# 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 6- 34 29

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Mi ch el le E. Coo pe r

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

ff - App el la nt

v.

Met ro po li ta n Li fe In su ran ce Co m pa ny

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

an t - Ap pe ll ee

Met Life , Inc

.

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

an t

__ __ __ __ __ __ App eal fro m

Uni te d S ta te s Di st ric t Co ur t fo r th e Eas te rn Dis tri ct of M is so ur i - St . Lou is

__ __ __ __ __ __

Su bm it te d: Apri l 6 , 20 17 Fil ed : J ul y

5, 2 01 7

__ __ __ __ __ __

Befo re WOL LMAN an d LOKEN, Circ ui t J ud ge s, an d NELSON, Dis tri ct Ju dg e. 1

__ __ __ __ __ __ NELSON, D is tri ct Ju dg e.

The Hon or ab l e Su sa n Ri ch ard Nels on , Uni te d St at es Dis tri ct Ju dg e fo r th e 1
Dis tri ct of M in ne so ta , si tt in g b y de si gn at io n.Mi ch el le Co op er br ou gh t th is act i o n p u rs ua nt to th e Em pl oyee Ret ire m en t

In co m e Secu rit y Act of 19 74 (“ ERISA”)

, 29 U.S.C. § 11 32 (a)( 1 ) ( B), cl ai m in g th at

Met ro po li ta n Life In su ran ce Co m pa ny (“ Met Life ”) im

pr op erl y de ni ed he r lo ng te rm di sa bi li ty (“ LTD”) be ne fit s un de r a gr ou p in su ran ce pl an sp on so r e d b y h e r fo rm er

em plo y er , A nhe use r- Bu sc h Co m pa nie s, L L C (“ Anh eu se r-Bu sc h” ). The di st ric t co ur t 2

en te r e d s u mm ary jud gm en t in fav or of Met Life

, fin di ng th at th ere was no ab us e of

di sc ret io n. C o o p e r no w ap pe al s fro m th at de ci si on , arg ui ng th at th e co ur t erre d in

ap pl y in g an ab us e of di sc ret io n st an da rd of rev ie w to Met Life ’s de ci si on , an d th at it

im pr op erl y ex cl ud ed two affi da vi ts fro m th e reco rd

. Alt ern at iv el y , Co op er co nt en ds

th at Met Life a b u s ed it s di sc ret io n in de nyin g LTD be ne fit s. Fi nd in g no erro r, we affi rm

.

I.

Fro m Aug us t 20 08 un ti l May 20 12

, Co op er wor ke d a t A n h e u s er-B us ch as a bu si ne ss -to -b us in es s c o o rd in at or

. Her res po ns ib il it ie s in th at po si ti on co ns is te d

pr im ari ly of act in g as a po in t of co nt act fo r cu st om ers , whi ch sh e acco m pl is he d

th ro ug h us e of th e ph on e, em ai l, an d so ci al ne two rk s. Thro ug h he r em pl oym en t,
C o o p e r w a s a pa rti ci pa nt in th e Gro up In su ran ce Pl an fo r Cert ai n Em pl oyees of

A n h e u s e r-Bu sc h Co m

pa ni es , LLC an d it s Su bs id ia rie s (th e “ Pl an ”). Dis ab il it y be ne fit s un de r th e Pl an are fu nd ed by Met Life

, whi ch

, as th e Pl an ’s cl ai m fid uc ia ry , is al so res po ns ib le for ad

jud ic at in g c la im s fo r th os e b en efi ts . For p ur po se s o f LTD

be ne fit s, t he Pla n d efi ne s t he ter m s “ di sa bl ed ” an d “ di sa bi li ty” as fo ll ows :

Dis ab le d or Dis ab il it y m ean s t h at , d ue to Si ck ne ss or as a di rect res ul t of acci de nt al in

jury:

The Hon or ab le Ro nn ie L. W hi te
, Uni te d St at es Dis tri ct Ju dg e fo r th e East ern 2
Dis tri ct of M is so ur i.

-2

-You are rece iv in g App ro pr ia te Care an d Treat m en t dete rm in ed by
You r Ph y si ci an as n eces sa ry to tre at th e Si ck ne ss or i nju ry ;

You are co m

pl y in g wit h th e req ui rem en ts of su ch tre at m en t; an d

You are u na bl e to earn :

du rin g th e Eli m in at io n Peri od an d t h e ne xt 24 m on th s of Si ck ne ss or acci de nt al in jury, m or e th an 80 % of You r Pred is ab il it y Earn in gs or ad jus te d Pred is ab il it y Earn in gs at You r Reg ul ar Occu pa ti on fro m an y em pl oyer in You r Loc al Econ om y ; an d

aft er su ch pe rio d, m or e th an 80 % of You r Pred is ab i l i t y Ea rn in gs fro m an y em

pl oyer in You r Loc al Eco no m y a t

an y ga in fu l oc cu pa ti on fo r whi ch yo u are reas on ab ly

qu al ifi ed ta ki ng in to acco un t You r tra in in g, ed uc at io n an d

ex pe rie nc e.

