Opinion ID: 215106
Heading Depth: 2
Heading Rank: 1

Heading: Existing Circuit Law

Text: In this circuit, we have held that an ERISA benefit determination is within the discretion of the plan administrator so long as it is reasoned and supported by substantial evidence. Wright v. R.R. Donnelley & Sons Grp. Benefits Plan, 402 F.3d 67, 74 (1st Cir.2005) (quoting Gannon, 360 F.3d at 213). We have emphasized that our review of whether a plan administrator abused its discretion does not require that we determine either the best reading of the ERISA plan or how we would read the plan de novo. Stamp v. Metro. Life Ins. Co., 531 F.3d 84, 94 (1st Cir.2008) (quoting Lennon v. Metro. Life Ins. Co., 504 F.3d 617, 624 (6th Cir.2007)) (internal quotation marks omitted). We have also noted that the doctrine of contra proferentem does not apply to review of an ERISA plan construction advanced by an administrator given authority to construe the plan. Id. at 93 (citing Morton v. Smith, 91 F.3d 867, 871 n. 1 (7th Cir. 1996)). Challenges to benefit determinations in this circuit have typically involved the application of contested facts to uncontested plan terms. In Leahy v. Raytheon Co., 315 F.3d 11 (1st Cir.2002), for example, we noted that the relevant plan terms were clear and unambiguous but that, [a]s in many such instances, the devil is in the details of applying the facts to those terms. Id. at 18. Most often, plaintiffs have challenged the sufficiency of the evidence underlying an ERISA plan administrator's factual conclusions. See, e.g., Cusson, 592 F.3d at 229-30; Orndorf, 404 F.3d at 518. They have also challenged benefit determinations on the grounds that the ERISA plan administrator improperly credited certain evidence. See, e.g., Medina v. Metro. Life Ins. Co., 588 F.3d 41, 45-47 (1st Cir.2009); Buffonge v. Prudential Ins. Co. of Am., 426 F.3d 20, 30 (1st Cir. 2005). We are aware of only two cases decided in this circuit concerning purely interpretive questions like the one raised in this appeal. Understandably, neither of these cases articulate general guidelines as to when a plan administrator's construction is sufficiently lacking in reason that it rises to the level of an abuse of discretion. In the more recent case, Coffin v. Bowater Inc., 501 F.3d 80 (1st Cir.2007), we upheld a plan administrator's construction because we found its construction significantly more persuasive than that offered by the plaintiffs. Id. at 96. In so holding, the court did not need to reach the more difficult question of when a plan administrator's construction will be sufficiently reasonable to warrant deference even though it is only as persuasive or less persuasive than the interpretation offered by the plaintiffs. In an earlier case, Kolling v. American Power Conversion Corp., 347 F.3d 11 (1st Cir.2003), we held it within a plan administrator's discretion to reasonably construe the term employee, which was circularly defined by the plan as Employee of the Employer. Id. at 14. (citing Trombetta v. Cragin Fed. Bank for Sav. Emp. Stock Ownership Plan, 102 F.3d 1435, 1439-40 (7th Cir.1996)). We held that the plan administrator had permissibly looked to the insurance company's intention in defining the Plan's scope and that the evidence supported its determination regarding that intention. Id. We also held that the insurance company had consistently applied its definition of employee in the past. Id. We did not address when these indicators or others might require a holding that a plan construction was unreasonable. The Supreme Court has not spoken directly to how courts should assess whether an administrator's construction of a plan term is so unreasonable as to constitute an abuse of discretion. In Firestone Tire & Rubber Co. v. Bruch, 489 U.S. 101, 109 S.Ct. 948, 103 L.Ed.2d 80 (1989), the Court noted that ERISA abounds with the language and terminology of trust law, id. at 110, 109 S.Ct. 948, and that given this, it had held that courts must develop a federal common law of rights and obligations under ERISA-regulated plans, id. (quoting Pilot Life Ins. Co. v. Dedeaux, 481 U.S. 41, 56, 107 S.Ct. 1549, 95 L.Ed.2d 39 (1987)) (internal quotation marks omitted). The Court held that [t]rust principles make a deferential standard of review appropriate when a trustee exercises discretionary powers, and that when a trustee is given such power to construe disputed or doubtful terms . . . the trustee's interpretation will not be disturbed if reasonable. Id. at 111, 109 S.Ct. 948. The Court has not given precise content to this standard. It has held that courts must consider conflicts of interest that may arise when an administrator, like Boston Mutual, both determines whether an employee is eligible for benefits and pays benefits out of its own pocket. Metro. Life Ins. Co. v. Glenn, 554 U.S. 105, 108, 128 S.Ct. 2343, 171 L.Ed.2d 299 (2008); see also Conkright v. Frommert, ___ U.S. ___, 130 S.Ct. 1640, 1647, 176 L.Ed.2d 469 (2010). In Glenn, the Court noted that courts will often take account of several different considerations of which a conflict of interest is one. Glenn, 554 U.S. at 117, 128 S.Ct. 2343. It did not identify other relevant factors, however, and warned against creating formulas that will `falsif[y] the actual process of judging' or serve as `instrument[s] of futile casuistry.' Id. at 119, 128 S.Ct. 2343 (quoting Universal Camera Corp. v. Nat'l Labor Relations Bd., 340 U.S. 474, 489, 71 S.Ct. 456, 95 L.Ed. 456 (1951)) (alterations in original).