Broyles v. A.U.L. Corp. Long Term Disability Insurance Plan , 408 F. App'x 67 ( 2011 )

FILED
NOT FOR PUBLICATION JAN 07 2011
MOLLY C. DWYER, CLERK
UNITED STATES COURT OF APPEALS U .S. C O U R T OF APPE ALS
FOR THE NINTH CIRCUIT
PATRICIA BROYLES, No. 09-17658
Plaintiff - Appellant, D.C. No. 3:07-cv-05305-MMC
v.
MEMORANDUM *
A.U.L. CORPORATION LONG TERM
DISABILITY INSURANCE PLAN,
Defendant - Appellee.
Appeal from the United States District Court
for the Northern District of California
Maxine M. Chesney, Senior District Judge, Presiding
Argued and Submitted December 9, 2010
San Francisco, California
Before: D.W. NELSON, THOMPSON, and McKEOWN, Circuit Judges.
Petitioner Patricia Broyles (“Broyles”) appeals the district court’s order
denying her claim for benefits under the A.U.L. Disability Plan (“Plan”), a long-
term disability benefits plan governed by the Employee Retirement Income
*
This disposition is not appropriate for publication and is not precedent
except as provided by 9th Cir. R. 36-3.
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Security Act (“ERISA”), 29 U.S.C. §§ 1001-1461. The district court found that
Appellee Standard Insurance Company (“Standard”) did “not abuse its discretion
in finding Broyles did not meet the Plan’s definition of disabled.” ER 14. We
have jurisdiction pursuant to 28 U.S.C. § 1291, and we affirm.
When a district court conducts a bench trial on the administrative record, we
review the “‘choice and application of the appropriate standard for reviewing
benefits decisions by an ERISA plan administrator’ de novo.” Montour v.
Hartford Life & Accident Ins. Co., 588 F.3d 623, 629 (9th Cir. 2009) (quoting
Sznewajs v. U.S. Bancorp Amended & Restated Supplemental Benefits Plan, 572
F.3d 727, 732 (9th Cir. 2009)). The district court’s findings of fact are reviewed
for clear error. Id.Because the Plan grants discretionary authority to Standard, we review
Standard’s decision for abuse of discretion. Id. (quoting Saffon v. Wells Fargo Co.
Long Term Disability Plan, 522 F.3d 863, 866 (9th Cir. 2008)). Where, as here,
“the same entity that funds an ERISA benefits plan also evaluates claims,” the plan
administrator has a “structural conflict of interest: since it is also the insurer,
benefits are paid out of the administrator’s own pocket, so by denying benefits, the
administrator retains money for itself.” Id. at 630. The existence of a conflict of
interest does not alter the standard of review itself, but instead alters its application.
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Id. at 631. “If [the] facts and circumstances [of a case] indicate the conflict may
have tainted the entire administrative decision-making process, the court should
review the administrator’s stated bases for its decision with enhanced skepticism:
this is functionally equivalent to assigning greater weight to the conflict of interest
as a factor in the overall analysis of whether an abuse of discretion occurred.” Id.
We conclude that Standard did not abuse its discretion in denying Broyles’
claim for benefits. The district court correctly reviewed the administrator’s
exercise of discretion with a low level of skepticism, as Broyles did not submit any
evidence demonstrating a conflict of interest beyond the structural conflict. The
district court then properly concluded that the Attending Physician’s Statement
provided by Broyles’ treating physician was “unclear and open to conflicting
interpretations,” and was unsupported; that any disability that occurred outside the
benefits period was irrelevant for the purposes of evaluating Broyles’ claim; and
that Broyles’ self-reported symptoms were inconsistent with a finding of disabling
pain. ER 11-14. In light of the conflicting evidence in the record, Standard did
not abuse its discretion in denying Broyles’ claim for benefits.
We also affirm the district court’s decision granting Standard’s motion to
strike Broyles’ supplemental evidence. The evidence submitted by Broyles did not
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relate to the effect of the structural conflict of interest on Standard’s decision. See
Abatie v. Alta Health Life Ins. Co., 458 F.3d 955, 970 (9th Cir. 2006) (en banc).
AFFIRMED.
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