts in vo lv in g c la im s, an d i ts fin di ng s an d d eci si on s o n cl ai m s wer e n otto be di sturbe d u nl es s t he cla im s fi du ci ary act edinanarb it rary an d c ap ric io us m an ne r. 2 Befo re cl ai m in g d is ab il ity , Ray was asen io r ex ecu ti ve with alo ng -ti m e work h is to ry

with h er em

pl oyer. In Se pt em

be r 20 05 , Ray

cla im edth atsh e h ad The policy

was issued by

GE Group L ife Assura

nce Company . GE Group L ife 1 Assuranc e Company

chang ed its name to Phoenix L ife Insuranc e Company and Phoenix L ife Insuranc e Company

chang ed its name to Ge nworth L ife a nd Hea lth Insuranc e Company
. Genwor th L ife a nd Hea lth Insuranc e Company chang ed its name to that of the D efe ndant, Sun L ife a nd Hea lth Insuranc e Company
. Ray disputes that Sun L ife wa s g rante d discretion under the plan. Ray

argues that a 2 chang e of ownership of G enwor th L ife a nd Hea lth Insuranc e Company acc ompanied the latter ’s chang e of na

me to that of Sun L ife. B ut Ray offe rs nothing to dispute that the e ntity first known as GE Gr oup L ife Assura nce Company

is the same entity

now known as Sun L ife. The district court c oncluded c orre ctly that Sun L ife ha s discretion under the plan. 2be co m e d is ab le d a s a r es ul t o f a h eartco nd it io n. In supp ort o f he r cl ai m , Ray

subm it te d ast at em en t fr om he r tr eat in g c ard io lo gi st , Dr. Bou rg e, th atin di cat edhe r he artco nd it io n l im it edco m pl et el y he r ab il it y

to work . Ray ’s cla im

forlo ng -te rm di sabi li ty ben efi ts was app ro ve d, b utsh e was advi se d t ha t p eri od ic m ed ic al up da te s wo ul d b e requi redto ve rif y th atsh e rem ai ne d t ot al ly dis ab le d. Dr. Bo ur ge co nf

irmed Ray’ s d is ab il it y

inst at em en ts sen t t o S un Life i n 20 06 th ro ug h 2 00 8. Bu t, as th e d is tri ctco urt s etou t i n i ts op in io n, Dr. Bo ur ge ’s of fic e n ot es oft enwere i nc on si st en t wi th th e d is ab il it y st at em en ts subm it te d t o S un Life ; the off

ic e n ot es su gg es te d t ha t Ra y ’s con di ti on was m uc h i m pr ov ed , th atsh e su ffer edfar fe wer s ym

pt om s t ha n was rep res en te d t o S un Life, an d t ha t s he was cap ab le of - - an d e ng ag edin-- m uc h m or e act iv ity

th anth e d is ab il it y

st at em en ts di sc lo se d. Su n Li fe o rd eredsu rv ei ll an ce o f Ray’ s ac ti vi ti es on two da te s i n t he sp rin g o f 20 08 . The s urve il la nc e v id eo s s ho wedRay en ga ge d i n a ct iv it ie s wi th a flu id ity of m ov em en t, wi th ou t n eedof a ss is ta nc e, an d wi th ou t ap pa ren t ef fo rt. Th e vi de o c on tra di ct edDr. Bou rg e’s rep res en ta ti on s o f Ray’ s l im it at io ns inth e di sabi li ty stat em en ts he subm it te d t o S un Life. Su n Li fe en ga ge d Dr. Eat on , an i nd ep en de ntm ed ic al co ns ul ta ntwith cred en ti al s co m

parab le to th os e o f Dr. Bo ur ge , to ev al ua te Ray’ s m ed ic al reco rd s an d t he su rv ei ll an ce i nf

