Defendant-Appellant-Cross-Appellee Sun Life and Health Insurance Co. ("Sun Life") appeals from a February 9, 2011 judgment of the District Court denying its motion for summary judgment and granting in part the cross-motion for summary judgment of Plaintiff-Appellee-Cross-Appellant Michael Levitian. Levitian appeals the portion of the District Court's order that denied its application for attorney's fees. We assume the parties' familiarity with the underlying facts and the procedural history, some of which we briefly reiterate here.
This appeal arises out of an application for disability benefits filed by Levitian, a former employee of Assured Guaranty ("Assured"). Levitian, a database administrator and a Vice President of Information Technology at Assured, alleged that carpal tunnel syndrome and DeQuervain tendonitis prevented him from performing keyboarding tasks for more than four hours per day. Accordingly, he claimed, he was totally disabled from performing in his capacity as a database administrator. Levitian ceased working at Assured on February 17, 2006, for reasons that are in dispute.
Upon receiving Levitian's application for long-term disability benefits, Sun Life, the long-term disability insurer for Assured's employees, commenced an investigation as to Levitian's medical condition. After initially denying Levitian's claim based on allegedly inadequate documentation of his disability, Sun Life reversed course. On November 20, 2006, based in part on an Occupational Analysis Report prepared by Sarah Coughlin (the "Coughlin Report"), which stated that Levitian's position at Assured would have required him to keyboard more than four hours per day, Sun Life awarded Levitian benefits.
On February 1, 2007, Levitian took a new position as Chief Technology Officer at Global Advertising Strategy ("Global"). At some point thereafter, Sun Life commissioned a new Occupational Analysis Report from Jacqueline Pickering (the "Pickering Report"). The Pickering Report was forwarded to Sun Life on March 14, 2008. Based upon the Pickering Report and Levitian's new position at Global, Sun Life informed Levitian on May 5, 2008, that it would cease his long-term disability benefits. Levitian's internal appeal was denied by Sun Life on August 26, 2008.
On March 26, 2009, Levitian filed the complaint in this action, alleging his entitlement to long-term disability benefits and attorney's fees pursuant to Employee Retirement Income Security Act of 1974, as amended ("ERISA"), 29 U.S.C. §1001, et seq. After a failed attempt at mediation, the parties filed cross-motions for summary judgment on May 3 and 4, 2010.
On February 9, 2011, the District Court denied Sun Life's motion for summary judgment and granted in part and denied in part Levitian's cross-motion for summary judgment. Levitian v. Sun Life & Health Ins. Co. (US), No. 09 Civ. 2965(GBD), 2011 WL 565330 (S.D.N.Y. Feb. 9, 2011) ("Levitian I"). As the District Court understood the record, Sun Life's adverse determination was taken in three steps:
Id. at *4 (citations omitted).
The District Court then evaluated Sun Life's evidentiary support for each step of its inquiry, and held that that Sun Life's decision to deny benefits was not supported by substantial evidence. Id. at *4-5. Specifically, the Court determined that Sun Life's reliance on the Pickering Report was misplaced, and that that Report did not provide the type of evidence of Levitian's vocational capacity that could justify a revocation of benefits.
This appeal followed. Sun Life alleges that the District Court erred by (1) relying on evidence outside the Administrative Record; (2) concluding that Sun Life's denial of benefits was arbitrary and capricious based upon evidence that was not presented to Sun Life during the pendency of the claim; (3) substituting its own judgment for that of Sun Life; and (4) deciding that Sun Life was arbitrary and capricious in concluding that Levitian was a manager at Assured and therefore was not required to keyboard for more than four hours per day. Levitian cross-appeals, arguing that the District Court abused its discretion in not granting him attorney's fees pursuant to Section 502(g)(1) of ERISA, 29 U.S.C. § 1132(g)(1).
