United States Court of Appeals

For the Eighth Circuit

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No. 16-3429

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Michelle E. Cooper

lllllllllllllllllllll Plaintiff - Appellant

v.

Metropolitan Life Insurance Company

lllllllllllllllllllll Defendant - Appellee

MetLife, Inc.

lllllllllllllllllllll Defendant

____________

Appeal from United States District Court 

for the Eastern District of Missouri - St. Louis

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 Submitted: April 6, 2017

 Filed: July 5, 2017 

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Before WOLLMAN and LOKEN, Circuit Judges, and NELSON, District Judge. 1

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NELSON, District Judge.

The Honorable Susan Richard Nelson, United States District Judge for the

1

District of Minnesota, sitting by designation.
Michelle Cooper brought this action pursuant to the Employee Retirement

Income Security Act of 1974 (“ERISA”), 29 U.S.C. § 1132(a)(1)(B), claiming that

Metropolitan Life Insurance Company (“MetLife”) improperly denied her long term

disability (“LTD”) benefits under a group insurance plan sponsored by her former

employer,Anheuser-Busch Companies,LLC (“Anheuser-Busch”). The district court

2

entered summary judgment in favor of MetLife, finding that there was no abuse of

discretion. Cooper now appeals from that decision, arguing that the court erred in

applying an abuse of discretion standard of review to MetLife’s decision, and that it

improperly excluded two affidavits from the record. Alternatively, Cooper contends

that MetLife abused its discretion in denying LTD benefits. Finding no error, we

affirm.

I.

From August 2008 until May 2012, Cooper worked at Anheuser-Busch as a

business-to-business coordinator. Her responsibilities in that position consisted

primarily of acting as a point of contact for customers, which she accomplished

through use of the phone, email, and social networks. Through her employment,

Cooper was a participant in the Group Insurance Plan for Certain Employees of

Anheuser-Busch Companies, LLC and its Subsidiaries (the “Plan”). Disability

benefits under the Plan are funded by MetLife, which, as the Plan’s claim fiduciary,

is also responsible for adjudicating claims for those benefits. For purposes of LTD

benefits, the Plan defines the terms “disabled” and “disability” as follows:

Disabled or Disability means that, due to Sickness or as a direct result

of accidental injury:

The Honorable Ronnie L. White, United States District Judge for the Eastern 2

District of Missouri.

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You are receiving AppropriateCare and Treatment determined by

Your Physician as necessary to treat the Sickness or injury;

You are complying with the requirements of such treatment; and

You are unable to earn:

during the Elimination Period and the next 24 months of

Sickness or accidental injury, more than 80% of Your

PredisabilityEarnings or adjusted PredisabilityEarnings at

Your Regular Occupation from any employer in Your

Local Economy; and

after such period, more than 80% of Your Predisability

Earnings from any employer in Your Local Economy at

any gainful occupation for which you are reasonably

qualified taking into account Your training, education and

experience.

Due to illness, Cooper ceased working at Anheuser-Busch in October 2011. 

On November 4, 2011, she submitted an initial claim with MetLife for short term

disability (“STD”) benefits. To support her claim, Cooper provided a Supplemental

Attending Physician Statement (“APS”) completed by her physician, Dr. Varsha

Rathod, which listed Cooper’s primary diagnosis as “Sjogren’s syndrome/SLE

[systemic lupus erythematosus],” and her secondary diagnosis asmigraine headaches.

Dr. Rathod subsequently determined that Cooper could return to work on January 9,

2012, which she did. MetLife approved Cooper’s claim for STD benefits through

January 8, 2012.

Cooper continued to work at Anheuser-Busch through May 21, 2012, when she

again left work, complaining of fatigue, joint pain, and poor focus. On September 12,

2012, MetLife received a second STD claim covering this new period of absence. In

the APS supporting the claim, Dr. Rathod opined that Cooper could sit for two hours

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continuously, stand or walk zero to one hour continuously, lift up to ten pounds

occasionally, perform variousfine motor movements, and operate a motor vehicle on

a limited basis. She went on to opine, however, that Cooper could not climb,

twist/bend/stoop, or reach above shoulder level, that she needed to move frequently

when sitting, and had “visual field affects caused by Plaquenil.” In Dr. Rathod’s

opinion, Cooper was “100% disabled currently” due to fatigue, joint pain, headaches,

pleurisy, chest pain, and inability to focus. She further noted that “[w]e have tried to

work thru’ work accommodations and push her limits – it did not work after a 5

month trial.” 

