IN THE UNITED STATES COURT OF APPEALS

FOR THE FIFTH CIRCUIT

No. 11-50500

Summary Calendar 

JOHN JURASIN,

Plaintiff-Appellant

v.

GHS PROPERTY & CASUALTY INSURANCE COMPANY; CAPROCK

CLAIMS MANAGEMENT, L.L.C.; ED BRADY, as Plan Administrator;

DILLON RESOURCES, INC., Occupational Injury Benefit Plan,

Defendants-Appellees

Appeal from the United States District Court 

for the Western District of Texas

USDC No. 5:09-CV-562

Before GARZA, SOUTHWICK and HAYNES, Circuit Judges.

PER CURIAM:*

John Jurasin seeks long-term disability benefits for a neck condition he

claims resulted from an accident during work. His employer provides an

Occupational Injury Benefit plan subject to the Employee Retirement Income

Security Act (ERISA). The plan is administered by Caprock Claims

Management and funded with an insurance policy issued by GHS Property &

United States Court of Appeals

Fifth Circuit

F I L E D

February 27, 2012

Lyle W. Cayce

Clerk

 Pursuant to 5TH CIR. R. 47.5, the court has determined that this opinion should not *

be published and is not precedent except under the limited circumstances set forth in 5TH CIR.

R. 47.5.4.

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Casualty. Caprock informed Jurasin his neck condition was not compensable. 

A review board also denied his claim. Jurasin brought suit, but the district court

granted summary judgment to the defendants. We AFFIRM. 

BACKGROUND

On January 21, 2008, while removing a tarp from his tractor-trailer, John

Jurasin slipped on some mud. Although he avoided a fall by grasping a rail, he

claimed to have heard a “pop.” Shortly thereafter, he sought treatment for pain

to his “right back and right abdominal wall.” After some improvement, Jurasin

returned to work with light-duty restrictions. By February 1, he resumed

unrestricted assignments after having completed physical therapy. 

Jurasin complained of renewed lower thoracic back pain that March and

was referred to a pain management specialist. He received a cortisone shot due

to a knot in his back. Complications ensued. Jurasin developed an abscess

which required surgery. After a hospital stay, he received home health care. In

July, an orthopedic surgeon, Dr. Dar, suggested conditioning and rehabilitation,

known as work hardening, and he sent Jurasin to another pain manager. Dr.

Dar reviewed MRI films and made what he termed an “incidental finding” that

Jurasin’s C6-7 cervical disc in the neck was herniated; Dar further noted that

Jurasin was not experiencing neck discomfort.

An independent medical examination on August 21 found that Jurasin’s

C6-7 herniation was not compressing his spinal cord and that his cervical spine’s

range of motion was unrestricted. Several other doctors specializing in

orthopedics and neurology expressed the opinion that his neck condition was

chronic and preexisting, not traceable to Jurasin’s injury at work. On November

18, 2008, Caprock informed Jurasin that it had determined, after consideration

by a Medical Review Officer, that his cervical condition was not compensable. 

Coverage was limited to the injury to his thoracic and lumbar spine. For the

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compensable injuries, the plan ultimately paid over $32,000 in medical expenses

and $17,000 in disability benefits. 

On February 4, 2009, Jurasin was examined by Dr. Garza-Vale. This

doctor found the neck injury was preexisting but that Jurasin’s accident had

aggravated the injury. His findings were submitted to Caprock. After reviewing

the medical evidence, including the submission from Dr. Garza-Vale, Caprock

again informed Jurasin, on March 20, 2009, that the only compensable injury

was to his back. Ten days later, Dr. Garza-Vale again examined Jurasin; a letter

reiterating his view more emphatically was furnished to the GHS appeals board.

The appeals board denied Jurasin’s claim on April 17, 2009.

Pursuant to ERISA’s civil enforcement provision, Jurasin filed suit

challenging the denial of benefits for his cervical condition. See 29 U.S.C. §

1132(a)(1)(B). The court granted summary judgment for the plan defendants,

Caprock and GHS. Jurasin timely appealed. In addition to contesting the

coverage decision, Jurasin claims that the district court erred in striking parts

of his own affidavit, as well as one from Dr. Garza-Vale.

DISCUSSION

We review the grant of summary judgment de novo and apply the same

standard as the district court. Schexnayder v. Hartford Life and Accident Ins.

Co., 600 F.3d 465, 468 (5th Cir. 2010). When, as here, the administrator of an

ERISA plan has discretion to determine eligibility and interpret plan terms, the

plan’s denial is reviewed for an abuse of discretion. Id. “A plan administrator

abuses its discretion where the decision is not based on evidence, even if

disputable, that clearly supports the basis for its denial.” Id. (quotation marks

and citation omitted). We are not “to engage in full review of the motivations

behind every plan administrator’s discretionary decisions.” Crosby v. La. Health

Serv. and Indem. Co., 647 F.3d 258, 264 (5th Cir. 2011) (quotation marks and

citation omitted). Our review is to “assure that the administrator’s decision

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fall[s] somewhere on a continuum of reasonableness – even if on the low end.” 

Corry v. Liberty Life Assurance Co. of Boston, 499 F.3d 389, 398 (5th Cir. 2007)

(quotation marks and citation omitted). 

