Kathy Dine v. Metropolitan Life Insurance Co , 449 F. App'x 646 ( 2011 )

FILED
NOT FOR PUBLICATION SEP 08 2011
MOLLY C. DWYER, CLERK
UNITED STATES COURT OF APPEALS U .S. C O U R T OF APPE ALS
FOR THE NINTH CIRCUIT
KATHY DINE, No. 09-56761
Plaintiff - Appellant, D.C. No. 2:05-cv-03773-RSWL-
PLA
v.
METROPOLITAN LIFE INSURANCE MEMORANDUM *
COMPANY; THE BOEING EXTENDED
DISABILITY BENEFITS PLAN;
BOEING MEDICAL PLAN; BOEING
LIFE INSURANCE PLAN; BOEING
PENSION/RETIREMENT PLAN,
Defendants - Appellees.
Appeal from the United States District Court
for the Central District of California
Ronald S.W. Lew, Senior District Judge, Presiding
Argued and Submitted August 1, 2011
Pasadena, California
Before: REINHARDT and BERZON, Circuit Judges, and PANNER, Senior
District Judge.**
*
This disposition is not appropriate for publication and is not precedent
except as provided by 9th Cir. R. 36-3.
**
The Honorable Owen M. Panner, Senior District Judge for the U.S.
District Court for Oregon, Portland, sitting by designation.
Kathy Dine brought this ERISA action against Metropolitan Life Insurance
Company (“MetLife”), the administrator of her former employer’s long-term
disability benefits plan. She contends the plan abused its discretion by terminating
her long-term disability benefits. We agree and reverse and remand for further
proceedings.
It is undisputed that MetLife’s denial of benefits is reviewed for abuse of
discretion, and that MetLife has a structural conflict of interest because it “both
evaluates claims for benefits and pays benefits claims.” Metropolitan Life Ins. Co.
v. Glenn, 554 U.S. 105, 112 (2008). When structural conflict exists “the court
must consider numerous case-specific factors, including the administrator's conflict
of interest, and reach a decision as to whether discretion has been abused by
weighing and balancing those factors together.” Montour v. Hartford Life &
Accident Ins. Co., 588 F.3d 623, 630 (9th Cir. 2009). “[A] higher degree of
skepticism is appropriate where the administrator has a conflict of interest.”
Salomaa v. Honda Long Term Disability Plan, 642 F.3d 666, 676 (9th Cir. 2011).
The administrator has the burden of proving that the conflict of interest did not
improperly influence its decision. See Muniz v. Amec Constr. Mgmt., Inc., 623
F.3d 1290, 1295 (9th Cir. 2010).
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Here, three circumstances cause us to conclude MetLife abused its
discretion. First, the record indicates MetLife notified Dine by letter that it was
“presently reviewing your claim” and stated that if “additional information is
needed to complete our review, we will notify you accordingly.” Notwithstanding
those statements, MetLife shortly thereafter denied Dine’s appeal, stating that she
had submitted insufficient evidence. Second, MetLife’s determination that Dine
was not disabled contradicted the opinion of her treating physician. Third, MetLife
ignored its own reviewing physician’s advice to order an independent medical
examination.
Given these circumstances, we conclude the administrator’s decision was
“without support in inferences that could reasonably be drawn from facts in the
record.” Salomaa, 642 F.3d at 676. Accordingly, we reverse and remand to the
district court to enter judgment in favor of Dine and to order reinstatement of her
long-term disability benefits “until the administrator properly applies the plan’s
provisions.” Pannebecker v. Liberty Life Assurance Co. of Boston, 542 F.3d 1213,
1221 (9th Cir. 2008).
REVERSED and REMANDED.
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