On December 11, 2012, MetLife denied Cooper’s second STD claim. In

explaining its decision, MetLife highlighted what it considered to be a lack of

“clinical evidence such as test results” to substantiate Cooper’s “subjective

complaints.” On the evidence before it, MetLife concluded that there was not a

sufficient basis upon which to conclude that Cooper could not performher job duties. 

It advised her that further consideration of her claim would require “clinical or

diagnostic evidence of functional deficits.” This decision was followed up the

following month with a notification that Cooper’s initial LTD claim—based on an

alleged disability date of October 26, 2011—was denied because she had returned to

work from January 9, 2012 to May 21, 2012, and therefore had failed to complete the

180-day elimination period required by the terms of the Plan. MetLife informed her

that it had opened a new LTD claim with a disability date of May 23, 2012.

3

To support this second LTD claim, Cooper once again submitted an APS from

Dr. Rathod, which was broadly similar in its diagnoses and conclusions to that

submitted in connection with the first STD claim. Dr. Rathod noted objective

Although Cooper did not dispute that she had not met the requirements of the

3

elimination period, she nevertheless appealed the denial of her initial LTD claim by

letter dated April 14, 2013, arguing that she was unable to work and was entitled to

benefits. 

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findings of pallor and slight tenderness of the left flank, and listed Cooper’s

medications as Lunesta, potassium bicarbonate effervescent, and Seasonique. 

MetLife also received treatment notes submitted by Cooper’s chiropractor,Dr.Joseph

Lane, which documented objective findings of muscle spasms in the cervical and

thoracic regions. Dr. Lane had treated Cooper with chiropractic manipulation and

unattended electrical muscle stimulation. 

MetLife denied Cooper’s second LTD claim by letter dated May 3, 2013. The

letter documented that Dr. Rathod had diagnosed Cooper with SLE, migraines,

Sjogren’s syndrome, and chronic fatigue syndrome, but noted that there was an

absence of clinical findings that would objectively support these diagnoses. In

particular, MetLife observed that although various lab tests had apparently been

ordered by Dr. Rathod, no results had been submitted for review. On the whole,

MetLife concluded that the findings submitted by Drs. Rathod and Lane did “not

appear to be of such severity as to correlate with the severely restrictive physical

limitations offered by Dr. Rathod.” The letter concluded by informing Cooper of her

right to appeal the claim denial, and advising her once again to submit any other

relevant records in her possession to facilitate further review.

Although Cooper did not specifically appeal the May 3, 2013 denial, she

continued to contact MetLife about all of her claims in connection with her appeal of

the first LTD benefits denial. On May 6, 2013, Dr. Rathod submitted notes from

office visits on February 5, March 22, and May 3, 2013, detailing complaints of

“kidney issues” and migraines. MetLife referred these and previous records to Dr.

Elena Schiopu, an Independent Physician Consultant (“IPC”), and—like Dr.

Rathod—a specialist in rheumatology, for review. Dr. Schiopu duly prepared a report

listing her findings and conclusions, which was submitted to MetLife on May 20,

2013. 

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In the report, Dr. Schiopu stated that she had reviewed all available

documentation from Cooper’s four disability benefits claims, as well as Cooper’s job

description. She also spoke by phone with Dr. Rathod, although she was unable to

reach Dr. Lane. Although Dr. Rathod opined that Cooper was “too fatigued to return

to work,” she conceded that there were “no musculoskeletal reasons for [Cooper] to

be having restrictions and limitations at work.” The report noted agreement between

the doctors that Cooper could potentially return to work on a trial basis, though she

should be “closely followed.” Ultimately, Dr. Schiopu concluded—in keeping with

previous MetLife determinations—that there was an absence of objective clinical

findings sufficient to support a determination that Cooper was disabled for purposes

of the Plan.