orm at io n. Onth e b as is of t ho se m ed ic al reco rd s (i nc lu di ng

3Dr. Bo ur ge ’s off ic e n ot es ) an d t he su rv ei ll an ce t ap es , Dr. Eato n c on cl ud edth at Ray w as cap ab le of r eturni ng to he r own oc cupa ti on . Dr. Eato n p erfo rm edno ph y si cal ex am in at io n o f Ray. Bas edon Ray’ s m ed ic al reco rd s, the su rv ei ll an ce t ap es , andDr. Eato n’s in de pe nd en t ev al ua ti on , Sun Life n ot ifi edRay th athe r di sabi li ty ben efi ts wou ldbe di sc on ti nu ed31 May 200 8. Ra y ap pe al edth atde te rm in at io n. Whil e Ray’ s di sabi li ty term in at io n was on adm in is tra ti ve ap pe al , th e So ci al Secu rit y Adm in is tra ti on (“ SSA”) a ward edRay so ci al sec ur it y be ne fit s. Dr. And ers on , a he artsp eci al is t an d S SA co ns ul ta nt , tes ti fie d a t the SSA h eari ng th athe r tr eat in g ph y si ci ancla ss ifi edhe r co nd it io n a s i nc om pa ti bl e wit h g ai nf

ul em pl oym en t. Acco rd in g t o t he SSA b en efi ts awardlet te r, Ray’ s m ed ic al reco rd s s up po rt a nd
co nf irm Dr. And ers on ’s tes ti m on y . Ray subm it te d t he SSA awardin fo rm at io n t o Su n Li fe fo r co ns id erat io n dur in g t he ap pe al pro ces s. Ra y als o s ub m it te d aSSA qu es ti on na ire co m

pl et edby D r. Bo ur ge st at in g t ha t Ra y was p erm an en tl y

di sabl ed
. Dur in g t he pe nd en cy

of t he adm in is tra ti ve ap pe al , Sun Life e ng ag eda se co ndin de pe nd en t n on -ex am in in g m ed ic al rev ie wer, Dr. Ro se nb erg , to ass es s Ray’ s cl ai m . Bas edon Rays m ed ic al reco rd s (wh ic h i nc lu de d t he res ul ts of c ert ai n cl in ic al tes ts ) an d the su rv ei ll an ce v id eo s, Dr. Ro se nb erg di sa gr eedwith Dr. Bo ur ge ’s cat eg or iz at io n o f Ray’ s fu nc ti on al li m it at io ns . Ins te ad , Dr. Ros enbe rg 4co nc lu de d t ha t Ray was c ap ab le of l ig htan d s ed en ta ry work ; s he was c ap ab le of returni ng to workat h er o wn o ccupa ti on . Sun Life p ro vi de d R ay with aco py of Dr. Ro se nb erg ’s rep ort an d o ffer edhe r ad di ti on al ti m e to subm itin fo rm at io n t o co un te r Dr. Ro se nb erg ’s con cl us io n. No ad di ti on al in fo rm at io n was subm it te d. Upo n re vi ew of

Ray’ s en ti re cl ai m

fil e, Sun Li fe d et erm in edth atRay “ ha s th e cap aci ty to p erfo rm

a se de nt ary to li gh t o ccupa ti on ” an d tha t s he is no t t ot al ly di sabl edfro m

th e p os it io n s he he ldwith h er em pl oyer be fo re s he fil edfor di sabi li ty, a p os it io n t ha t fa ll s wi th in th e se de nt ary to li gh t ca te go ry . Sun Life ackno wled ge d i ts rece ip t an d c on si de rat io n o f th e SSA’s d eci si on to gra nt di sabi li ty butadvi se d t ha t i t was no t b ou ndby tha t d eci si on , th atth e SSA m ay no t ha ve ha d a ll of t he in fo rm at io n S un Life h ad , andth ateli gi bi li ty und er the pl an was de pe nd an t o n t he sp eci fic term s o f th e p ol ic y . Ray bro ug htth is ERISA act io n to ch al le ng e Su n Li fe’s t erm in at io n o f he r di sabi li ty ben efi ts . ERISA i ts el f pr ov id es no st an da rdforrev ie w of t he be ne fit s d eci si on of pl anadm in is tra to rs . Fire st on e Tire an d R ub be r Co ., v. Bru ch , 10 9 S .Ct. 9 48 , 95 3 (1 98 9) . Bas edon Supr em e Co urt g ui danc e in Fir es to ne an d M etro po li ta n Li fe In s. Co . v. Gle nn , 12 8 S .Ct. 2 34 3 (2 00 8) , we hav e es tabl is he d am ul ti -s te p fr am ewo rk fo r rev ie w of ERI SA be ne fitde ci si on s:

