Opinion ID: 3046981
Heading Depth: 1
Heading Rank: 2

Heading: MetLife’s Denial of Benefits

Text: Under Firestone Tire & Rubber Co. v. Bruch, 489 U.S. 101, 115 (1989), if the ERISA plan gives the administrator discretion to interpret the terms of the benefit plan, a court reviews the administrator’s decision for abuse of discretion. The Plan in this case grants MetLife such discretionary authority: “MetLife in its discretion has authority to interpret the terms, conditions, and provisions of the entire contract.” (App. 86.) Recently, the Supreme Court opined in MetLife v. Glenn, 128 S. Ct. 2343 (2008), that where there is a conflict of interest under Firestone when a plan administrator both evaluates claims for benefits and pays those claims, the district court should weigh the 5 conflict of interest as one factor in determining whether there was an abuse of discretion. 128 S. Ct. at 2351-53. Our previous jurisprudence had instructed the district court to apply a “heightened standard of review” or “heightened scrutiny” in such cases. See Pinto v. Reliance Standard Life Ins. Co., 214 F.3d 377, 387 (3d Cir. 2000). Here, MetLife both evaluates and pays claims under the Plan, and all parties acknowledged that such a dual role created a conflict. The District Court, acting before publication of the Glenn decision and in accordance with Pinto, applied a heightened standard of review. We will apply the new standard ourselves on appeal, unless we believe that remand is necessary to avoid prejudice.2 Here, the heightened review applied by the District Court was more favorable to the plaintiff than the new standard, so we find no prejudice to her in our considering this appeal using the Glenn standard without remanding. Even with Pinto’s heightened standard, the District Court found that MetLife’s denial of benefits was reasonable and supported by substantial evidence. The court held 2 See, e.g., United States v. Patrin, 575 F.2d 708, 712 (9th Cir. 1978) (holding that an appellate court may hear a new issue resulting from a recent change in the law as long as the party against whom the issue is raised is not prejudiced and would not have tried the case differently); see also Singleton v. Wulff, 428 U.S. 106, 121 (1976) (“The matter of what questions may be taken up and resolved for the first time on appeal is one left primarily to the discretion of the courts of appeals, to be exercised on the facts of individual cases. . . . Certainly there are circumstances in which a federal appellate court is justified in resolving an issue not passed on below, as where the proper resolution is beyond any doubt or where injustice might otherwise result.”) (internal quotations omitted). 6 that MetLife’s decision was based on the objective medical recommendations of Evans’s treating pulmonologist, Dr. Gross, who cleared Evans to return to work. Evans admitted that Dr. Gross knew that Evans’s job exposed her to dust and fumes. She argued that MetLife should have given more weight to reports from other physicians, but the Court observed that none of the other doctors Evans consulted reported any objective etiology for her shortness of breath. Evans also pointed to an inaccurate initial job description submitted by CDM to MetLife when she sought Short Term Disability benefits (the CDM employee who filled out the form answered “No” to an inquiry about whether Evans was required to “be exposed to dust, gas, or fumes” in the course of her job). (App. 920.) The Court acknowledged that such an inaccuracy could potentially affect the claim decision-making process, but concluded that the inaccurate description (made before Evans received her asthma diagnosis) did not preclude a full and fair review of Evans’s claim, because MetLife’s decision was based primarily on Dr. Gross’s recommendation, not on the initial job description, and Dr. Gross’s findings detailed Evans’s occupational exposures. There is no reason to remand for application of the Glenn standard to the facts. Viewing the conflict of interest here as one factor, rather than applying a heightened standard of review, does not alter the outcome. The District Court correctly concluded that MetLife had given Evans’s claim a full and fair review and that its denial of LTD benefits did not amount to an abuse of discretion. We would affirm the District Court’s 7 decision, even if the Supreme Court had not clarified in Glenn that MetLife’s conflicted position does not change the standard of review, but is one of several factors to be considered in a district court’s review for abuse of discretion. We do so applying Glenn as well. We will affirm the District Court’s decision that MetLife did not abuse its discretion in denying Evans’s LTD claim.