MetLife faxed the IPC report to Drs. Lane and Rathod on May 22, 2013, and

requested that they provide any comments by June 5, 2013. Neither doctor

responded. MetLife also alerted Cooper to the contents of the report and requested

thatshe contact her doctors to ensure that they had received the report, and to forward

any commentsthey might have. Cooper acknowledged receipt of MetLife’s letter on

May 28, 2013, and attached a copy of a blood test showing an abnormal anti-nuclear

antibody (“ANA”) reading to her response. She also indicated that she had met with

a retinal specialist who had confirmed that she still had blind spots in her central

vision, and had recommended thatshe not take Plaquenil, asthat could exacerbate the

problem. Cooper stated that taking Plaquenil had previously enabled her to work full

time, and that since she had stopped taking it, her fatigue had increased greatly. On

June 5, 2013, MetLife received a report from the Retina Institute in St. Louis,

Missouri, regarding Cooper’s visual impairments. The report indicated that a full

field electroretinogram (“ERG”) had shown mild, diffuse rod and cone dysfunction

in the right eye, and borderline rod and cone dysfunction in the left eye. The treating

physician noted, however, that these results were not consistent with Plaquenil

retinopathy. He recommended that Cooper undergo a follow-up ERG in two to three

years to monitor progression.

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These new reports were reviewed by a MetLife Appeals Nurse Consultant

(“APNC”) to determine whether they needed to be forwarded to Dr. Schiopu for

reconsideration of her IPC report. The APNC ultimately concluded that the ANA lab

report did not need to be forwarded because it merely confirmed the diagnosis of

lupus, which Dr. Schiopu had not disputed when reviewing Dr. Rathod’s records. 

The APNC further determined that the ERG report did not impact the claimgiven that

the findings of mild rod and cone dysfunction were not consistent with Plaquenil

retinopathy. Finally, the APNC reviewed Dr. Rathod’s previous commentsregarding

Cooper’s “brain fog” and poor concentration, for purposes of determining whether

they warranted referral to a psychiatrist for review. Because there was no objective

medical evidence to indicate the severity of the impairment, however, the APNC

decided no referral was necessary. 

MetLife notified Cooper that her appeal had been denied on June 12, 2013. 

While recognizing Cooper’s continued subjective symptoms and complaints, MetLife

noted that it was “without proof” that these symptoms or complaints rendered her

disabled as defined by the Plan. Cooper filed this action on November 18, 2014, and

MetLife moved for summary judgment, which the district court granted on July 20,

2016. Applying an abuse of discretion standard of review, the court concluded that

MetLife had properly considered the medical records before it in finding that

Cooper’s illness did not render her disabled as defined by the Plan. In making this

decision, the court refused to consider affidavits from Drs. Lane and Rathod

questioning the veracity of Dr. Schiopu’s report, because itfound that these affidavits

were not properly part of the administrative record.

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II.

A.

Cooper first challenges the district court’s application ofthe abuse of discretion

standard to her denial of benefits. We review the district court’s decision de novo. 

Ingram v. Terminal R.R. Ass’n of St. Louis Pension Plan for Nonschedule Emps., 812

F.3d 628, 630 (8th Cir. 2016).

In general, a claim administrator’s denial of benefits is subject to de

novo review by the district court. Firestone Tire & Rubber Co. v. Bruch, 489 U.S.

101, 115 (1989). Where the plan grants the administrator or fiduciary “discretionary

authority” to determine eligibility for benefits, however, the standard of review is

relaxed, and abuse of discretion becomes the appropriate benchmark. See id. Under

the abuse of discretion standard, we will uphold a claim fiduciary’s decision so long

as it is reasonable and supported by substantial evidence. Hampton v. Reliance

Standard Life Ins. Co., 769 F.3d 597, 600 (8th Cir. 2014) (citing King v. Hartford

Life & Accident Ins. Co., 414 F.3d 994, 998-1000 (8th Cir. 2005) (en banc)). “A

decision is reasonable if a reasonable person could have reached a similar decision,

given the evidence before him, not that a reasonable person would have reached that

decision.” Ingram, 812 F.3d at 634 (emphasis original) (citation and quotation

omitted).

Here, the Plan confers on fiduciaries, including MetLife, “discretionary

authority to interpret the terms of the Plan and to determine eligibility for and

entitlement to Plan benefits in accordance with the terms of the Plan.” The parties do

not disagree that this language is sufficient on its face “to trigger the abuse-ofdiscretion standard.” Waldoch v. Medtronic, Inc., 757 F.3d 822, 829 (8th Cir. 2014). 

