WIENER, Circuit Judge:
Harvey McCorkle ("Harvey") died in January 2010. His wife, Plaintiff-Appellee Loy M. McCorkle ("Loy"), sued both Harvey's employer, Turner Industries Group, LLC ("Turner"), and Metropolitan Life Insurance Company ("MetLife"), the administrator of Turner's ERISA-governed
From 2002 until his death in January 2010, Harvey was a Turner employee and was eligible for coverage under the Plan for both accidental death and dismemberment ("AD & D") and supplemental life insurance benefits. The Plan vested MetLife as plan administrator with "discretionary authority to interpret the terms of the Plan and to determine eligibility" for benefits.
On January 13, 2010, Harvey visited his family physician, complaining of stress at work and trouble sleeping during the previous six months. He indicated that he had not been able to sleep at all for the three days preceding that office visit. His physician ruled out depression and treated Harvey for insomnia and anxiety by prescribing 3 milligrams per day of the sleep aid Lunesta. Harvey took his first dose of Lunesta on January 13 and repeated it on January 14 and 15. While taking the drug, he complained to Loy at some point about having problems with "fuzzy memory."
Before going to bed at midnight on January 16, Harvey again took Lunesta as prescribed. A few hours later, he got out of bed. Shortly thereafter, Loy found him lying in their driveway in a pool of blood suffering from a gunshot wound to his head. She called 911.
Detectives from the East Baton Rouge Sheriff's Department ("EBRSD") responded to the scene "in reference to an attempted suicide." Harvey was transported to the hospital where he died several hours later. According to the treating physician at the hospital, Harvey had likely placed the handgun found at the scene
Detectives recovered a .45 caliber revolver lying approximately two feet from the blood stain on the driveway. The gun's cylinder contained five live rounds and one fired round; the fired round was in line with the barrel and hammer. This evidence led detectives to "believe that the weapon was only fired one time and that no other attempt to fire the weapon had been made." No one found a suicide note.
The parish coroner issued Harvey's death certificate the following month, listing the cause of death as "suicide." Although he later provided affidavits explaining that Harvey was likely under the influence of Lunesta and therefore did not "consciously and intentionally t[ake] his own life," the coroner made no move to amend the death certificate to reclassify the death as accidental.
Loy filed a claim under the Plan in August 2010 seeking basic life insurance, optional life insurance, and AD & D benefits. MetLife paid her $50,000 in basic life insurance benefits in September 2010. In a subsequent letter to Loy, MetLife denied the remainder of her claim because the information in the administrative claim file indicated that Harvey had committed suicide. Regarding AD & D benefits, MetLife explained that Harvey's death was not an accident, so the Plan's exclusions for suicide and intentionally self-inflicted injury applied. Regarding optional life insurance benefits, MetLife explained that, because Harvey's death occurred less than two years after his optional life coverage had become effective, the Plan's suicide exclusion applied.
Through counsel, Loy administratively appealed MetLife's adverse benefits determinations. She contended, inter alia, that Lunesta caused his behavior, so he did not intentionally shoot himself. In support of her Lunesta theory, Loy submitted to MetLife: (1) copies of Harvey's medical records from his treating family physician; (2) an affidavit from another medical doctor; (3) an affidavit from the coroner; (4) an affidavit from a pharmacist; (5) her own affidavit; (6) Lunesta package inserts;
MetLife reviewed Loy's appeal and, in April 2011, stood by its original decision. MetLife nevertheless afforded Loy another opportunity to appeal, which it was not required to do under the Plan. In September 2011, MetLife again reviewed Loy's claim and again denied it. MetLife also notified Loy of her right to bring a civil action pursuant to ERISA to recover any benefits that she believed were still owed. Instead, in December 2011 and January 2012, Loy sent MetLife further evidence in
In February 2012, Loy filed the instant civil action in the Middle District of Louisiana pursuant to 29 U.S.C. § 1132(a)(1)(B), seeking full benefits due under the Plan, plus attorney's fees, costs, and interest. The parties eventually filed cross-motions for summary judgment. In their motion, Appellants insisted that MetLife's administrative determination denying Loy's claim was reasonable and based on substantial evidence, and therefore was not an abuse of discretion. In her motion, Loy countered that MetLife had failed to give her claim a full and fair review and that it had abused its discretion when it denied her claim.
The district court held oral argument on the summary judgment motions, at the conclusion of which the court granted Loy's motion and denied Appellants'. The district judge orally stated
On appeal, Appellants present but one question for this court's consideration: Did the district court reversibly err in holding that MetLife abused its discretion when it determined that Loy was not entitled to benefits under the Plan?
This court reviews "a district court judgment on cross-motions for summary judgment de novo."
It apparently bears repeating here that district courts hearing complaints from disappointed ERISA plan members or their beneficiaries for the administrative denial of benefits are not sitting, as they usually are, as courts of first impression. Rather, they are serving in an appellate role.
When, in an ERISA case, "the language of the plan" — like the one at issue here — "grants discretion to an administrator to interpret the plan and determine eligibility for benefits, a court will reverse an administrator's decision only for abuse of discretion."
Even though the "administrator's decision to deny benefits must be supported by substantial evidence,"
Appellants insist that MetLife did not abuse its discretion in denying Loy's claim because substantial evidence supports its determination that Harvey committed suicide.
The district judge also disregarded the rule that, when an ERISA plan vests a fiduciary with discretion to interpret plan terms, the fiduciary "has the power to resolve ambiguities."
We have repeatedly emphasized that the standard of review the district courts — and this court, for that matter — must apply in these ERISA cases is the deferential abuse of discretion standard.
Harvey's death under the circumstances of this case is indeed tragic. Distressing facts, however, do not relieve the district court of its duty to uphold a plan administrator's benefits determination when, as here, it falls "somewhere on a continuum of reasonableness."
Our de novo review confirms that MetLife's benefits determination was grounded in substantial evidence and was neither arbitrary nor unreasonable. We therefore hold that MetLife did not abuse its discretion in denying Loy's claim for benefits under the Plan. Accordingly, we reverse the district court's judgment and render judgment in Appellants' favor, dismissing Loy's action with prejudice at her cost.
REVERSED and RENDERED.
We note that a "court must take into consideration the conflict of interest inherent in a benefits system in which the entity that pays the benefits ... maintains discretionary control over the ultimate benefits decision." Anderson, 619 F.3d at 512 (citing Metro. Life Ins. Co. v. Glenn, 554 U.S. 105, 111-16, 128 S.Ct. 2343, 171 L.Ed.2d 299 (2008); Holland, 576 F.3d at 247 n. 3). Although such a conflict is "one factor among many that a reviewing judge must take into account" when considering a fiduciary's benefits determination, the mere existence of a conflict does not alter the standard of review. See Holland, 576 F.3d at 247 ("[W]eighing a conflict as a factor in the abuse of discretion analysis does not `impl[y] a change in the standard of review, say, from deferential to de novo review.'" (quoting Glenn, 554 U.S. at 115, 128 S.Ct. 2343)). When a claimant, like Loy here, does not come forward with any evidence that the conflict of interest influenced the fiduciary's benefits decision, the court gives this factor little or no weight. Glenn, 554 U.S. at 117, 128 S.Ct. 2343; Anderson, 619 F.3d at 512; Holland, 576 F.3d at 249.