Doyle v. Liberty Life Assur. Co. of Boston

542 F.3d 1352, 2008 WL 4272748
CourtCourt of Appeals for the Eleventh Circuit
DecidedJanuary 7, 2008
Docket07-10348
StatusPublished
Cited by32 cases

This text of 542 F.3d 1352 (Doyle v. Liberty Life Assur. Co. of Boston) is published on Counsel Stack Legal Research, covering Court of Appeals for the Eleventh Circuit primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Doyle v. Liberty Life Assur. Co. of Boston, 542 F.3d 1352, 2008 WL 4272748 (11th Cir. 2008).

Opinion

COX, Circuit Judge:

Before the court is Liberty Life Assurance Company of Boston’s petition for rehearing en banc of our opinion in Doyle v. Liberty Life Assurance Co. of Boston, 511 F.3d 1336 (11th Cir.2008). About the time Liberty Life filed this petition, the Supreme Court of the United States granted certiorari in a case from the United States Court of Appeals for the Sixth Circuit involving an issue we admonished our court, in our previous opinion, to consider en banc. See Glenn v. Metro. Life Ins. Co., 461 F.3d 660 (6th Cir.2006), cert. granted — U.S.-, 128 S.Ct. 1117, 169 L.Ed.2d 845 (Jan. 18, 2008). We postponed ruling on the petition pending the Supreme Court’s decision. On June 19, 2008, the Court issued its decision in Metro. Life Ins. Co. v. Glenn, — U.S.-, 128 S.Ct. 2343, 171 L.Ed.2d 299 (2008).

We construe Liberty Life’s petition for rehearing en banc to include a petition for panel rehearing, see 11th Cir. R. 35-5, and grant the petition for panel rehearing. We withdraw our previous opinion and substitute the following opinion in its place:

The issue in this case is whether the district court correctly decided that the administrator of an ERISA-governed long-term disability plan did not abuse its discretion in refusing to award disability benefits to a plan participant. We affirm the district court’s grant of summary judgment in favor of the administrator because the court applied a proper standard of review and because the administrator did not abuse its discretion in denying benefits to the plan participant.

I. Background

The Plaintiff, Robin Doyle, began working for ChoicePoint Services on February 24, 2003, as a Registered Nurse/Clinical Information Line Specialist. ChoicePoint *1355 sponsored for its eligible employees a long-term disability (“LTD”) benefit plan governed by the Employee Retirement Income Security Act of 1974, 29 U.S.C. § 1001 et seq. The Defendant, Liberty Life Assurance Company of Boston, insured the plan pursuant to a group policy, and administered the plan.

On January 30, 2004, Doyle filed a claim with ChoicePoint for disability benefits under the plan, claiming that an anal fissure, enlarged internal hemorrhoids, and external anal skin tags prevented her from working. On February 10, 2004, she underwent a fissurotomy and sphincterotomy in an attempt to alleviate these problems. Liberty Life granted Doyle short-term disability (“STD”) benefits through the maximum date available, May 9, 2004.

While Doyle was receiving STD benefits, Liberty Life obtained her medical records to determine whether she would qualify for LTD benefits, for which she had applied, after her STD benefits expired. After receiving medical records from six of Doyle’s treating physicians, Liberty Life retained an independent physician to review her records. Liberty Life notified Doyle that she would not receive LTD benefits because she was still able to perform the duties of her “Own Occupation.” Doyle would qualify for LTD benefits for the initial 24 months only if she were unable to perform the duties of her “Own Occupation.” Thereafter, she would qualify for LTD benefits only if unable to perform the duties of “Any Occupation.” Specifically, the policy provided:

For persons other than pilots, co-pilots, and crewmembers of an aircraft:
a. if the Covered Person is eligible for the 24 Month Own Occupation benefit, “Disability” or “Disabled” means that during the Elimination Period and the next 24 months of Disability the Covered Person, as a result of Injury or Sickness, is unable to perform the Material and Substantial Duties of his Own Occupation; and
b. thereafter, the Covered Person is unable to perform, with reasonable continuity, the Material and Substantial Duties of Any Occupation.

(R.2-12 at 6.)

After Liberty Life denied her claim for LTD benefits, Doyle visited a rheumatologist who diagnosed her -with fibromyalgia. In light of this new diagnosis, Doyle appealed the denial of her claim. Liberty Life reviewed her additional medical records and received further peer review from a specialist in internal medicine. Liberty Life upheld its decision denying Doyle benefits, stating that she could still perform the duties of her “Own Occupation,” and so did not qualify for LTD benefits under the policy.

Invoking ERISA jurisdiction, 29 U.S.C. §§ 1132(a)(1)(B), (e)(1), Doyle filed this action against Liberty Life seeking judicial review of its decision. Liberty Life filed a motion for summary judgment, which the district court granted. Doyle appeals.

II. Pre-Glenn ERISA Framework and the District Court Proceeding

ERISA does not set out standards under which district courts must review an administrator’s decision to deny benefits. Firestone Tire & Rubber Co. v. Bruch, 489 U.S. 101, 109, 109 S.Ct. 948, 953, 103 L.Ed.2d 80 (1989). In order to fill this void, the Supreme Court held in Firestone that district courts should review de novo benefit decisions made by an administrator who is without discretion to determine eli *1356 gibility or construe the terms of an ERISA-governed plan. Id. at 115, 109 S.Ct. at 956. On the other hand, the Court said that where the administrator exercises discretion, deferential (i.e., arbitrary and capricious 1 ) review is appropriate according to trust principles, which guide review of decisions affecting ERISA-governed plans. Id. at 111, 109 S.Ct. at 954. Finally, the Court observed that when an administrator with discretion operates under a conflict of interest, “that conflict must be weighed as a ‘facto[r] in determining whether there is an abuse of discretion.’ ” Id. at 115, 109 S.Ct. at 957 (quoting Restatement (Second) of Trusts § 187 cmt. d (1959)).

Following Firestone, we undertook the “task [of] developing] a coherent method for integrating factors such as self-interest into the legal standard for reviewing benefits determinations.” Brown v. Blue Cross & Blue Shield of Ala., Inc., 898 F.2d 1556, 1561 (11th Cir.1990). In Brown, we reasoned that trust principles mandated that some deferential level of review applies to benefits decisions, id. at 1568, but refused to apply “highly deferential” review when the administrator operated under a conflict of interest, id. at 1562.

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Bluebook (online)
542 F.3d 1352, 2008 WL 4272748, Counsel Stack Legal Research, https://law.counselstack.com/opinion/doyle-v-liberty-life-assur-co-of-boston-ca11-2008.