Opinion ID: 4673684
Heading Depth: 2
Heading Rank: 2

Heading: Other Arguments for a Less Deferential Review

Text: Roebuck separately argues her appeal should receive de novo review, rather than review for abuse of discretion, because USAble Life has a conflict of interest as the claim’s insurer. Specifically, she notes the insurer benefits from denying the claim. Roebuck further argues for a less deferential standard because USAble Life breached its fiduciary duty by improperly ignoring relevant evidence and relying on unqualified nurses to decide her claim. Neither argument is persuasive. The dual role played by USAble Life as administrator of the Policy and claim evaluator is generally recognized as a conflict of interest. Metro. Life Ins. Co. v. Glenn, 554 U.S. 105, 108, 111–12 (2008). But, this conflict of interest is only one of many factors weighed in the abuse of discretion analysis. Id. at 115. Courts determine what weight to give an insurer’s conflict of interest on a case-by-case basis, and we give greater weight to situations in which (1) “the insurer’s claims review process was tainted by bias”; (2) the medical professionals reviewing the claim were employed by the insurer; (3) the medical professionals reviewing the claim had their compensation tied to their findings; or (4) “the insurer acted as little more than a rubberstamp for favorable medical opinions.” Boyd, 879 F.3d at 320– 21 (quoting Cooper v. Metro. Life Ins. Co., 862 F.3d 654, 661 (8th Cir. 2017)). “But when the record ‘contains no evidence about [the plan administrator]’s “claims administration history or its efforts to ensure that claims assessment is not affected by the conflict,” [the court] only “give[s] the conflict some weight.”’” Id. at 321 (alterations in original) (quoting Donaldson v. Nat’l Union Fire Ins. Co. of Pittsburgh, 863 F.3d 1036, 1039 (8th Cir. 2017)). Until recently, some courts have used a less deferential standard of review if a claimant showed “a ‘serious procedural irregularity existed which caused a serious before the district court or briefed for this court, we decline to consider the newly submitted authority at this time. Twin Cities Galleries, LLC v. Media Arts Grp., Inc., 476 F.3d 598, 602 n.1 (8th Cir. 2007). -7- breach of the plan trustee’s fiduciary duty to the plan beneficiary.’” Menz v. Procter & Gamble Health Care Plan, 520 F.3d 865, 869 (8th Cir. 2008) (quoting Buttram v. Cent. States, Se. & Sw. Areas Health & Welfare Fund, 76 F.3d 896, 900 (8th Cir. 1996)). However, after briefing closed in this appeal, we held procedural irregularities do not trigger de novo review. McIntyre v. Reliance Standard Life Ins. Co., 972 F.3d 955, 963 (8th Cir. 2020). Thus, any irregularities present in USAble Life’s review of Roebuck’s claim are only factors to be considered in the court’s abuse of discretion review. Accordingly, we hold abuse of discretion is the appropriate standard of review for USAble Life’s denial of Roebuck’s claim.