Opinion ID: 2997339
Heading Depth: 3
Heading Rank: 1

Heading: ERISA Standard of Review

Text: When a participant of an ERISA employee benefits plan challenges the denial of benefits, we must review that denial “under a de novo standard unless 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 (1989); see Hightshue v. AIG Life Ins. Co., 135 F.3d 1144, 1147 (7th Cir. 1998). When a plan confers such discretion upon the plan administrator or fiduciary, we shall not disturb a decision concerning eligibility for benefits unless it is arbitrary and capricious. See Firestone Tire, 489 U.S. at 114-15. In this case, the policy grants Provident “full, exclusive, and discretionary authority to control, manage, and administer claims.” R.95, Ex.D at 25. Thus, we shall apply the arbitrary and capricious standard and shall not overturn Provident’s decision to terminate Ms. Houston’s long term disability benefits “as long as (1) ‘it is possible to offer a reasoned explanation, based on the evidence, for a particular outcome,’ (2) the decision ‘is based on a reasonable explanation of relevant plan documents,’ or (3) the administrator ‘has based its decision on a consideration of the relevant factors that encompass the important aspects of the problem.’ ” Hess v. Hartford Life & Accident Ins. Co., 274 10 No. 03-2776 F.3d 456, 461 (7th Cir. 2001) (quoting Exbom v. Cent. States, Southeast & Southwest Areas Health & Welfare Fund, 900 F.2d 1138, 1142-43 (7th Cir. 1990)).