5(1 ) App ly the de no vo st an da rdto de te rm in e whe th er the cla im

adm in is tra to r’s be ne fit s- de ni al de ci si on is “ wro ng ” (i .e., th e co urt di sa gr ees with t he adm in is tra to r’s de ci si on ); i f itis no t, the n e ndth e in qu iry andaffi rm

th e d eci si on . (2 ) If the adm in is tra to r’s de ci si on infactis “ de no vo wron g,” th en de te rm in e whe th er h e was ve st edwith d is cret io n i n re vi ewin g c la im s; if n ot , endjud ic ia l i nqui ry an d re ve rs e th e d eci si on . (3 ) If the adm in in st rat or ’s dec is io n i s “ de no vo wron g” an d h e was ve st edwith d is cret io n i n re vi ewin g c la im s, the n d et erm in e whe th er “ reas on ab le ” g ro un ds supp orte d i t (h en ce, rev ie w hi s d eci si on un de r th e m or e d efer en ti al arb it rary andcap ric io us st an da rd ). (4 ) If n o re as on ab le gro un ds ex is t, the n e ndth e in qu iry andrev ers e th e ad min is tra to r’s de ci si on ; i f reas on ab le gro un ds do ex is t, the n de te rm in e if

he op erat edun de r a co nf li ctof i nt eres t. (5 ) If the re i s n o c on fli ct , th enen d the in qu iry andaffi rm th e d eci si on . (6 ) If the re i s a c on fli ct , th e co nf li ctsh ou ldm erel y

be a fact orforth e co urt t o t ak e in to acco un t wh ende te rm in in g wh ethe r an adm in is tra to r’s de ci si on was a rb it rary andcap ric io us . Bl an ke ns hi p v . Metro po li ta n Li fe In su r. Co ., 64 4 F .3d13 50 , 13 55 (11 Cir . 20 11 ). th The di st ric t co urt ap pl ie d p ro pe rly thi s fr am ewo rk
. The di stric t co urt fi rs t co nc lu de d t ha t Su n Li fe’s d eci si on to term in at e be ne fit s was no t d e n ov o wro ng . The t erm s o f th e p lan d efi ne to ta ll y di sabl edas

“un ab le to pe rfo rm

all th e m at eri al an d s ub st an ti al du ti es of you r reg ul ar oc cupa ti on .” Ray arg ue s t he m ed ic al reco rd s an d o pi ni on s o f he r tr eat in g p hysic ia n (co nf irmed by her s oc ia l s ecu rit y be ne fit s awa rd ) es tabl is h h er d is ab il ity . But , as

6th e d is tri ctco urt fu ll y setou t, o th er d oc um en ts inth e rec or d c on tra di ctDr. Bo ur ge ’s ass es sm en t; an d, i n fa ct , Dr. Bou rg e’s own off ic e rec or ds an d o pi ni on s are i nc on si st en t i nt ern al ly andin co ns is te ntwith h is co nc lu si on th atRay is pe rm an en tl y

di sabl ed . Thes e in co ns is te nc ie s ca stdo ub t upo n t he rel iabi li ty of Dr. Bo ur ge ’s ass es sm en t o f th e se ve rit y of R ay ’s con di ti on . Dr. Bou rg e’s co nc lu si on of to ta l d is ab il it y

