Dew v. Metropolitan Life Insurance

69 F. Supp. 2d 898, 1999 U.S. Dist. LEXIS 16311, 1999 WL 965602
CourtDistrict Court, S.D. Texas
DecidedSeptember 17, 1999
DocketCiv.A. H-98-4136
StatusPublished
Cited by2 cases

This text of 69 F. Supp. 2d 898 (Dew v. Metropolitan Life Insurance) is published on Counsel Stack Legal Research, covering District Court, S.D. Texas primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Dew v. Metropolitan Life Insurance, 69 F. Supp. 2d 898, 1999 U.S. Dist. LEXIS 16311, 1999 WL 965602 (S.D. Tex. 1999).

Opinion

MEMORANDUM AND ORDER

ATLAS, District Judge.

Plaintiff Annette Dew filed this lawsuit under the Employee Retirement Income Security Act (“ERISA”), 29 U.S.C. § 1001 et seq., alleging that Metropolitan Life Insurance Company (“Met Life”) improperly denied her claim for long-term disability benefits under Dew’s employer’s group plan (the “Plan”). The case is now before the Court on Met Life’s Motion for Summary Judgment (“Motion”) [Doc. # 10]. 1 The Motion has been fully briefed by both parties. 2 Based on the Court’s review of the parties’ briefing, the administrative record, and the applicable legal principles, the Court grants Met Life’s Motion.

I. FACTUAL AND ADMINISTRATIVE BACKGROUND

. Dew was employed by John Brown E & C as an administrative assistant. In connection with her employment with John Brown E & C, Dew collected and compiled data for records and reports, prepared general correspondence, and handled routine filing. The administrative assistant position is primarily sedentary, involves no heavy lifting, and requires good interpersonal relationships.

As an employee of John Brown E & C, Dew was covered under the employer’s group long-term disability plan. Dew submitted to Met Life a claim for long-term disability benefits, asserting that she was totally disabled as the result of chronic fatigue syndrome. 3 By letter dated February 5, 1997, Met Life denied Dew’s *901 claim. February 5 Letter, Exh. 12 to Motion. Dew requested reconsideration of the denial and, after again reviewing the administrative record as it existed at that time, Met Life maintained its decision that Dew was not entitled to long-term disability benefits under the Plan.

Dew again “appealed” Met Life’s decision. Met Life obtained a second independent medical review of Dew’s file, which supported Met Life’s prior decision to deny Dew’s claim. Met Life continues to deny Dew’s claim.

II. STANDARD OF REVIEW

The United States Supreme Court has held that the denial of benefits under an ERISA plan is “reviewed under a de novo standard unless the benefit plan gives the administrator or fiduciary discretionary authority to determine eligibility for benefits or to construe the terms of the plan.” Firestone Tire & Rubber Co. v. Bruch, 489 U.S. 101, 115, 109 S.Ct. 948, 103 L.Ed.2d 80 (1989). See also Vega v. National Life Insurance Services, Inc., 188 F.3d 287, 295 (5th Cir.1999); Meditrust Financial Services Corp. v. The Sterling Chemicals, Inc., 168 F.3d 211, 213 (5th Cir.1999). If the plan grants to the administrator such discretionary authority, the reviewing court applies an “abuse of discretion” standard. Id.

“In applying the abuse of discretion standard, we analyze whether the plan administrator acted arbitrarily or capriciously.” Meditrust, 168 F.3d at 214 (internal quotations and citations omitted). “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 omitted). If the administrator’s decision is supported by substantial evidence in the administrative record and is not erroneous as a matter of law, the administrator has not abused his discretion. Wildbur v. ARCO Chemical Co., 974 F.2d 631, 646 n. 12 (5th Cir.1992).

The Fifth Circuit applies a “sliding scale” approach to denials made by an administrator that is also the insurer. Vega, 188 F.3d 287, 295. Under this “sliding scale” approach, the “court always applies an abuse of discretion standard, but gives less deference to the administrator in proportion to the administrator’s apparent conflict.” Id. at 296. “The greater the evidence of conflict on the part of the administrator, the less deferential our abuse of discretion standard will be.” Id. at 297. The Court reviews the merits of the administrator’s decision to “determine whether it is consistent with an exercise of discretion by a fiduciary acting free of the interests that conflict with those of the beneficiaries.” Id. at 296.

The Fifth Circuit does not impose a duty on the administrator to “conduct a good faith, reasonable investigation.” Id. at 297. Instead, the reviewing court must focus on whether the administrative “record adequately supports the administrator’s decision.” Id. at 298. “The administrative record consists of relevant information made available to the administrator prior to the complainant’s filing of a lawsuit and in a manner that gives the administrator a fair opportunity to consider it.” Id. at 300. This Court, in reviewing the administrator’s decision, may not stray beyond the administrative record except for certain, very limited, situations. 4 Id. at 299. This approach serves the dual purpose of (1) preventing the district court from engaging in additional fact-finding; and (2) encouraging both parties to present to the administrator the evidence that best supports their case and to resolve the dispute at the administrative level. Id. at 298-99.

*902 III. ANALYSIS

A. Appropriate Standard of Review in this Case

The Plan in this case expressly grants to the administrators “discretionary authority to interpret the terms of the Plan and to determine eligibility for and entitlement to Plan benefits in accordance with the terms of the Plan.” Plan, Exh. 1 to Motion, at 12. Because the Plan clearly and unequivocally gives the administrators discretionary authority to construe the terms of the plan, the administrators’ decisions are reviewed under the “abuse of discretion” standard. See Firestone, 489 U.S. at 115, 109 S.Ct. 948; Vega, 188 F.3d 287, 295; Meditrust, 168 F.3d at 213.

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Bluebook (online)
69 F. Supp. 2d 898, 1999 U.S. Dist. LEXIS 16311, 1999 WL 965602, Counsel Stack Legal Research, https://law.counselstack.com/opinion/dew-v-metropolitan-life-insurance-txsd-1999.