Cooper contends, however, that the conflict ofinterest inherent in MetLife’s dualrole

as both the evaluator and the payor of benefits claims under the Plan renders a “less

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deferential” version of abuse of discretion review appropriate. Relying on the

Supreme Court’s decision in Metropolitan Life Insurance Co. v. Glenn, 554 U.S. 105

(2008), she argues that the district court erred by not properly weighing MetLife’s

conflict of interest as a factor in its analysis.

Cooper is correct that Glenn requires a reviewing court to account for conflicts

of interest in determining whether an administrator has abused its discretion. Our

precedent, however, has consistently rejected the notion that the mere presence of a

potential conflict of interest is sufficient to warrant a less deferential standard. See

e.g., Whitley v. Standard Ins. Co., 815 F.3d 1134, 1140 (8th Cir. 2016); Hackett v.

Standard Ins. Co., 559 F.3d 825, 830 (8th Cir. 2009) (observing that “the conflict

does not change the standard of review applied by the district court”). Such a result,

we have recognized, would be “contrary to the case-specific test adopted in Glenn.” 

Whitley, 815 F.3d at 1140. While a conflict of interest must be “weighed as a factor,”

Glenn, 554 U.S. at 115 (citation and quotation omitted), the weight afforded to it will

depend on the facts presented to the court. Factors we have identified in the past as

tending to demonstrate a consequential conflict of interest include evidence that the

insurer’s claims review process was tainted by bias; that the medical professionals

who reviewed the claim for benefits were employed by the insurer, or that their

compensation was tied to their findings; and that the insurer acted as little more than

a rubberstamp for favorable medical opinions. See Whitley, 815 F.3d at 1140;

Carrow v. Standard Ins. Co., 664 F.3d 1254, 1259 (8th Cir. 2012). 

Here, Cooper presents us with no evidence of these factors, or of other indicia

of biased decision making. Indeed, the record suggests that MetLife conducted a

careful and thorough review of all of the documents provided to it, and that it relied

on the medical expertise of an appropriately qualified independent expert in making

its final decision. As the Glenn Court noted, an inherent conflict of interest “should

prove less important (perhaps to the vanishing point) where the administrator has

taken active steps to reduce potential bias and to promote accuracy.” 554 U.S. at 117. 

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In this instance, the district court did not err in affording only minimal weight to

MetLife’s conflict of interest. See Whitley, 815 F.3d at 1140.

It was likewise not error, as Cooper contends, for the district court to exclude

the affidavits of Drs. Lane and Rathod which she proffered at summary judgment. 

When an administrator’s benefits determination is reviewed for abuse of discretion,

“the scope of review is limited to the evidence that was before the administrator.” 

Siegel v. Conn. Gen. Life Ins. Co., 702 F.3d 1044, 1049 (8th Cir. 2013). Although

this standard may be relaxed where the purpose of admitting the extrinsic evidence

is limited to determining the proper standard of review, Waldoch, 757 F.3d at 830,

Cooper’s purpose here is to challenge the accuracy of Dr. Schiopu’s report. This is

a matter that could have been brought before MetLife in the claims appeal process,4

and the district court did not abuse its discretion in excluding these affidavits from

the record.

B.

We now turn to consider whether MetLife abused its discretion in denying

LTD benefits to Cooper. In doing so, “we do not substitute our own weighing of the

evidence for that of the administrator,” Gerhardt v. Liberty Life Assurance Co. of

Boston, 736 F.3d 777, 780 (8th Cir. 2013), and will affirm if the decision was

reasonable and supported by substantial evidence. 

On review of the record, we find that MetLife’s denial of LTD benefits was not

an abuse of discretion. MetLife properly considered all medicalrecords, APS reports,

comments, and other information submitted by Cooper and her physicians. On appeal

Indeed, MetLife faxed Dr. Schiopu’s report to Drs. Lane and Rathod on May 4

22, 2013 for the express purpose of soliciting their comments on its accuracy, but

neither of them replied.