was c on tra ry

to th e as se ss m en ts of t he two no n- ex am in in g m ed ic al expe rts who rev ie wedRay’ s m ed ic al hi st ory an d t he su rv ei ll an ce t ap es ; th es e ex pe rts bo th op in edth atRay was cap ab le of r eturni ng to he r own oc cupa ti on . No s pe ci al weig htis to be acco rd edth e o pi ni on of atre at in g p hysic ia n. Se e Bl ack& Deck er Di sabi li ty Planv. No rd , 12 3 S .Ct. 1 96 5, 1 97 0- 72 (20 03 ). And whi le ap pr ov al of s oc ia l s ecu rit y be ne fit s m ay

be co ns id ered , itis no t co nc lu si ve on whe th er a cl ai m an t i s al so di sabl edun de r th e te rm s o f anERISA p lan. Se e Wha tl ey v. CNA In s. Co m

pa ni es , 18 9 F .3d13 10 , 13 14 n.8 (11 Cir . 19 99 ). Bas ed th
on th e ad m in is tra ti ve reco rdav ai labl e to Sun Li fe wh enitm ad e it s d eci si on , see Bl an ke ns hi p, 6 44 F.3dat 1 35 4 (r ev ie w of b en efi ts de ni al is li mit edto co ns id erat io n of th e m at eri al av ai labl e to th e ad m in is tra to r atth e ti m e itm ad e it s d eci si on ), we
can no t s ay

th atSun Li fe’s d en ia l o f be ne fit s was de no vo wron g. Tha t we co nc lu de th atSun Li fe’s d eci si on was n otde no vo wron g s ho ul d
en d the in qu iry un de r ou r m ul ti -s te p fr am ewo rk . The d is tri ctco urt al so co ns id ered

7th e rea so nabl en es s o f Su n Li fe’s d eci si on as i f th e d eci si on was d e n ov o wro ng an d

st il l co nc lu de d t he term in at io n was du e to be affi rm edaft er co ns id eri ng all st ep s o f th e m ul ti -s te p fr am ewo rk . In s ho rt, t he di st ric t co urt co nc lu de d t ha t Su n Li fe d id
no t ab us e it s d is cret io n; it s d eci si on was n otarb it rary andcap ric io us ; an d, af te r co ns id erat io n o f th e en ti re re co rd , term in at io n was a reas on ab le de te rm in at io n. Ray argu es co nf

li ctof i nt eres t t ai nt edSun Li fe’s d eci si on : Su n Li fe m ad e el ig ib il ity de ci si on s an d p ai d a ward edbe ne fit s o utof i ts own fun ds . Butth e di st ric t co urt -- no twi th st an di ng Ray’ s p ro te st at io ns to th e co nt rary -- di d c on si de r Su n Li fe’s co nf

li ctas afact orinit s as se ss m en t; itco nc lu de d t ha t the co nf li ctof in te res t -- co ns id eredinth e li gh t o f th e ev id en ce o f rec or d -- di d n otcau se Sun Li fe to ab us e it s d is cret io n. Itwas R ay ’s bu rd en , as t he cla im an t, t o s ho w th e d eci si on was arb it rary; itwas n otSun Li fe’s b ur de n t o p ro ve it s d eci si on was n ottai nt edby
se lf- in te res t. See id . at 1 35 5. An d e ve n wh ere aco nf li ctex is ts , def

eren ce i s o wed to th e p la n a dm in is tra to r’s di sc ret io na ry de ci si on -m ak in g. Id
. Eve n a ss um in g t he de ci si on of S un Life was de no vo wron g (a n a ss um pt io n we do no t ac cep t), t he adm in is tra ti ve reco rdsh ows a reas on ab le ba si s ex is te d fo r Su n Li fe’s b en efi t d eci si on ; an d S un Life’s co nf li ctof i nt eres t d idno t s o t ai ntit s de ci si on so as t o re nd er the de ci si onarb it rary andcap ric io us . AFFIR MED. 8