We review the decision of the District Court granting summary judgment to the appellee de novo. Durakovic v. Bldg. Serv. 32 BJ Pension Fund, 609 F.3d 133, 137 (2d Cir. 2010). We therefore conduct our own independent review of the decision of Sun Life (the "Plan Administrator") under the deferential "arbitrary and capricious standard." See id. at 141 (on de novo review of a decision by the district court, conducting "arbitrary and capricious" review of Plan Administrator action); but see Conkright v. Frommert, 130 S.Ct. 1640, 1651 (2010) (deference "does not mean that the plan administrator will prevail on the merits. It means only that the plan administrator's interpretation of the plan `will not be disturbed if reasonable.'" (quoting Firestone Tire & Rubber Co. v. Bruch, 489 U.S. 101, 111 (1989))).
We will find that a decision of a Plan Administrator is arbitrary and capricious if it is "without reason, unsupported by substantial evidence, or erroneous as a matter of law." Krauss v. Oxford Health Plans, Inc., 517 F.3d 614, 623 (2d Cir. 2008) (quotation marks omitted). Substantial evidence is "such evidence that a reasonable mind might accept as adequate to support the conclusion reached by the [Plan Administrator] . . . and requires more than a scintilla but less than a preponderance." Durakovic, 609 F.3d at 141 (quotation marks omitted); Miller v. United Welfare Fund, 72 F.3d 1066, 1072 (2d Cir. 1995).
We agree with the District Court that the decision of the Plan Administrator to deny benefits was not supported by substantial evidence and was therefore arbitrary and capricious.
The Pickering Report cannot support the denial of benefits. The Report drew a bright line tying managerial responsibility directly to the number of subordinates: if a "manager" had one subordinate, his keyboarding would likely be more than four hours per day, whereas if he had two or more subordinates, his keyboarding would likely be less than four hours per day. The Report does not provide any evidence, let alone any substantial evidence, to justify its choice to draw this line. The action of the Plan Administrator in denying benefits based upon the Report was therefore arbitrary and capricious.
We reach this conclusion in part because of Sun Life's undisputed conflict of interest. See Levitian I, 2011 WL 565330, at *4 (noting that the conflict of interest is not disputed). Where, as here, a Plan Administrator both evaluates and pays benefits, the Administrator is under a conflict of interest that must be considered by a reviewing court, along with the other factors discussed above, in determining whether a decision of the Administrator is arbitrary and capricious. Metro. Life, 554 U.S. at 117. Such a conflict should be viewed as more determinative where the Administrator relies upon one report, favoring the Administrator's position, more heavily than (or to the exclusion of) another report favoring the benefits claimant. Id. The Plan Administrator did precisely that in this case, where it discredited the Coughlin Report, which was the initial basis for the favorable (to Levitian) benefits determination, in favor of the unfavorable Pickering Report.
Levitian cross-appeals from the District Court's denial of attorney's fees, arguing that as a "prevailing party" he is entitled to such fees. We review the District Court's decision to deny attorney's fees for abuse of discretion. Chambless v. Masters, Mates & Pilots Pension Plan, 815 F.2d 869, 871 (2d Cir. 1987); see also Sims v. Blot, 534 F.3d 117, 132 (2d Cir. 2008) (explaining that the term of art "abuse of discretion" includes errors of law).
The District Court relied solely upon the five-factor Chambless test previously mandatory in our Circuit in deciding to deny attorney's fees to Levitian.
We therefore vacate the District Court's decision on attorney's fees and remand for a new determination of Levitian's entitlement to fees. On remand, regardless of the outcome of the attorney's fees issue, the District Court should explain in writing the basis for its decision as required by Connors v. Connecticut General Life Insurance Co., 272 F.3d 127, 137 (2d Cir. 2001).
Having conducted an independent review of the record, we agree with the District Court that Sun Life's reliance upon the Pickering Report indicates that its denial of benefits was not supported by substantial evidence. We further hold that the District Court erred as a matter of law by relying solely upon the abrogated Chambless test in denying Levitian attorney's fees. We therefore AFFIRM the February 9, 2011 judgment of the District Court as to the cross-motions for summary judgment on the substantive ERISA claim, VACATE that judgment with regard to attorney's fees, and REMAND the cause to the District Court to determine and explain, using the proper legal standard, whether attorney's fees are appropriate in this case.