Due to il ln es s, Co op er ceas ed wor ki ng at Anh eu se r-Bu sc h in O c t o b e r 20 11

. On Nov em

be r 4

, 2 0 1 1

, sh e su bm it te d an in it ia l cl ai m wit h Met Life fo r sh or t te rm di sa bi li ty (“ STD”) be ne fit s. To su pp or t he r cl ai m , Co op er pr ov id ed a Su pp le m en ta l

Att en di ng Ph y si ci an St at em en t (“ APS”) co m pl et ed by h e r p h ysi ci an , Dr. Vars ha

Rat ho d, whi ch li st ed Co op er’s pr im ary di ag n o s i s a s “ Sjog ren ’s synd ro m e/ SLE [s y ste m ic lu pu s erythe m at os us ], ” an d he r se co nd ary di ag no si s as m ig rai ne he ad ac he s.
Dr. Rat ho d su bs eq ue nt ly de te rm in ed th at Co op er co ul d ret ur n to wor k on Ja nu ary 9,

2 0 1 2, whi ch sh e di d. Met Life ap pr ov ed Co op er’s cl ai m fo r STD be ne fit s th r o u g h

Ja nu ary 8, 2 01 2.

Co op er co nt in ue d to wor k at Anh eu se r- Bu sc h th ro ug h May 21

, 20 12

, whe n sh e

ag ai n le ft wor k, co m

pl ai ni ng of fat ig ue , joi nt pa in

, an d po or fo cu s. On Sep te m be r 12

, 20 12

, Met Life rece iv ed a se co nd STD cl ai m co ve rin g th is ne w pe rio d of ab se nc e. In

th e APS su pp or ti ng th e cl ai m , Dr. Rat ho d op in ed th at Co op er co ul d si t fo r two ho ur s

-3

-co nt in uo us ly, st an d or walk ze r o t o on e ho ur co nt in uo us ly, li ft up to te n po un ds

oc cas io na ll y , pe rfo rm va rio us fin e m ot or m ov em en ts
, an d op erat e a m ot or ve hi cl e on

a li m it ed ba si s. Sh e wen t on to op i n e , h o w e ve r, th at Co op er co ul d no t cl im b,

twi st /b en d/ st oo p, or reac h ab ov e sh ou ld er le ve l, th at sh e ne ed ed to m ov e freq ue nt ly

whe n si tt in g, an d ha d “ vi s u a l fie ld affe ct s cau se d by Pl aq ue ni l.” In Dr. Rat ho d’s

op in io n, Co op er was “ 10 0% di sa bl ed cu rren tl y ” du e to fat ig ue , joi nt pa in

, he ad ach es , pl eu ris y , ch es t pa in

, an d in ab il it y to fo cu s. Sh e fu rth er no te d th at “ [w]e ha ve tri ed to

wor k th ru ’ w o r k a c co m

m od at io ns an d pu sh he r li m it s – it di d no t wor k aft er a 5

m on th tri al .”

On Decem

be r 11

, 20 12

, Met Life de ni ed Co op er’s se co n d S TD c l a i m

. In

ex pl ai ni ng it s de ci si on , Met Lif e h i gh li gh te d wha t it co ns id ered to be a la ck of

“ cl in ic al ev id en ce su ch as te st res ul ts ” to su bs ta n t ia te Co op er’s “ su bjec ti ve

co m pl ai nt s.” On th e ev id en ce be fo re it

, Met Life co nc lu de d t h a t th ere was no t a

su ffi ci en t ba si s up on whi ch to co nc lu de th at Co op er co ul d no t pe rfo rm he r job du ti es

. It ad vi se d he r th at fu rth er co ns id erat io n of he r cl ai m wou ld req ui re “cl in ic al or di ag no st ic ev id en ce of fu nc ti on al de fic it s.” Thi s de ci si on was fo ll owe d up th e fo ll owi ng m on th wit h a no ti fic a t i on th at Co op er’s in it ia l LTD cl ai m —b as ed on an al le ge d di sa bi li ty da te of Octo be r 26

, 20 11 —was de ni ed be cau se sh e ha d ret ur ne d to

wor k fro m Ja nu ary 9, 20 12 to May 21

, 20 12

, an d th eref or e ha d fai le d to co m

pl et e th e
18 0- da y el im in at io n pe rio d req ui red by th e te rm s of th e Pl an

. Met Life in fo rm ed he r th at it ha d o pe ne d a ne w LTD cl ai m wit h a di sa bi li ty dat e o f May 23 , 20 12

. 3

To su pp or t th is se co nd LTD cl ai m , Co op er on ce ag ai n su bm it te d an APS fro m
Dr. Rat ho d, whi ch was br oa dl y si mi l a r i n it s di ag no se s an d co nc lu si on s to th at

su bm it te d in co nn ect io n wit h th e fir st ST D c la im

. Dr. Rat ho d no te d ob jecti ve

Alt ho ug h Co op er di d no t di sp ut e th at sh e ha d no t m et th e req ui rem en ts of th e 3
el im in at io n pe rio d, sh e ne ve rth el es s ap pe al ed th e de ni al of he r in it ia l LTD cl ai m by le tt er dat ed Apri l 1 4, 20 13

, arg ui ng th at sh e was un ab le to wor k and was en ti tl ed to be ne fit s.

