Opinion ID: 178125
Heading Depth: 3
Heading Rank: 1

Heading: The Claimant's Burden of Proof

Text: Muniz brought suit under ERISA's civil-enforcement provision, which allows a claimant to recover benefits due to him under the terms of his plan, to enforce his rights under the terms of the plan, or to clarify his rights to future benefits under the terms of the plan. 29 U.S.C. § 1132(a)(1)(B). The district court assigned the burden of proof to Muniz as the claimant. Muniz contends that the burden should properly be borne by the plan administrator, but we agree with the district court. As concluded by other circuit courts which have addressed the question, when the court reviews a plan administrator's decision under the de novo standard of review, the burden of proof is placed on the claimant. See, e.g., Horton v. Reliance Standard Life Ins. Co., 141 F.3d 1038, 1040 (11th Cir.1998) (A plaintiff suing under [29 U.S.C. § 1132(a)(1)(B)] bears the burden of proving his entitlement to contractual benefits.); Farley v. Benefit Trust Life Ins. Co., 979 F.2d 653, 658 (8th Cir.1992) ([W]e agree that it was [the claimant's] burden to show that he was entitled to the `benefits ... under the terms of his plan.') (omission in original) (quoting 29 U.S.C. § 1132(a)(1)(B)). [1] Muniz argues that after he met the initial burden of proof of disability by submitting evidence of Dr. Towner's assessment of his disability, the burden of proof should have shifted to CGLIC to demonstrate that its decision to terminate his benefits was justified. Muniz does not cite any precedent where a court conducting a de novo review of the record shifted the burden of proof to the claim administrator, but rather points to cases where courts reviewed claim administrator decisions under the abuse-of-discretion standard. The abuse-of-discretion standard is used to review a benefits decision when, as is often the situation but is not in this case, the benefit plan gives the administrator or fiduciary discretionary authority to determine eligibility for benefits or to construe the terms of the plan. Firestone Tire & Rubber Co. v. Bruch, 489 U.S. 101, 115, 109 S.Ct. 948, 103 L.Ed.2d 80 (1989). There is an additional issue to consider in such a case, however. If the plan administrator or decisionmaker is also the party from whose pocket the claim would have to be paid, such as an insurer or an employer sponsoring a self-funded plan, the court must determine whether the denial of benefits was improperly affected by this conflict of interest. The burden of proving that its decision was not improperly influenced has, logically, been placed on that administrator. See, e.g., Tremain v. Bell Indus., Inc., 196 F.3d 970, 976 (9th Cir. 1999) (when a claimant produces evidence that a plan administrator's self-interest caused a breach of the administrator's fiduciary obligations to the claimant, a rebuttable presumption arises in favor of the claimant and the plan bears the burden of proving that a conflict of interest did not affect its decision to deny or terminate benefits). [2] We clearly limited this burden-shifting approach to abuse-of-discretion cases where the administrator's potential conflict of interest was in question, however. See, e.g., Lang v. Long-Term Disability Plan of Sponsor Applied Remote Tech., Inc., 125 F.3d 794, 798 (1997) (under the abuse of discretion standard, [i]f the plan fails to carry its burden, however, our review becomes de novo and the plan's interpretation is no longer relevant because the court in conducting a de novo review of the record does not give deference to the administrator's tainted exercise of discretion) (internal quotation marks omitted). When conducting a de novo review of the record, the court does not give deference to the claim administrator's decision, but rather determines in the first instance if the claimant has adequately established that he or she is disabled under the terms of the plan. Muniz also contends that the burden of proving a disability should be shifted to the claim administrator when the claim administrator terminates disability benefits without providing any evidence that the claimant's condition has improved or changed since its initial award of benefits. There is no case law supporting this proposition. [3] Rather, district courts within this circuit have consistently held that the burden of proof continues to lie with the plaintiff when disability benefits are terminated after an initial grant. See, e.g., Clifford v. Prudential Ins. Co. of Am., No. 07-CV-126-ST, 2008 WL 4164750, at ,  (D.Or. Aug.27, 2008) (the plaintiff had the burden of proving she was disabled under the plan's terms when the plan terminated her benefits after a reevaluation of her claim); Gardner v. Bear Creek Corp., No. C 06-02822 MHP, 2007 WL 2318969, at ,  (N.D.Cal. Aug.6, 2007) (same). We agree. That benefits had previously been awarded and paid may be evidence relevant to the issue of whether the claimant was disabled and entitled to benefits at a later date, but that fact should not itself shift the burden of proof.