McCauley v. First Unum Life Insurance

551 F.3d 126, 45 Employee Benefits Cas. (BNA) 1961, 2008 U.S. App. LEXIS 26094
CourtCourt of Appeals for the Second Circuit
DecidedDecember 24, 2008
DocketDocket 06-5100-cv(L), 06-5529-cv (Con)
StatusPublished
Cited by153 cases

This text of 551 F.3d 126 (McCauley v. First Unum 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
McCauley v. First Unum Life Insurance, 551 F.3d 126, 45 Employee Benefits Cas. (BNA) 1961, 2008 U.S. App. LEXIS 26094 (2d Cir. 2008).

Opinion

JOHN M. WALKER, JR., Circuit Judge:

In light of the Supreme Court’s decision in Metropolitan Life Insurance Co. v. Glenn, — U.S.-, 128 S.Ct. 2343, 171 L.Ed.2d 299 (2008), we must reassess our standard of review governing cases such as this one that challenge an Employee Retirement Income Security Act (“ERISA”) plan administrator’s decision to deny disability benefits, where the administrator has a conflict of interest because it has both the discretionary authority to determine the validity of the employee’s claim and pays the benefits under the policy. Our current standard of review allows a court to review de novo the administrator’s decision when it is shown that a conflict of interest actually influenced that decision. See Sullivan v. LTV Aerospace & Defense Co., 82 F.3d 1251, 1255-56 (2d Cir.1996). We find this standard to be inconsistent with the Supreme Court’s instructions in Glenn and abandon it. We now adhere to the Supreme Court’s clarified explication of the standard review governing such cases, which is that such a conflict of interest is to be “weighed as a factor in determining whether there [wa]s an abuse of discretion,” Glenn, 128 S.Ct. at 2348 (quotation marks omitted) (emphasis in original). After applying this standard, we hold that, as a matter of law, the plan administrator abused its discretion in denying plaintiffs claim for long-term disability benefits.

BACKGROUND

Plaintiff-Appellant John McCauley (“McCauley”) was a Senior Vice President and Director of the Tax Department at Sotheby’s Service Corporation in April 1991, when he was diagnosed with advanced colon cancer. On April 24,1991, he underwent a radical hemicolectomy and experimental chemotherapy, in which several gallons of special chemotherapy drugs were inserted into his peritoneal cavity to “bathe all the organs in the stomach cavi *129 ty.” McCauley’s treatment also included intravenous chemotherapy and chemo catalyst drugs. These drastic procedures saved McCauley’s life. From April 1991 through July 1991, McCauley took short-term disability leave because of his cancer treatment.

In December 1991, McCauley accepted a transfer within Sotheby’s to Hamilton, Bermuda, where he worked as Senior Vice President and Chief Executive Officer of Fine Art Insurance, Ltd., a subsidiary of Sotheby’s. Over the course of the next three years, McCauley continued to experience other health problems and took short term disability leaves. Specifically, in September 1992, McCauley had part of his liver removed because his cancer had metastasized there. By December 1992, he suffered from a severe liver infection, and in April 1994, he underwent surgery to repair a hernia.

In November 1994, after notifying Sotheby’s that he could no longer work, McCauley requested disability benefits. At that point, McCauley took short term disability leave one final time for a period of three months. Although McCauley’s cancer treatment was successful, the procedures had taken a toll on his body. In particular, McCauley suffered from chronic diarrhea, chronic and acute renal impairment, incontinence, progressive vascular sclerosis, high cholesterol, insomnia, depression, and incisional scarring and pain. Defendant-Appellee First Unum Life Insurance Company (“First Unum”) was Sotheby’s disability insurance provider. Under the disability plan, First Unum was both the administrator and ultimate payor of benefits.

On May 19, 1995, First Unum denied McCauley’s claim, and on June 14, 1995, McCauley appealed the decision and submitted additional information for First Unum to consider. On September 18, 1995, First Unum rejected McCauley’s appeal. After this denial, McCauley, attempting to return to the workforce, accepted employment as General Counsel of IBJ Schroeder, Ltd. in Bermuda. Despite paying premiums on McCauley’s policy with First Unum during his absence from the workforce, Sotheby’s informed McCau-ley that it would stop paying those premiums now that he had other employment; however, Sotheby’s informed McCauley that he was eligible to convert the policy and make future payments, which he did. McCauley’s symptoms and health problems persisted. After working at several jobs for short periods of time, McCauley realized that he was not able to work. On January 16, 1996, he applied for long term disability benefits under his conversion policy. First Unum denied this claim on the basis that McCauley’s employment with Sotheby’s had terminated on November 26, 1994, and, therefore, that he had exercised his conversion after the allowable period.

McCauley then brought this action alleging that First Unum had denied his claims under the original and conversion policies in bad faith. After taking discovery, First Unum moved for judgment on the administrative record. At the same time, McCau-ley moved for summary judgment under Federal Rule of Civil Procedure 56. Treating both requests as motions for summary judgment, the District Court for the Southern District of New York (Lawrence M. McKenna, J.) denied McCauley’s motion and granted summary judgment in favor of First Unum, finding that a de novo standard of review was not applicable and that First Unum’s actions were neither arbitrary nor capricious. McCauley v. First UNUM Life Ins. Co., No. 97 Civ. 7662, 2006 WL 2854162 (S.D.N.Y. Oct. 5, 2006). McCauley appeals from that dismissal.

*130 DISCUSSION

I. Legal Standard

We review de novo a district court’s decision granting summary judgment in an ERISA action based on the administrative record and apply the same legal standard as the district court. Pagan v. NYNEX Pension Plan, 52 F.3d 438, 441 (2d Cir.1995); see also Glenn v. Met-Life, 461 F.3d 660, 665 (6th Cir.2006). “Summary judgment is appropriate only where the parties’ submissions show that there is no genuine issue as to any material fact and the moving party is entitled to judgment as a matter of law.” Fay v. Oxford Health Plan, 287 F.3d 96, 103 (2d Cir.2002).

The standard governing the district court’s review, and accordingly our review here, of an administrator’s interpretation of an ERISA benefit plan was first articulated by the Supreme Court in Firestone Tire & Rubber Co. v. Bruch, 489 U.S. 101, 109 S.Ct. 948, 103 L.Ed.2d 80 (1989). The Court explained that “a denial of benefits ... is to be reviewed under a de novo standard unless the benefit plan gives the administrator ... authority to determine eligibility for benefits or to construe the terms of the plan.” Id. at 115, 109 S.Ct. 948.

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551 F.3d 126, 45 Employee Benefits Cas. (BNA) 1961, 2008 U.S. App. LEXIS 26094, Counsel Stack Legal Research, https://law.counselstack.com/opinion/mccauley-v-first-unum-life-insurance-ca2-2008.