-4

-fin di ng s of pa ll or an d sl ig ht te nd ern es s of th e le ft fla nk

, an d li st ed Co op er’s

m ed ic at io ns as Lun es ta
, po ta ss iu m bi carb on at e effe rv es ce n t, an d Seas on iq ue

. Met Life al so rece iv ed tre at m en t no te s su bm it te d by Co op er ’ s ch ir opr ac tor
, D r. Jo se ph

Lan e, whi ch do cu m en te d ob ject i v e f i nd in gs of m

us cl e sp as m s in th e cerv ic al an d

th or aci c reg io ns

. Dr. Lan e ha d tre at ed Co op er wit h c h i r o p r act ic m an ip ul at io n an d

un at te nd ed ele ct ric al m

us cl e st im

ul at io n.

Met Life de ni ed Co op er’s se co nd LTD cl ai m by le tt er da te d May 3, 20 13

. The

le tt er do cu m en te d th at Dr. Rat ho d ha d di ag no se d Co op e r w i t h SLE, m ig rai ne s,
S jo g r e n ’s synd ro m e, an d ch ro ni c fat ig ue synd ro m e, bu t no te d th at th ere was an ab se nc e of cl in ic al fin di ng s th at wou ld ob jecti ve ly su pp or t t h e s e d i a gn os es

. In

pa rti cu la r, Met Life ob se rv ed th at al th ou gh va rio us la b te st s ha d ap pa re n t ly be en

or de red by Dr. Rat ho d, no res ul ts ha d be en s u b m it te d fo r rev ie w. On th e who le

, Met Life co nc lu de d th at t h e f i nd in gs su bm it te d by Drs. Rat ho d an d Lan e di d “ no t

ap pe ar t o b e o f s u c h se ve rit y as to co rrel at e wit h th e se ve rel y res tri ct iv e ph y si cal

li m it at io ns of

fere d by Dr. Rat ho d.” The le tt er co nc lu de d by in fo rm in g Co op er of he r

r i g h t to ap pe al th e cl ai m de ni al

, an d ad vi si ng he r on ce ag ai n to su bm it an y o t h e r rel ev an t re co rd s i n h er p os se ss io n t o fa ci li ta te fur th er re vi ew.

Alt ho ug h Co op er d i d n o t sp eci fic al ly ap pe al th e May 3, 20 13 de ni al

, sh e

co nt in ue d to co nt act Met Life ab ou t al l of he r cl ai m s in co nn ect io n wit h he r ap pe al of

th e f i r s t LTD be ne fit s de ni al

. On May 6, 20 13

, Dr. Rat ho d su bm it te d no te s fro m of fic e vi si ts on Feb ru ary 5, Mar ch 22

, an d May 3, 20 13

, de ta il in g co m pl ai nt s of

“ ki dn ey is su es ” an d m ig rai ne s. Met Life refe rred th es e an d pr ev io us reco rd s t o Dr.
Elen a Sch io pu , a n I n de pe nd en t Ph y si ci an Co ns ul ta nt (“ IPC” ), an d— li ke Dr.

Rat ho d— a sp eci al is t in rh eu m at ol og y , fo r rev ie w. Dr. Sch io pu du ly pr ep ared a rep or t
li st in g he r fin di ng s an d co nc lu si on s, whi ch was su bm it te d to Met Life o n May 20

, 20 13

.

-5

-I n t h e r e po rt, Dr. Sch io pu st at ed th at sh e ha d rev ie wed al l av ai la bl e

do cu m en ta ti on fro m Co op er’s fo ur di sa bi li ty be ne fit s cl ai m s, as well as Co op er’s job

de sc rip ti on

. Sh e al so sp ok e by p ho ne wit h Dr. Ra th od , alt ho ug h s he was u na bl e to

reac h Dr. Lan e. Alt ho ug h Dr. Rat ho d op in ed th at Co op er was “ to o fat ig ue d to ret ur n

to wor k,” sh e co nc ed ed th at th ere were “ no m us cu lo sk el et al reas on s fo r [Co op er] to
be ha vi ng res tri ct io ns an d li m it at io ns at wor k.” The rep or t no te d ag reem en t be twee n th e do ct or s th at Co op er cou ld po te nt ia ll y ret ur n t o wo rk on a tr ia l bas is

, th ou gh sh e sh ou ld be “ cl os el y fo ll owe d.” Ult im at el y , Dr. Sch io pu co nc lu de d— in ke ep in g wit h

pr ev io us Met Life de te rm in at io ns —t ha t th ere was an ab se nc e of ob jecti ve cl in ic al

fin di ng s su ffi ci en t to su pp or t a de te rm in at io n th at Co op er was di sa bl ed fo r pu rp os es of th e Pl an

.