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of its initial decision, it consulted a neutral, independent doctor—with the same

specialty as Cooper’s attending physician—to review the record and make a

recommendation, and gaveCooper’s physicians an opportunity to respond. Although

Cooper contends that Dr. Schiopu’s report arbitrarily relied on a lack of objective

indicia of disability to the exclusion of subjective indicia, it is generally “not

unreasonable for a plan administrator to deny benefits upon a lack of objective

evidence.” Pralutsky v. Metro. Life Ins. Co., 435 F.3d 833, 839 (8th Cir. 2006)

(quoting McGee v. Reliance Standard Life Ins. Co., 360 F.3d 921, 924-25 (8th Cir.

2004)). This is especially so where, as here, the administrator has consistently

specified the type of information sought, and the purpose is to substantiate the extent

of the disability, rather than to question the diagnosis. See id.

Cooper’s argument that it was arbitrary for MetLife to credit Dr. Schiopu’s

opinion that Cooper was not objectively disabled over Dr. Rathod’s competing

assessment is equally unavailing. MetLife is entitled to favor its own specialist’s

opinion, particularly given that Dr. Rathod was not tasked with interpreting

“disability” as defined by the Plan. Based on the objective evidence, there was at best

disagreement between the doctors as to Cooper’s functional abilities, and in such a

situation “plan administrators are not obliged to accord special deference to the

opinions of treating physicians.” Black & Decker Disability Plan v. Nord, 538 U.S.

822, 825 (2003). As we have observed, “[w]hen there is a conflict of opinion

between a claimant’s treating physicians and the plan administrator’s reviewing

physician, the plan administrator has discretion to deny benefits unless the record

does not support denial.” Johnson v. Metro. Life Ins. Co., 437 F.3d 809, 814 (8th Cir.

2006). Here, Dr. Schiopu’s conclusion was one “that a reasonable mind might accept

as adequate on this record.” Hunt v. Metro. Life Ins. Co., 425 F.3d 489, 491 (8th Cir.

2005).

Finally, Cooper makes much of the fact that a MetLife APNC—not a

doctor—determined that her ANA and ERG test results did not need to be forwarded

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to Dr. Schiopu for her consideration. In particular, she notes that Department of

Labor regulations require a claim administrator to “consult with a health care

professional who has appropriate training and experience in the field of medicine

involved in the medical judgment” when “deciding an appeal of any adverse benefit

determination that is based in whole or in part on a medical judgment.” 29 C.F.R. §

2560.503-1(h)(3)(iii). Because MetLife allowed a nurse with unspecified training to

decide the medical importance of her lab tests, Cooper argues it violated these

regulations. In her view, this procedural failure warrants remand to the Plan or even

outright reversal.

Arguably, we need not decide thisissue, asthe record suggeststhat Cooper did

not raise this theory before the district court. In any event, even if Cooper is correct

in her application of the regulation—an issue we decline to reach here—MetLife’s

error would not warrant the relief she suggests because it was harmless. As our sister

circuits have recognized, the proper inquiry in analyzing a claim administrator’s

compliance with § 2560.503-1 is “substantial compliance,” rather than “technical

compliance.” See Grasso Enters., LLC v. Express Scripts, Inc., 809 F.3d 1033, 1038

(8th Cir. 2016) (citing Lafleur v. La. Health Serv. & Indem. Co., 563 F.3d 148, 154

(5th Cir. 2009)). “While we have not expressly adopted this substantial compliance

standard, we have applied a substantively equivalent standard, evaluating whether a

plan’s entire claim denial process provided the claimant ‘a full and fair review of her

claim.’” Id. (quoting Midgett v. Wash. Grp. Int’l Long Term Disability Plan, 561 F.3d

887, 896 (8th Cir. 2009)). Here, Cooper presents no evidence to suggest that review

of her ANA and ERG test results by a doctor would have altered MetLife’s

conclusion that she was not disabled for purposes of the Plan. Indeed, the record

reflects that the APNC correctly determined that the ANA result merely confirmed

a diagnosis of lupus—which Dr. Schiopu had already accepted—and that the ERG

had shown only mild rod and cone dysfunction that was inconsistent with Plaquenil

retinopathy. Nothing in the record shows that these findings would have altered the

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Plan’s determination of no disability, or that Cooper was denied a “full and fair”

review of her claim. 

III.

For the foregoing reasons, the judgment of the district court is affirmed. 

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