Opinion ID: 78557
Heading Depth: 1
Heading Rank: 2

Heading: standard of review

Text: We review de novo a district court's grant of summary judgment, applying the same legal standards governing the district court's decision. Sierra Club, Inc. v. Leavitt, 488 F.3d 904, 911 (11th Cir. 2007). ERISA provides no standard for reviewing decisions of plan administrators or fiduciaries. Firestone Tire & Rubber Co. v. Bruch, 489 U.S. 101, 109, 109 S.Ct. 948, 953, 103 L.Ed.2d 80 (1989). However, the Supreme Court in Firestone established three distinct standards for reviewing an ERISA plan administrator's decision: (1) de novo where the plan does not grant the administrator discretion; (2) arbitrary and capricious where the plan grants the administrator discretion; [8] and (3) heightened arbitrary and capricious where the plan grants the administrator discretion and the administrator has a conflict of interest. See Buckley v. Metro. Life, 115 F.3d 936, 939 (11th Cir.1997). Recent cases from this circuit have expanded the Firestone test into a six-step analysis to guide district courts in reviewing an administrator's benefits decision: (1) Apply the de novo standard to determine whether the claim administrator's benefits-denial decision is wrong (i.e., the court disagrees with the administrator's decision); if it is not, then end the inquiry and affirm the decision. (2) If the administrator's decision in fact is  de novo wrong, then determine whether he was vested with discretion in reviewing claims; if not, end judicial inquiry and reverse the decision. (3) If the administrator's decision is  de novo wrong and he was vested with discretion in reviewing claims, then determine whether reasonable grounds supported it (hence, review his decision under the more deferential arbitrary and capricious standard). (4) If no reasonable grounds exist, then end the inquiry and reverse the administrator's decision; if reasonable grounds do exist, then determine if he operated under a conflict of interest. (5) If there is no conflict, then end the inquiry and affirm the decision. (6) If there is a conflict of interest, then apply heightened arbitrary and capricious review to the decision to affirm or deny it. Williams v. BellSouth Telecomms., Inc., 373 F.3d 1132, 1137 (11th Cir.2004) overruled on other grounds by Doyle v. Liberty Life Assurance Co. of Boston, 542 F.3d 1352 (11th Cir.2008). Until recently, the hallmark of the heightened arbitrary and capricious standard was its burden shifting requirement. When a plan administrator had a conflict of interest by both reviewing and paying claims, the burden shifts to the fiduciary to prove that its interpretation of plan provisions committed to its discretion was not tainted by self-interest. Brown v. Blue Cross & Blue Shield of Ala. Inc., 898 F.2d 1556, 1566 (11th Cir.1990). However, in Metropolitan Life Ins. Co. v. Glenn, the Supreme Court called into question the Eleventh Circuit's heightened arbitrary and capricious standard. ___ U.S. ___, 128 S.Ct. 2343, 2351, 171 L.Ed.2d 299 (2008). Glenn dealt with the denial of benefits under an employee benefit plan governed by ERISA. Glenn agreed that the appropriate standard for reviewing a conflicted administrator's decision was arbitrary and capricious, but held that an individualized inquiry is required to determine the circumstances of each decision. Id. As such, a generalized test is inappropriate. Id. In Doyle, this circuit recognized that Glenn implicitly overrules Brown and other cases requiring courts to apply the heightened standard to a conflicted administrator's benefits decision. 542 F.3d at 1359. Instead, the existence of a conflict of interest should merely be a factor for the district court to take into account when determining whether an administrator's decision was arbitrary and capricious. Id. at 1360. Furthermore, the burden remains on the plaintiff to show the decision was arbitrary; it is not the defendant's burden to prove its decision was not tainted by self-interest. Id. The parties dispute the impact of Doyle on the six-step methodology set forth in Williams. However, the district court found and we agree that the Williams methodology remains intact except for the sixth step. In Doyle itself, this circuit approved the district court's use of the Williams methodology, as modified by Glenn. See also White v. Coca Cola Co., 542 F.3d 848, 854 (11th Cir.2008) (Although Glenn affects the sixth step of Williams, Glenn does not alter our analysis unless Coca-Cola operated under a conflict of interest). Therefore, we will apply the Williams methodology as modified by Glenn. This requires the court to first determine whether Aetna's denial of benefits was de novo wrong.