Cohen v. Metropolitan Life Insurance

334 F. App'x 375
CourtCourt of Appeals for the Second Circuit
DecidedJune 9, 2009
DocketNos. 07-2071-cv(L), 07-2286-cv(XAP), 07-2290-cv(CON), 07-5710-cv(CON), 08-2334-cv(CON)
StatusPublished
Cited by1 cases

This text of 334 F. App'x 375 (Cohen v. Metropolitan Life Insurance) is published on Counsel Stack Legal Research, covering Court of Appeals for the Second Circuit primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Cohen v. Metropolitan Life Insurance, 334 F. App'x 375 (2d Cir. 2009).

Opinion

SUMMARY ORDER

Defendant-Appellant-Cross-Appellee Metropolitan Life Insurance Company (“MetLife”) appeals several decisions of the United States District Court for the Southern District of New York (Laura Taylor Swain, /.), which, inter alia, found that MetLife’s decision to deny Plaintiff-Appellee-Cross-Appellant Rachel Cohen’s application for long term disability (“LTD”) benefits based on an alleged “Pre-Existing Condition” was arbitrary and capricious. In this action, brought pursuant to the Employee Retirement Income Security Act of 1974 (“ERISA”), the District Court granted summary judgment for Cohen on the issue of whether she had a “Pre-Existing Condition” and remanded the case to MetLife to determine whether, under the remaining terms of Cohen’s insurance policy, she would be entitled to benefits.

On appeal, MetLife contends (1) that the District Court erred in finding that Met-Life’s denial of Cohen’s claim for LTD benefits was arbitrary and capricious, (2) that the District Court abused its discretion in granting Cohen’s request for attorneys’ fees, (3) that the District Court improperly held MetLife in contempt in its April 22, 2008 order, 2008 WL 1826484, and (4) that the District Court erred in denying MetLife’s motion, pursuant to Rule 62(d), to file a supersedeas bond, which would stay payment of the benefits and of attorneys’ fees. On cross-appeal, Cohen argues that the District Court erred in failing to consider evidence that MetLife was acting under a conflict of interest. Moreover, Cohen contends that this Court does not have jurisdiction to hear this appeal because there has not yet been a “final order.” We assume the parties’ familiarity with the facts, the procedural history, and the scope of the issues on appeal.

For the purposes of this appeal — mindful that the question is one of statutory rather than constitutional jurisdiction — we assume hypothetical jurisdiction over these claims as we did in Crocco v. Xerox Corp., 137 F.3d 105, 108-09 (2d Cir.1998) (reasoning that hypothetical jurisdiction was appropriate in a case which presented a similar question regarding jurisdiction over orders to remand cases to ERISA plan administrators).

MetLife first contends that the District Court erred in granting Cohen summary judgment on the issue of whether she had a “Pre-Existing Condition” that precluded coverage under the insurance policy. This Court reviews “de novo a district court’s decision granting summary judgment in an ERISA action based on the administrative record and applfies] the same legal standard as the district court.” McCauley v. First Unum Life Ins. Co., 551 F.3d 126, 130 (2d Cir.2008). We affirm only when no genuine issue of material fact exists, and the movant is entitled to [377]*377judgment as a matter of law. Fed. R.Civ.P. 56(c). Since the terms of the insurance policy grant MetLife discretionary authority to interpret the plan, the standard governing the District Court’s review, and accordingly our review here, is whether MetLife’s decision was arbitrary and capricious. Miller v. United Welfare Fund, 72 F.3d 1066, 1070 (2d Cir.1995). Under this deferential standard of review, the Court will not overturn MetLife’s denial of benefits unless the decision is found to be “without reason, unsupported by substantial evidence or erroneous as a matter of law.” Id. (internal quotation marks omitted).

Cohen correctly argues, however, that in evaluating whether MetLife’s decision was arbitrary and capricious, the Court should take into account whether the plan administrator operated under a conflict of interest. As in many cases, MetLife faced a conflict of interest here because it acted both as a fiduciary to Cohen and administrator (i.e., payor) of the policy. Therefore, while MetLife had a fiduciary duty to evaluate Cohen’s claim fairly, it also had a financial incentive to deny that claim. Cohen contends, moreover, that the conflict of interest was particularly salient here because of MetLife’s Best Practices Pilot Project, the details of which we have considered under seal. Following the Supreme Court’s instructions in Metropolitan Life Insurance Company v. Glenn, — U.S. -, 128 S.Ct. 2343, 171 L.Ed.2d 299 (2008), we weigh this conflict of interest “as a factor in determining whether” Met-Life acted arbitrarily. Id. at 2346.

We find that the District Court did not err in granting Cohen summary judgment as MetLife’s conclusion that Cohen suffered from a “Pre-Existing Condition” was arbitrary and capricious. MetLife’s determination that Cohen had a “Pre-Existing Condition” was premised on its finding that during the exclusionary period, “Cohen sought medical advice or treatment for several of the symptoms which she states caused her to be unable to work.” Although there is overlap between the symptoms for which Cohen received treatment during the exclusionary period and the symptoms of the Chronic Fatigue Syndrome that made her unable to work, these are relatively common symptoms, and are attributable to many different underlying conditions. Significantly, MetLife failed to have a physician review Cohen’s file to determine whether the symptoms Cohen described as part of her Chronic Fatigue Syndrome derived from the same underlying ailment for which she received treatment during the exclusionary period. There is, moreover, significant evidence in the record from treating physicians suggesting that the earlier symptoms were not attributable to Chronic Fatigue Syndrome. Factoring in MetLife’s conflict of interest, we cannot fault the District Court for finding that MetLife’s determination was arbitrary and capricious.1

Next, MetLife contends that the District Court abused its discretion in awarding Cohen attorneys’ fees and litigation costs. In an ERISA action, “the court in its discretion may allow a reasonable attorney’s fee and costs of action to either party.” 29 U.S.C. § 1132(g)(1). In determining whether to award attorneys’ fees in an ERISA case, courts should consider:

(1) the degree of the offending party’s culpability or bad faith, (2) the ability of the offending party to satisfy an award of attorney’s fees, (3) whether an award of fees would deter other persons from acting similarly under like circum[378]*378stances, (4) the relative merits of the parties’ positions, and (5) whether the action conferred a common benefit on a group of pension plan participants.

Chambless v. Masters, Mates & Pilots Pension Plan, 815 F.2d 869, 871 (2d Cir.1987). The District Court, after weighing these five factors, acted well within its authority in awarding attorneys’ fees and costs.

Lastly, MetLife asserts that the District Court improperly held it in contempt for failing to pay Cohen LTD benefits.

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334 F. App'x 375, Counsel Stack Legal Research, https://law.counselstack.com/opinion/cohen-v-metropolitan-life-insurance-ca2-2009.