Met Life fax ed th e IPC repo rt to Drs. Lan e an d R at ho d o n M ay 22 , 20 13 , and

req ue st ed th at th ey pr ov id e a n y c o m m en ts by Ju ne 5, 20 13

. Neit he r do ct or

res po nd ed

. Met Life als o a le rte d C oo pe r to th e co nt en ts of t he rep or t and req ue st ed

th at sh e co nt act he r do ct or s to en su re th at th ey ha d rece iv ed th e rep or t, an d to fo rward

an y co m m en ts th ey m ig ht ha ve

. Co op er ack no wled ge d rece ip t of Met Life ’s le tt er on May 28

, 20 13

, an d at ta ch ed a co py of a bl oo d te st sh owi ng an ab no rm al an ti -n uc le ar

an ti bo dy (“ ANA”) read in g to he r res po ns e. Sh e al so in di cat ed th at sh e ha d m et wit h

a ret in al sp eci al is t wh o h a d co nf irmed th at sh e st il l ha d bl in d sp ot s in he r cen tra l

vi si on , an d ha d reco m

m en de d th at sh e no t ta ke Pl aq ue ni l, as th at co ul d ex acer ba te th e

pr ob le m

. Co op er st at ed th at ta ki ng Pl aq ue ni l ha d pr ev io us ly en ab le d he r to wor k fu ll

ti m e, an d th at si nc e sh e ha d st op pe d ta ki ng it

, he r fat ig ue ha d in crea se d gr eat ly. On

Ju ne 5, 20 13

, Met Life rece iv e d a r e p o r t fro m th e Ret in a In st it ut e in St

. Lou is

, Mi s s ou ri, reg ard in g Co op er’s vi su al im pa irments

. The rep or t in di cat ed th at a fu ll

fie ld ele ct ro ret in og ram

(“ ERG”) h ad sh own m il d, di ffu se ro d and co ne dysfu nc ti on in th e rig ht ey e, an d bo rd erl in e ro d an d co ne dysfu nc ti on in th e le ft ey e. The tre at in g ph ys i c ia n no te d, ho wev er, th at th es e res ul ts were no t co ns is te nt wit h Pl aq ue ni l

ret in op at hy. He reco m

m en de d th at Co op er un de rg o a fo ll ow- up ERG in two to th ree

y ears to m on it or

pro gr es si on

.

-6

-Th es e ne w rep or ts were rev ie wed by a Met Life App eal s Nur se Co ns ul ta n t

(“ APNC”) to de te rm in e whe th er th ey ne e d e d to be fo rward ed to Dr. Sch io pu fo r

reco ns id erat io n of he r IPC rep or t. The APNC ul ti m at el y co nc lu de d th at th e ANA la b

rep or t di d no t ne ed to be fo rward ed be cau se it m erel y co nf irmed th e di ag no si s of

lu pu s, whi ch Dr. Sch io pu ha d no t di sp ut ed wh e n r e v i e win g Dr. Rat ho d’s reco rd s. The APNC fu rth er de te rm in ed th at th e ERG rep or t di d no t im pa ct th e cl ai m gi ve n th at
th e fin di ng s of mi l d ro d an d co ne dysfu nc ti on were no t co ns is te nt wit h Pl aq ue ni l

ret in op at hy. Fi na ll y , th e APNC rev ie wed Dr. Rat ho d’s pr ev io us co m m en ts reg ard in g
Co op er’s “ br ai n fo g” an d po or co nc en tr a t i on , fo r pu rp os es of de te rm in in g whe th er th ey warra nt ed refe rral to a ps y ch ia tri st fo r rev ie w. Bec au se th ere was no ob jecti ve

m ed ic al ev id en ce to in di cat e th e se ve rit y of th e im pa irme n t
, ho wev er, th e APNC

de ci de d n o re ferr al was n eces sa ry

.

