Seyfarth Synopsis: In a strong decision for insurers, the Eighth Circuit affirmed summary judgment for the administrator, rejected plaintiff's conflict of interest argument, and found that it was not arbitrary for the administrator to require objective evidence of impairment when processing an LTD claim.
Cooper v. Metropolitan Life Insurance Company, No 16-3429, 2017 WL 2853729 (8th Cir. July 5, 2017), is a fairly typical ERISA long-term disability case, but has unusually strong pro-insurer holdings. On appeal from a summary judgment win for MetLife, the Eight Circuit conclusively rejected the plaintiff's claim that the insurer's dual role as decisionmaker and payor of benefits warranted a closer review of its decision.
In support of the LTD claim at issue, plaintiff submitted documentation from both her treating physician and her chiropractor. MetLife found no clinical findings to support disability. Plaintiff did not formally appeal, but continued to correspond with MetLife and supplied additional notes from her treating physician. MetLife referred those records, as well as the records from previous STD and LTD claims, to an independent physician for review. The reviewing physician found no objective clinical support for the conclusion that plaintiff was disabled as defined in the plan.
On appeal, the plaintiff argued that the district court erred in applying the abuse of discretion standard and refusing to consider affidavits from her treating physician and chiropractor that were outside the administrative record. The court rejected plaintiff's argument that MetLife's dual role warranted more searching review. The court noted that plaintiff's generic claim of conflict was devoid of evidence of biased decision making. Instead, the court found that the record evinced a comprehensive review, including reliance on the opinion of a qualified independent expert, and did not require a "less deferential" review under the U.S. Supreme Court's decision in Metropolitan Life Insurance Co. v. Glenn, 554 U.S. 105 (2008).
The Eighth Circuit also found it permissible for the insurer to rely on the opinion of its retained physician instead of the competing views of a treating physician, especially where the plaintiff was given repeated notice of the type of evidence missing from her physician's submissions. In reaching its conclusion, the court rejected the oft-heard argument that it was arbitrary to insist upon objective evidence of impairment. The court stated that that MetLife was entitled to favor the reviewing physician's opinion over that of plaintiff's treating physician—particularly where the treating physician was not tasked with interpreting "disability" as defined in the plan—so long as the reviewing physician's conclusion was a reasonable one to draw from the record. Finally, the court rejected plaintiff's argument that MetLife violated the ERISA claims regulations by having a nurse with unspecified credentials interpret certain lab tests, reasoning that MetLife was in substantial compliance with the claim regulations and that there was no evidence that having a different professional review the tests would have changed the outcome.
Cooper will become a go to case for insurers and other benefit plan administrators to cite in their summary judgment briefs, at least as to its "objective evidence" and conflict holdings. The court's "substantial compliance" holding, however, may not survive the implementation of the revised DOL claim regulations.
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