Opinion ID: 3095155
Heading Depth: 2
Heading Rank: 1

Heading: standard of review

Text: This court reviews “a district court judgment on cross-motions for summary judgment de novo.” 5 All evidence and inferences must be construed in the light most favorable to the non-moving party. 6 “Summary judgment is only appropriate if the evidence shows that there is no genuine issue as to any material fact, and that the moving party is entitled to judgment as a matter of law.” 7 It apparently bears repeating here that district courts hearing complaints from disappointed ERISA plan members or their beneficiaries for the administrative denial of benefits are not sitting, as they usually are, as courts of first impression. Rather, they are serving in an appellate role. 8 And, their latitude in that capacity is very narrowly restricted by ERISA and its regulations, as interpreted by the courts of appeals and the Supreme Court, Cedyco Corp. v. PetroQuest Energy, LLC, 497 F.3d 485, 488 (5th Cir. 2007) (citing 5 White Buffalo Ventures, LLC v. Univ. of Tex., 420 F.3d 366, 370 (5th Cir. 2005)). 6 Id. 7 High v. E-Sys. Inc., 459 F.3d 573, 576 (5th Cir. 2006). Anderson v. Cytec Indus., Inc., 619 F.3d 505, 511-12 (5th Cir. 2010) (per curiam). 8 (“This court reviews de novo the district court’s conclusion that an ERISA plan administrator did not abuse its discretion in denying benefits, and in doing so reviews the plan administrator’s decision from the same perspective as the district court.” (internal citations omitted)). 6 Case: 13-30745 Document: 00512686671 Page: 7 Date Filed: 07/03/2014 No. 13-30745 including the oft-repeated admonition to affirm the determination of the plan administrator unless it is “arbitrary” or is not supported by at least “substantial evidence”—even if that determination is not supported by a preponderance. 9 We had thought that by now this was understood and accepted by all district judges of this circuit. But, as this case demonstrates that we were wrong, at least as to one of them, we try yet again to drive that message home. When, in an ERISA case, “the language of the plan”—like the one at issue here—“grants discretion to an administrator to interpret the plan and determine eligibility for benefits, a court will reverse an administrator’s decision only for abuse of discretion.” 10 “A plan administrator abuses its discretion where the decision is not based on evidence, even if disputable, that clearly supports the basis for its denial.” 11 “We reach a finding of abuse of discretion only [when] ‘the plan administrator acted arbitrarily or 9 Ellis v. Liberty Life Assurance Co. of Bos., 394 F.3d 262, 273 (5th Cir. 2004) (“If the plan fiduciary’s decision is supported by substantial evidence and is not arbitrary and capricious, it must prevail.”). 10 High, 459 F.3d at 576. As we have previously stated, “[a]pplying an abuse of discretion review of an administrator’s interpretation of the plan consists of a two-step process: first inquiring whether the plan administrator’s decision was ‘legally correct,’ and, if it is not, secondly inquiring whether the administrator abused his discretion.” Porter v. Lowe’s Cos., Inc.’s Bus. Travel Accident Ins. Plan, 731 F.3d 360, 364 (5th Cir. 2013) (citing Crowell v. Shell Oil Co., 541 F.3d 295, 312 (5th Cir. 2008)). Nevertheless, this court may “ ‘bypass, without deciding, [the issue] whether the Plan Administrator’s denial was legally correct, reviewing only whether the Plan Administrator abused its discretion in denying the claim’ if that can be ‘more readily determine[d].’ ” Porter, 731 F.3d at 364 (quoting Holland v. Int’l Paper Co. Ret. Plan, 576 F.3d 240, 246 n.2 (5th Cir. 2009)). Because the parties have not briefed whether MetLife’s decision was “legally correct,” but rather debate whether the benefits denial ultimately was an “abuse of discretion,” we dispense with step one of the analysis. 11 Holland, 576 F.3d at 246 (citation and internal quotation marks omitted). 7 Case: 13-30745 Document: 00512686671 Page: 8 Date Filed: 07/03/2014 No. 13-30745 capriciously.’ ” 12 “A decision is arbitrary if it is ‘made without a rational connection between the known facts and the decision.’ ” 13 Even though the “administrator’s decision to deny benefits must be supported by substantial evidence,” 14 substantial evidence is merely “more than a scintilla, less than a preponderance, and is such relevant evidence as a reasonable mind might accept as adequate to support a conclusion.” 15 Ultimately, a court’s “ ‘review of the [Plan] administrator’s decision need not be particularly complex or technical; it need only assure that the administrator’s decision fall[s] somewhere on a continuum of reasonableness— even if on the low end.’ ” 16 Obviously, no court may substitute its own judgment for that of the plan administrator. 17 12 Id. (quoting Meditrust Fin. Servs. Corp. v. Sterling Chems., Inc., 168 F.3d 211, 214 (5th Cir. 1999)). To put it another way, the “abuse of discretion” standard “is the functional equivalent of arbitrary and capricious review: ‘[t]here is only a semantic, not a substantive, difference between the arbitrary and capricious and the abuse of discretion standards in the ERISA benefits review context.’ ” Anderson, 619 F.3d at 512. 13 Holland, 576 F.3d at 246 (quoting Meditrust Fin. Servs., 168 F.3d at 215). 14 Id. 15 Ellis, 394 F.3d at 273 (citation and internal quotation marks omitted). 16 Holland, 576 F.3d at 247 (quoting Corry v. Liberty Life Assurance Co. of Boston, 499 F.3d 389, 398 (5th Cir. 2007)); see also Lain v. UNUM Life Ins. Co. of Am., 279 F.3d 337, 342 (5th Cir. 2002) (stating that the administrator’s decision must be “based on evidence, even if disputable, that clearly supports the basis for its denial” (citation omitted)). 17 Truitt v. Unum Life Ins. Co. of Am., 729 F.3d 497, 513 (5th Cir. 2013), cert. denied, 2014 WL 235015 (U.S. Mar. 31, 2014) (“[W]e decline to substitute our judgment for that of the plan administrator.”); McDonald v. Hartford Life Grp. Ins. Co., 361 F. App’x 599, 608 (5th Cir. 2010) (unpublished) (“The reviewing court may not substitute its judgment for that of the plan administrator.”). We note that a “court must take into consideration the conflict of interest inherent in a benefits system in which the entity that pays the benefits . . . maintains discretionary control over the ultimate benefits decision.” Anderson, 619 F.3d at 512 (citing Metro. Life Ins. Co. v. Glenn, 554 U.S. 105, 111-16 (2008); Holland, 576 F.3d at 247 n.3). Although such a conflict is “one factor among many that a reviewing judge must take into account” when considering a fiduciary’s benefits determination, the mere existence of a conflict does not alter 8 Case: 13-30745 Document: 00512686671 Page: 9 Date Filed: 07/03/2014 No. 13-30745