Court Opinion

ID: 9492142
Source: CourtListenerOpinion
Date Created: 2023-08-05 14:33:01.082175+00
Date Added: 2024-06-11T17:55:07.890304
License: Public Domain

SILVERMAN, Circuit Judge,
with whom FLETCHER, Circuit Judge, joins, concurring in part and dissenting in part:
I am pleased to join Parts I and II of the majority opinion. However, I fail to see the point of remanding this case for a “trial” at which the district judge will admit no new evidence, merely re-read the evidence he already read in connection with the cross-motions for summary judgment, and then render a “verdict.” He’s *1100been there and done that.1 The only question is whether the information in Standard’s possession was — in the language of the plan — “satisfactory.” On cross-motions for summary judgment, the district judge ruled that it is not. And that is a question of law, which itself is reviewed de novo on appeal.
With all due respect, the majority gets off the track by latching on to the contradictory evidence of Kearney’s condition in Standard’s possession, then finding “a genuine question of fact as to whether Kear-ney was disabled in the sense defined by the policy.” In my view, the question at this stage is not whether Kearney is disabled. The question is whether the evidence of disability in Standard’s possession was “satisfactory.” Either it was or it wasn’t. There is no dispute over what information Standard possessed. The only question is whether it was sufficient. That is the question to be reviewed de novo.
There are no factual disputes. In their cross-motions for summary judgment, the parties recognized this and so did the judge. Although Kearney and Standard disagree over the legal conclusions to be drawn from the written information that Standard had received, there is no disagreement over what it had received. It is “satisfactory” or it isn’t.
The plan administrator doesn’t conduct a trial. It pays or denies plan benefits on basis of the information in its possession, even if some of it is contradictory. In reviewing Standard’s decision de novo, we are in the same boat. Mongeluzo v. Baxter Travenol Long Term Disability Benefit Plan, 46 F.3d 938, 943 (9th Cir.1995). It is true that in an ERISA case, additional evidence can be received in the course of judicial review to supplement what was presented to the administrator. However, whether to allow supplementary evidence is a matter wholly within the discretion of the district judge. Id. at 943-944. I agree with the majority that the district judge did not abuse his discretion in declining to receive new evidence. But, with no new evidence to consider, that leaves us where we started: de novo review of whether the proof of disability in Standard’s possession was “satisfactory.” That was the legal question before the district court on cross-motions for summary judgment, the question on which it ruled in favor of Standard, and where the district judge and I part company.
In my view, Kearney’s motion for summary judgment should have been granted and Standard’s denied. Rather than repeat it here, I commend the reader to Judge Reinhardt’s powerful description of the cogent evidence Kearney submitted to prove his disability. Kearney v. Standard Ins. Co., 144 F.3d 597, 600-603 (9th Cir.) rehearing granted, opinion withdrawn, 152 F.3d 1098 (1998). It is also true that Standard was in possession of information that suggested otherwise. Of course, the insurance company must not be made to pay for losses that are not covered by the plan or for claims that have not been proven. But in cases such as this one, where there is strong evidence of a covered loss, some evidence to the contrary, and no definitive way to know for sure, the benefit of the doubt should have been resolved in favor of the beneficiary. For that reason, viewing it on a de novo basis, I would have found Kearney’s proof of disability to be “satisfactory” in light of the totality of the evidence in Standard’s possession.
Accordingly, I would reverse the district court with directions to grant Kearney’s *1101motion for summary judgment and deny Standard’s.

. Judge Posner wrote in an analogous situation:
But because, as we have said, there is no right to a jury trial in an ERISA case ..., and here no evidence besides that introduced at the summary judgment stage that the parties would be presenting at a trial, all the evidence bearing on the issue of contractual meaning was before the trier of fact at that stage. In these unusual circumstances, to remand the case for trial would be an empty formality; ...
Mathews v. Sears Pension Plan, 144 F.3d 461, 468 (7th Cir.1998).