Met Life no ti fie d Co op er th at h e r a p p e al ha d be en de ni ed on Ju ne 12

, 20 13

. W hi le reco gn iz in g Co op er’ s co nti nue d subj ec tiv e sy m pto m s an d co m

pl ai nt s, Met Life

no te d th at it was “ wit ho ut pr oo f” t h a t th es e sym pt om s or co m

pl ai nt s ren de red he r di sa bl ed as de fin ed by th e Pl an

. Co op er fil ed th is act io n on Nov em be r 18

, 20 14

, an d

Met Life m ov ed for su m

m ary jud gm en t, whic h th e di st ric t co ur t g ran te d o n J ul y 20

, 20 16

. App lying an ab us e of di sc ret io n st an da rd of rev ie w, th e co ur t co nc lu de d th at

Met Life ha d pr op e r l y c o n si de red th e m ed ic al reco rd s be fo re it in fin di ng th at
Co op er’s il ln es s di d no t r e n d er he r di sa bl ed as de fin ed by t he Pl an

. In m ak in g th is

de ci si on , th e co ur t refu se d to co ns id e r affi da vi ts fro m Drs. Lan e an d Rat ho d

qu es ti on in g th e ve raci ty of Dr. Sch io pu ’s rep or t, be cau se it fo un d th at th es e affi da vi ts

were n ot pro pe rly part of t he ad m in is tra ti ve reco rd

.

-7

-II

.

A.

Co op er fi rs t ch al le nge s th e di st ric t co ur t’s ap pl ic at io n of th e ab us e of di sc ret io n

st an da rd to he r de ni al of be ne fit s. W e rev i e w t h e d i s tri ct co ur t’s de ci si on de no vo

. In gr am v. Ter min al R.R. Ass ’n of St

. Lo ui s Pen si on Pla n fo r No ns ch ed ul e Emps

. , 81 2

F.3 d 6 28 , 63 0 (8 th Cir . 20 16 ).

In ge ne ral

, a c l a i m ad m in is tra to r’s de ni al of be ne fit s is su bjec t to de

no vo rev ie w by th e di st ric t co ur t. Fir es to ne Ti re & Rub be r Co

. v. Bru ch

, 48 9 U.S.

10 1, 11 5 (1 98 9)

. W he re th e pl an gr an ts th e ad m in is tra to r or fid uc ia ry “ di sc ret io na ry

au th or i t y” t o d et erm in e el ig ib il it y fo r be ne fit s, ho wev er, th e st an da rd of rev ie w is

rel ax ed

, an d ab us e of di sc ret io n be co m es th e ap pr op ria te be nc hm ark

. Se e id

. Und er th e ab us e of di sc ret io n st an da rd

, we wil l up ho ld a cl ai m fid uc ia ry ’s de ci si on so lo ng

as it is r e a s on ab le an d su pp or te d by su bs ta nt ia l ev id en ce. Hamp to n v. Reli an ce St an da rd Li

fe In s. Co

. , 76 9 F.3 d 59 7, 60 0 (8 th Ci r. 20 14 ) (ci ti ng Ki ng v. Har tf or d

Li fe & Acci de nt In s. Co

. , 41 4 F.3 d 99 4, 99 8- 10 00 (8 th Ci r. 20 0 5 ) ( e n ba nc )). “ A

de ci si on is reas on ab le if a reas on ab le pe rs on co ul d ha ve reac he d a si m il ar deci si on , gi ve n th e ev id en ce be fo re hi m , no t th at a reas on ab le pe rs on wo ul d ha ve reac he d th at
de ci si on .” In gr am , 81 2 F.3 d at 63 4 (em ph as is or ig in al ) (ci ta ti on an d qu ot at io n

om it te d)

.

Here, th e Pl an co nf

ers on fid uc ia rie s, in cl ud in g Met Life

, “ di sc r e t i o n ary

a u t ho rit y to in te rp ret th e te rm s of th e Pl an an d to de te rm in e el ig ib il it y f o r a n d

en ti tl em en t to Pl an be ne fit s in acco rd an ce wit h th e te rm s of th e Pl an .” The pa rti es do

no t di sa gr ee th at th is la ng ua ge i s s u f fic ie nt on it s face “ to tri gg er th e ab us e-o fdi sc ret io n st an da rd .” W

al do ch v. Med tr on ic

, In c. , 75 7 F.3 d 82 2, 82 9 (8 th Ci r. 20 14 ).

Co op er co nt en ds

, ho wev er, th at th e co nf li ct of in te res t in he ren t in Met Life ’s du al ro le

as bo th th e ev al ua to r an d th e pa y or of be ne fit s cl ai m s un de r th e Pl an ren de rs a “ le ss

-8

-de fere nt ia l” ve rs io n of ab us e of di sc ret io n re v ie w ap pr op ria te

. Rel y in g on th e

Su pr em e Co ur t’s de ci si on in Met ro po li ta n Li fe In su ra nc e Co

. v. Glen n , 55 4 U.S. 10 5 (2 00 8)

, sh e arg ue s th at th e di st ric t co ur t erre d by no t pr op erl y weig hi ng M e t Li f e ’s

co nf li ct of i nt eres t as a fact or

in it s an al y si s.

