Opinion ID: 42893
Heading Depth: 1
Heading Rank: 3

Heading: conditions of the Plan; (2) make payment for

Text: A. benefits payable; and (3) decide appeals of Rule 56 of the Federal Rules of Civil Pro- claims.” The claims administrator “has full cedure states that summary judgment “shall be discretion and authority to construe and interrendered forthwith if the pleadings, deposi- pret all terms and provisions which relate to tions, answers to interrogatories, and admis- the amount of, or eligibility for, benefits under sions on file, together with affidavits, if any, the Plan.” Hartford argues that this language show that there is no genuine issue as to any grants it the discretionary authority to determaterial fact and that the moving party is en- mine eligibility for benefits, notwithstanding titled to a judgment as a matter of law.” FED. that the Plan also states that “the Employer has R. CIV. P. 56(c). We review a grant of sum- the responsibility for making final determinamary judgment de novo, using the same crite- tions regarding eligibility for coverage.” ria as employed by the district court. Pat- terson v. Mobil Oil Corp., 335 F.3d 476, 487 We agree with Hartford. The fact that (5th Cir. 2003). Time Warner possesses the final authority to determine eligibility for coverage does not B. deprive Hartford of discretionary authority “Whether a district court employed the ap- with respect to the determination of the benepropriate standard in reviewing an eligibity de- fits available under the Plan for discrete claims. termination made by an ERISA plan admin- istrator is a question of law” that we review de Additionally, as the district court noted, novo. Ellis v. Liberty Life Ins. Co., 394 F.3d Chandler has not challenged Hartford’s inter262, 269 (5th Cir. 2004). The district court pretation of any Plan term. Rather, she claims determined that Hartford’s denial of Chand- that she has submitted sufficient proof of total ler’s claim should be reviewed only for an disability. Accordingly, this case turns on abuse of discretion. We agree. Hartford’s factual determination that Chandler is not totally disabled. “Regardless of the ad- “Consistent with established principles of ministrator’s ultimate authority to determine trust law, a denial of benefits challenged under benefit eligibility . . . factual determinations § 1132(a)(1)(B) is to be reviewed under a de made by the administrator during the course of novo standard unless the benefit plan gives the a benefits review will be rejected only upon the administrator or fiduciarydiscretionary author- showing of an abuse of discretion.” Meditrust ity to determine eligibility for benefits or to Fin. Serv. Corp. v. Sterling Chem., Inc., 168 construe the terms of the plan.” Estate of F.3d 211, 213 (5th Cir. 1999). Bratton v. Nat’l Union Fire Ins. Co., 215 F.3d 516, 521 (5th Cir. 2000). When an adminis- C. trator or fiduciary is given such discretionary To determine whether a plan administrator authority, however, a denial of benefits is r- abused its discretion in denying benefits, we 4 ask whether the administrator acted arbitrarily or capriciously. Id. at 214. “When reviewing for arbitrary and capricious actions resulting in an abuse of discretion, we affirm an administrator’s decision if it is supported by substantial evidence. A decision is arbitrary only if made without a rational connection between the known facts and the decision or between the found facts and the evidence.” Id. at 215 (internal quotations and citations omit- ted). Hartford’s denial of Chandler’s claim was based on the conclusions of its own medical director and the analyses of independent physi- cians. Chandler places special weight on the conclusions of her own treating physician. Nothing in ERISA, however, “suggests that plan administrators must accord special defer- ence to the opinions of treating physicians.” Black & Decker Disability Plan v. Nord, 538 U.S. 822, 831 (2003). Additionally, courts “may not impose on plan administrators a dis- crete burden of explanation when they credit reliable evidence that conflicts with a treating physician’s evaluation.” Id. at 834. Though Chandler may disagree with Hart- ford’s determination that she is not totally dis- abled, it cannot be said that there is no rational connection between the administrator’s found facts and the evidence, particularlyconsidering that Chandler arguably never submitted any information, other than her own subjective complaints, that supports a conclusion that her physical abilities have been limited to such a degree that she cannot perform the largely sed- entary position of an account executive. Con- cluding that the administrator’s denial of Chandler’s claim for benefits under the Plan was not an abuse of discretion, we AFFIRM the summary judgment. 5