Alaska Employment Law

The 9th Circuit has again applied MetLife v. Glenn, this time holding that an administrator’s (MetLife, as it happens) structural conflict of interest wasn’t sufficient to set aside a denial of ERISA benefits.  The panel said:

The Supreme Court has indicated that an ERISA fiduciary’s structural conflict of interest is but one factor in considering whether the fiduciary abused its discretion. See Metro. Life Ins. Co. v. Glenn, 128 S. Ct. 2343, 2351 (2008). The conflict of interest may be an important factor if “circumstances suggest a higher likelihood that it affected the benefits decision, including, but not limited to, cases where an insurance company administrator has a history of biased claims administration.” Id. The importance of a conflict of interest may be low if there is no “evidence of malice, of self-dealing, or of a parsimonious claims-granting history.” Abatie v. Alta Health & Life Ins. Co., 458 F.3d 955, 968 (9th Cir. 2006) (en banc). 

Although the district court did not have the benefit of the Supreme Court’s decision in Glenn, it made a careful analysis of the relevant factors, including MetLife’s structural conflict of interest. Because the record does not contain evidence of malice, self-dealing, or other circumstances suggesting a higher likelihood that the structural conflict affected the benefits decision, the district court did not err in holding that the importance of MetLife’s conflict was low. See Glenn, 128 S. Ct. at 2351; Abatie, 458 F.3d at 968.

Factoring in the appropriate weight accorded to MetLife’s inherent conflict of interest, we conclude that the district court did not err in rejecting Daic’s remaining arguments that MetLife abused its discretion when it denied her claim for long-term disability benefits. MetLife did not abuse its discretion by relying on the opinions of its own doctors, who had never personally examined Daic. ERISA does not “impose a heightened burden of explanation on administrators when they reject a treating physician’s opinion,” nor does it require that plan decisionmakers “accord special deference to the opinions of treating physicians.” Black & Decker Disability Plan v. Nord, 538 U.S. 822, 831 (2003). Moreover, contrary to Daic’s assertions, MetLife did not rely on the opinions of its own physicians in the face of the consistent countervailing opinions of Daic’s physicians that she was disabled.  Rather, one of Daic’s physicians indicated that she was in good health and another advised Daic that she was able to return to work part-time. Nor does the Social Security Administration’s determination that Daic was disabled undermine MetLife’s decision. The social security disability analysis is different than the ERISA analysis, not least because the social security disability standard involves special deference to the opinions of the claimant’s treating physician. As noted above, this deferential standard is not applicable in the ERISA context. See id.

Daic v. Hawaii Pacific Health Group Plan, 2008 WL _______ (9th Cir. Aug. 13, 2008)(unpub.)