Co op er is co rrec t th at Glen n req ui res a rev ie win g co ur t to acco un t fo r co nf li ct s of in te res t in de te rm in in g whe th er an ad m in is tra to r ha s ab us ed it s di sc ret io n. Our

pr eced en t, ho wev er, ha s co ns is te nt ly reject ed th e no ti on th at th e m ere pre se nc e of a

po te nt ia l co nf

li ct of in te res t is su ffi ci en t to warra nt a le ss de fere nt ia l s ta nd ard

. Se e

e.g

. , W hi tl ey v. St an da rd I

ns

. Co

. , 81 5 F.3 d 11 34

, 11 40 (8 th Ci r. 20 16 ); Hac ket t v. St an da rd In s. Co

. , 55 9 F.3 d 82 5, 83 0 (8 th Ci r. 20 09 ) (o bs erv in g th at “t h e co nf li ct
do es no t ch an ge th e st an da rd of rev ie w ap pl ie d by th e di st ric t co ur t” ). Su ch a res ul t,

we ha ve reco gn iz ed

, wou ld be “ co nt rary to th e cas e-s pe ci fic te st ad op te d in Glen n .”

W hi tl ey , 81 5 F.3 d at 11 40

. W hi le a co nf li ct of in te res t m

us t be “ weig he d as a fact or ,”
Glen n , 55 4 U.S. at 11 5 (ci ta ti on an d qu ot at io n om it te d)

, th e weig ht affo rd ed to it wil l

de pe nd on th e fact s pr es en te d to th e co ur t. Fact or s we ha ve id en ti fie d in th e pa st as

te nd in g to de m on st rat e a co ns eq ue nt ia l co nf li ct of in te res t in cl ud e ev id en ce th at th e in su rer’s cl ai m s rev ie w pr oc es s was ta in te d by bi as ; th at th e m ed ic a l p ro fes si on al s who rev ie wed th e cl ai m fo r be ne fit s were emp lo y ed by th e in su rer, or th at th ei r

co m pe ns at io n was ti ed to th ei r fin di ng s; an d th at th e in su rer act ed as li tt le m or e th an

a ru bb ers ta m

p fo r fav or ab le m ed ic a l o p in io ns

. Se e W hi tl ey , 81 5 F.3 d at 11 40 ;
Ca rr ow v. St an da rd

Ins . Co. , 66 4 F .3d 12 54 , 12 59 (8t h C ir. 2 01 2)

.

Here, Co op er pr es en ts us wit h no ev id en ce of th es e fact or s, or of ot he r in di ci a of bi as ed de ci si on m ak in g. In de ed

, th e reco rd su gg es t s t h a t Met Life co nd uc te d a

care fu l an d th or ou gh rev ie w of al l of th e do cu m en ts pr ov id ed to it

, an d th at it rel ie d

on th e m ed ic al ex pe rti se of an ap pr op ria te ly qu al ifi ed in de pe nd en t ex pe rt in m ak in g it s fin al de ci si on

. As th e Glen n Co ur t no te d, an in he ren t co nf li ct of in te res t “ sh ou ld

pr ov e le ss im

po rta nt (p e r h a p s to th e va ni sh in g po in t) whe re th e ad m in is tra to r ha s

ta ke n act iv e st ep s to red uc e po te nt ia l bi as an d to pr om ot e accu racy.” 55 4 U.S. at 11 7.

-9

-In th is in st an ce, th e di st ric t co ur t di d no t err in affo rd in g on ly m in im al weig ht to

Met Life ’s con fli ct of i nt eres t. Se e W hi tl ey , 81 5 F .3d at 1 14 0.

It was li ke wis e no t erro r, as Co op er co nt en ds

, fo r th e di st ric t co ur t to ex cl ud e th e affi da vi ts of D r s

. La ne an d Rat ho d whi ch sh e pr of fere d at su m

m ary jud gm en t.

W he n an ad m in is tra to r’s be ne fit s de te rm in at io n is rev ie wed fo r ab us e of di sc ret io n,

“ th e sc op e o f r ev ie w is li m it ed to th e ev id en ce th at was be fo re th e ad m in is tra to r.”

Si eg el v. Co nn . Ge n. Li

fe In s. Co

. , 7 02 F.3 d 10 4 4

, 1 0 4 9 ( 8 t h Ci r. 20 13 ). Alt ho ug h

th is st an da rd m ay be rel ax ed whe re th e pu rp os e of ad m it ti ng th e ex tri ns ic ev id en ce is li m it ed to de te rm in in g th e pr op er st an da rd of rev ie w, W al d o c h

, 75 7 F.3 d at 83 0,

Co op er’s pur

po se he re is to ch al le ng e th e acc ur acy of Dr. Sch io pu ’s rep or t. Thi s is

a m at te r th at co ul d ha ve be en br ou gh t be fo re Met Life in th e cl ai m s ap pe al pr oc es s, 4

an d th e d i s t r i c t co ur t di d no t ab us e it s di sc ret io n in ex cl ud in g th es e affi da vi ts fro m th e rec or d.