We employ a two-step inquiry as to ERISA plan decisions. We first decide

if the determination by the plan administrator was legally correct, and if it is,

there is no abuse of discretion. Holland v. Int’l Paper Co. Ret. Plan, 576 F.3d

240, 246 n.2 (5th Cir. 2009). If the determination is not legally correct, we then

determine whether the administrator’s decision was an abuse of discretion. Id. 

Because Jurasin does not assert any improper plan interpretation, we exercise

our discretion to bypass the first step here. Id.

I. Conflict of Interest

Jurasin alleges two sources of conflict that “should have tilted the [district]

court’s review toward a less-than-deferential standard.” Though Jurasin refers

to some of our earlier caselaw about a sliding scale of review, this Court no

longer employs that method. Holland, 576 F.3d at 247-248 & n.3 (discussing

Metro. Life Ins. Co. v. Glenn, 554 U.S. 105 (2008)). It is fair to say that “conflicts

are but one factor among many,” and the “specific facts of the conflict will dictate

its importance.” Id. at 247-48. 

Both his arguments relate to a conflict of interest rooted in Caprock’s dual

role as the evaluator and the payor. See, e.g., Holland, 576 F.3d at 248 n.3. We

are required to take into account this dual role in reviewing a benefit

determination. Metro. Life, 554 U.S. at 115. Jurasin claims bias stemming from

the fact that the Medical Review Officer on whom Caprock relied for its

November 2008 denial, Dr. Cunningham, was employed by Blue Cross and Blue

Shield of Oklahoma, a division of the funding insurance company GHS. 

Jurasin’s suggestion that Cunningham provided a dishonest medical assessment

merely due to an attenuated employment relationship with GHS is too

theoretical and speculative for us to entertain. See Davis v. Unum Life Ins. Co.

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of Am., 444 F.3d 569, 575-76 (7th Cir. 2006). There needs to be, for example,

evidence that Cunningham had “some specific stake in the outcome of [Jurasin’s]

case, such as paying the doctors more” when claims were denied. Id. at 575. 

Jurasin also claims an institutional-level conflict because the review board

that processed his appeal was entirely composed of GHS employees. As noted,

Caprock has been delegated the responsibility of independently deciding claims

in the first instance. Conflict takes a “case-specific importance.” Metro. Life, 554

U.S. at 117. Jurasin points to nothing suggesting a “likelihood that it affected

the benefits decision,” such as an allegation that this “insurance company

administrator has a history of biased claims administration,” misconduct by the

board members, or the absence of firewalls and other internal operating

procedures to insulate the decisionmakers. Id. 

We agree with the district court that the unsupported assertions here are

not evidence of a conflict. Schexnayder, 600 F.3d at 470. 

II. Abuse of Discretion

Jurasin asserts the district court erred by striking portions of Dr. GarzaVale’s and Jurasin’s affidavits. Evidence is irrelevant to the validity of the

decision regarding coverage under the plan unless it “is in the administrative

record, relates to how the administrator has interpreted the plan in the past, or

would assist the court in understanding medical terms and procedures.” Crosby,

647 F.3d at 263. The district court hewed carefully to this limitation, striking

offending portions and admitting only those that assisted “the district court in

understanding the medical terminology or practice.” 

The evidence required in support of the plan’s decision is “more than a

scintilla, less than a preponderance, and is such relevant evidence as a

reasonable mind might accept as adequate to support a conclusion.” Ellis v.

Liberty Life Assurance Co. of Boston, 394 F.3d 262, 273 (5th Cir. 2004) (quotation

marks and citation omitted). Jurasin’s claim that the accident worsened his

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condition has some evidentiary support, but that is not enough for reversal. See

id. The physician who administered Jurasin’s independent medical exam

concluded Jurasin’s neck condition was unrelated to the incident at work:

In my opinion, the injuries sustained from the work injury of 1/21/08

are the abdominal wall strain, thoracic strain/sprain, and lumbar

strain/sprain. . . . More likely than not, the herniated disc at C6-7

was a pre-existing herniation. There is no mention made in the

medical records of any neck pain or arm pain that would date back

to the 1/21/08 injury.

Jurasin relies on the opinion of Dr. Garza-Vale, who examined Jurasin

only after he was denied coverage. That doctor agreed with the other doctors

that the neck spur preexisted the injury at work. He believed, though, that the

neck condition was traceable to work because it first became symptomatic after

the accident. That evidence did not have to be accepted in light of contrary

medical findings. Jurasin’s argument that the review process ignored the

contrary perspective of Dr. Garza-Vale is incorrect. When Caprock informed

Jurasin on January 21, 2008 that it was upholding its earlier denial, it reported

that it had reviewed Dr. Garza-Vale’s findings.

In his brief, Jurasin also discusses the possibility of “referred pain,” a

phenomenon by which an injury at one location in the body manifests as pain

elsewhere. That possibility is relevant as it could explain why Jurasin did not

report any neck pain soon after the injury at work. That opinion was presented

and not found to control over the other medical evidence. We do not weigh the

evidence on our review, but only determine whether there is some evidence to

support the administrator’s decision. There is.

“We reach a finding of abuse of discretion only where the plan

administrator acted arbitrarily or capriciously.” Holland, 576 F.3d at 246

(quotation marks and citation omitted). That did not occur. 

AFFIRMED.

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