B.

W e no w tu rn to co ns id er whe th er Met Life ab us e d it s di sc ret io n in de nyin g
LTD be ne fit s to Co op er. In do in g so , “ we do no t su bs ti tu te ou r own weig hi ng of th e

ev id en ce fo r th at of th e ad m in is tra to r,” Ger ha rd t v. L i b e r t y Li fe Ass ur an ce Co

. of

Bos to n , 73 6 F.3 d 77 7, 78 0 (8 th Ci r. 20 13 ), an d wil l a f f i r m if th e de ci si on was

reas on ab le an d s up po rte d b y su bs ta nt ia l ev id en ce.

On rev ie w of th e reco rd

, we fin d th at Met Life ’s de ni al of LTD be ne fit s was no t

an ab us e of di sc ret io n. Met Life pr op erl y co ns id ered al l m ed ic al reco rd s, APS rep or ts
,

co m m en ts
, an d ot he r in fo rm at io n su bm it te d by Co op er an d he r ph y si ci an s. On ap pe al

In de ed

, Met Life fax ed Dr. Sch io pu ’s rep or t to Drs. Lan e an d Rat ho d on May 4
22

, 20 13 fo r th e ex pr es s pu rp os e of so li ci ti ng th e i r c o mm e nt s on it s accu racy, bu t

ne it he r of th em rep li ed

.

-1 0-of it s in it ia l d e c i s io n, it co ns ul te d a ne ut ral

, in de pe nd en t do ct or —wi th th e sa m e

sp eci al ty as Co op er’s at te nd in g ph y si ci an —t o rev ie w th e reco rd an d m ak e a

reco m m en da ti on , an d ga ve Co op er’ s ph y si ci an s an op po rtu ni ty to res po nd

. Alt ho ug h

Co op er co nt en ds th at Dr. Sch io pu ’s rep or t arb it rari ly rel ie d on a la ck of ob ject i v e in di ci a of di sa bi li ty to th e ex cl us io n of su bjec ti ve in di ci a, it is ge ne ral ly “ no t

un reas on ab le fo r a pl an ad m in is t r a t or to de ny be ne fit s up on a la ck of ob jecti ve

ev id en ce.” Pra l u t

s k y v

. M e tr o. Li fe In s. Co

. , 43 5 F.3 d 83 3, 83 9 (8 th Ci r. 20 06 ) (q uo ti ng McGee v. Reli an ce St an da rd Li fe In s. Co

. , 3 60 F.3 d 9 21 , 9 24 -2 5 (8 th Ci r.
20 04 ) )

. Th i s is es pe ci al ly so whe re, as he re, th e ad m in is tra to r ha s co ns is te nt ly

sp eci fie d th e type of in fo rm at io n so ug ht

, an d th e pu rp os e is to su bs ta nt ia te th e ex te nt
of th e d is ab il it y , rat he r th an to qu es ti on th e d ia gn os is

. Se e id

.

Co op er’s arg um en t th at it was arb it rary fo r Met Life to cred it Dr. Sch io pu ’s

op in io n th at Co op er was no t ob jecti ve l y d i s a b le d ov er Dr. Rat ho d’s co m pe ti ng

as se ss m e n t is eq ua ll y un av ai li ng

. Met Life is en ti tl ed to fav or it s own sp eci al is t’s

o p i n io n, pa rti cu la rly gi ve n th at Dr. Rat ho d was no t ta sk ed wit h in te rp ret in g

“ di sa bi li ty” as de fin ed by th e Pl an

. Bas ed on th e ob jecti ve ev id en ce, th ere was at be st
di sa gr eem en t be twee n th e do ct or s as to Co op er’s fu nc ti on al ab il it ie s , a nd in su ch a si tu at io n “ pl a n ad m in is tra to rs are no t ob li ge d to acco rd sp eci al de fere nc e to th e

op in io ns of tre at in g ph y si ci an s.” Bla ck & Decke r Dis ab il it y Pla n v. No rd

, 53 8 U.S.

82 2, 82 5 (2 00 3)

. As we ha ve ob se r v e d

, “[w] he n th ere is a co nf li ct of op in io n be t w e en a cl ai m an t’s tre at in g ph y si ci an s an d th e pl an ad m in is tra to r’s rev ie win g ph y si ci an , t h e p l a n ad m in is tra to r ha s di sc ret io n to de ny be ne fit s un le ss th e reco rd

do es no t su pp or t de ni al .” Jo hn so n v. Met ro

. Li fe In s. Co

. , 43 7 F.3 d 80 9, 81 4 (8 th Ci r.
20 06 ). Here, Dr. Sch io pu ’s co nc lu si on was on e “ th at a reas on ab le m in d m ig ht acce pt

as ad eq ua te on th is reco rd .” Hun t v. Met ro

. Li fe In s. Co

. , 42 5 F.3 d 48 9, 49 1 (8 th Ci r.
20 05 ).

Fi na ll y , Co op er m a k e s m uc h of th e fact th at a Met Life APNC—n ot a do ct or —d et erm in ed th at he r ANA an d ERG te st res ul ts di d no t ne ed to be fo rward ed

-1 1-to Dr. Sch io pu fo r he r co ns id erat io n. In pa rti cu la r, sh e no te s th at Dep art m en t of

La b o r reg ul at io ns req ui re a cl ai m ad m in is tra to r to “ co ns ul t wit h a he al th car e

pr of es si on al who ha s ap pr op ria te t r a i n i ng an d ex pe rie nc e in th e fie ld of m ed ic in e in vo lv ed in th e m ed ic al jud gm en t” whe n “ de ci di ng an ap pe al of an y ad ve rs e be ne fit

de te rm in at io n th at is ba se d in who le or in pa rt on a m ed ic al jud gm en t.” 29 C.F.R. §

25 60 .50 3- 1( h) (3 )(i ii ). Bec au se Met Life al lo wed a nu rs e wit h un sp eci fie d tra in in g to
de ci de th e m ed ic al im

po rta nc e of he r la b te st s , Co op er arg ue s it vi ol at ed th es e

reg ul at io ns

. In he r vi ew, th is pr oc ed ur al fai lu re warra nt s rem an d to th e Pl an or ev en

ou tri gh t re ve rs al

.

Arg ua bl y , we ne ed no t de ci de th is is su e, as th e reco rd su gg es ts th at Co op er di d

no t rai se th is th eo ry be fo re th e di st ric t co ur t. In an y ev en t, ev en if Co op er is co rrec t
in he r ap pl ic at io n of th e reg ul at io n— an is su e we de cl in e to reac h he re— Met Life ’s

erro r wou ld no t warra nt th e rel ie f sh e su gg es ts be cau se it was ha rm le ss

. As ou r si st er ci rcu it s ha ve reco gn iz ed

, th e pr op er in qu iry in an al y zi ng a c l a i m ad m in is tra to r’s

co m pl ia nc e wit h § 25 60 .50 3- 1 is “ su b s ta nt ia l co m pl ia nc e,” rat he r th an “ te ch ni cal

co m pl ia nc e.” Se e Gra ss o Ent er s., LLC v. Exp re ss Sc ri

pt s, In c. , 80 9 F.3 d 10 33

, 10 38 (8 th Cir

. 20 16 ) (ci ti ng La fl eu r v. La . Heal th Se rv . & Ind em. Co

. , 56 3 F .3d 14 8, 1 54 (5 th Ci r. 20 09 )). “ W hi le we ha ve no t ex pr es sl y ad op te d th is su bs ta nt ia l co m pl ia nc e

st an da rd

, we ha ve ap pl ie d a su bs ta nt iv el y eq ui va le nt st an da rd

, ev al ua ti ng whe th er a pl an ’s en ti re cl ai m de ni al pr oc es s pr ov id ed th e cl ai m an t ‘a fu ll an d fai r rev ie w of he r cl ai m .’ ” Id

. (q uo ti ng Mid

ge tt v. W as h. Grp

. In t’l Lo ng Ter m Dis ab il it y Pla n , 56 1 F.3 d

88 7, 89 6 (8 th Ci r. 20 09 )). Here, Co op er pr es en ts no ev id en ce to su gg es t th at rev ie w of he r ANA an d ERG te st res ul ts by a do ct or wou ld ha ve al te r e d M e t Li f e’s

co n c l u s i o n th at sh e was no t di sa bl ed fo r pu rp os es of th e Pl an

. In de ed

, th e reco rd

refl ect s th at th e APNC co rrec tl y de te rm in ed th at th e ANA res ul t m erel y co nf irmed

a di ag no si s of lu pu s— whi ch Dr. Sch io pu ha d al read y acce p t e d

— a n d t ha t th e ERG

ha d sh own on ly m il d ro d an d co ne dysfu nc ti on th at was in co ns is te nt wit h Pl aq ue ni l

ret in op at hy. Not hi ng in th e reco rd sh ows th at th es e fin di ng s wou ld ha ve al te red th e

-1 2-P l a n ’s d et erm in at io n of no di sa bi li ty, or th at Co op er was de ni ed a “ fu ll an d fai r ”

rev ie w of h er cl ai m

.

II I.

Fo r th e fo reg oi ng reas on s, t he jud gm en t o f th e d is tri ct co ur t i s af fir m ed

.

__ __ __ __ __ __ __ __ __ __ __ __ __ __ __

-1 3-