United States Court of Appeals
For the First Circuit
No. 02-1215
DANIEL J. LEAHY,
Plaintiff, Appellant,
v.
RAYTHEON COMPANY ET AL.,
Defendants, Appellees.
APPEAL FROM THE UNITED STATES DISTRICT COURT
FOR THE DISTRICT OF MASSACHUSETTS
[Hon. Morris E. Lasker, Senior U.S. District Judge]
Before
Selya, Circuit Judge,
Coffin and B. Fletcher,* Senior Circuit Judges.
Robert O. Berger for appellant.
Stephen S. Churchill, with whom James F. Kavanaugh, Jr. and
Conn Kavanaugh Rosenthal Peisch & Ford, LLP were on brief, for
appellees.
December 17, 2002
___________
*Hon. Betty B. Fletcher, of the Ninth Circuit, sitting by
designation.
SELYA, Circuit Judge. In this case, brought pursuant to
the Employee Retirement Income Security Act of 1974 (ERISA), 29
U.S.C. §§ 1001-1461 (2000), plaintiff-appellant Daniel J. Leahy
alleges that defendant-appellee Metropolitan Life Insurance Company
(MetLife), as the claims administrator for Raytheon Company's long-
term disability plan (the Plan), unreasonably denied his claim for
benefits. The district court granted summary judgment in the
defendants' favor.1 The plaintiff appeals. After addressing
certain questions raised by the plaintiff anent the standard of
review in ERISA benefit denial cases, we affirm.
I.
Background
The basic facts are uncontradicted. The Plan is an
employee benefit plan funded by employee contributions and governed
by ERISA. As the claims administrator, MetLife is responsible for
making benefit determinations. For a participant to receive
benefits, MetLife must determine that he is "fully disabled" as
defined by the Plan. To meet that criterion, a claimant must show
that by reason "of a sickness or an injury which is not covered by
an applicable workers' compensation statute . . . [he or she]
cannot perform the essential elements and substantially all of the
1
The named defendants, appellees here, include MetLife,
Raytheon, the Plan (formally known as the Raytheon Employees
Disability Trust), and the Plan's trustees. For ease in reference,
we treat the case as if MetLife were the sole defendant.
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duties of his or her job at Raytheon even with a reasonable
accommodation."
The plaintiff began working for Raytheon in 1969. He
eventually became a departmental administrator and a Plan
participant. On October 18, 1996, Raytheon furloughed him from
that essentially sedentary position. The plaintiff received a
severance benefit that included six months of salary continuation.
Over the years, the plaintiff has had more than his share
of serious health problems; among other things, he has undergone
three hip replacements and two knee replacements. In April of
1997, he applied for benefits under the Plan, claiming that he had
become fully disabled on or about October 19, 1996 (the day after
he was furloughed). The linchpin of his claim was an allegation
that chronic hip pain prevented him from sitting for any length of
time (and, therefore, prevented him from performing his job, even
with a reasonable accommodation).
MetLife denied the claim on the ground that the plaintiff
did not meet the Plan's definition of "fully disabled." In
embellishing its decision, MetLife wrote that, taking into account
available accommodations, the plaintiff had not established an
inability to perform substantially all the duties of his job.
After exhausting his administrative remedies, the
plaintiff filed suit in the United States District Court for the
District of Massachusetts. He asserted that MetLife had violated
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ERISA when it unreasonably denied his claim. In due season, the
parties cross-moved for summary judgment. The district court
granted the defendants' motion and denied the plaintiff's
counterpart motion. Leahy v. Raytheon Co., No. 00-CV-12093, slip
op. (D. Mass. Jan. 29, 2002) (unpublished). The court noted that
the Plan vested broad discretionary authority in MetLife to
determine eligibility for benefits and declared that while some
medical evidence supported the plaintiff's claim of disability,
other evidence supported MetLife's denial of benefits. On that
scumbled record, the court ruled that MetLife's determination was
neither arbitrary nor capricious. This timely appeal followed.
II.
Standard of Review
This denial-of-benefits claim arises under 29 U.S.C. §
1132(a)(1)(B).2 The Supreme Court has provided the ground rules
for determining the proper standard of review. In Firestone Tire
2
The statute provides in pertinent part:
A civil action may be brought—
(1) by a participant or beneficiary—
* * *
(B) to recover benefits due to him under the
terms of his plan, to enforce his rights under
the terms of the plan, or to clarify his
rights to future benefits under the terms of
the plan; . . . .
29 U.S.C. § 1132(a)(1)(B).
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& Rubber Co. v. Bruch, 489 U.S. 101 (1989), the Court stated that
when a denial of benefits is challenged under ERISA §
1132(a)(1)(B), the standard of review depends largely upon whether
"the benefit plan gives the administrator or fiduciary
discretionary authority to determine eligibility for benefits or to
construe the terms of the plan." Firestone, 489 U.S. at 115. If
so, "Firestone and its progeny mandate a deferential 'arbitrary and
capricious' standard of review." Recupero v. New Engl. Tel. & Tel.
Co., 118 F.3d 820, 827 (1st Cir. 1997) (quoting Firestone, 489 U.S.
at 115). The threshold question, then, is whether the provisions
of the employee benefit plan under which remediation is sought
reflect a clear grant of discretionary authority to determine
eligibility for benefits. Terry v. Bayer Corp., 145 F.3d 28, 37
(1st Cir. 1998); Rodriguez-Abreu v. Chase Manhattan Bank, 986 F.2d
580, 583 (1st Cir. 1993). We turn, therefore, to the text of the
Plan.
The Plan documents give MetLife "the exclusive right, in
[its] sole discretion, to interpret the Plan and decide all matters
arising thereunder . . . ." The documents further provide that any
decision by MetLife in the exercise of that authority "shall be
conclusive and binding on all persons unless it can be shown that
the . . . determination was arbitrary and capricious." This
discretionary grant hardly could be clearer. Consequently, the
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arbitrary and capricious standard applies to judicial review of
MetLife's determination.3
In an effort to blunt the force of this reasoning, the
plaintiff makes two points. First, he suggests that a less
deferential standard of review is appropriate in this case because
the plan administrator operated under a conflict of interest. As
a purely theoretical matter, this suggestion rests on a sound
foundation. It is well settled that when a plan administrator
labors under a conflict of interest, courts may cede a diminished
degree of deference — or no deference at all — to the
administrator's determinations. See, e.g., Doe v. Travelers Ins.
Co., 167 F.3d 53, 57 (1st Cir. 1999); Doyle v. Paul Revere Life
Ins. Co., 144 F.3d 181, 184 (1st Cir. 1998); Brown v. Blue Cross &
Blue Shield of Ala., Inc., 898 F.2d 1556, 1562-64 (11th Cir. 1990).
But there is no meaningful conflict here, and so this case does not
fit within that rubric. We explain briefly.
3
We note that, in this context, the terms "arbitrary and
capricious" and "abuse of discretion" have been used
interchangeably. Although at least one commentator has lamented
this usage, see Kathryn J. Kennedy, Judicial Standard of Review in
ERISA Benefit Claim Cases, 50 Am. U.L. Rev. 1083, 1130 (2001)
(positing that abuse of discretion signifies a less deferential
standard), the Firestone Court did not distinguish between the
terms. Compare Firestone, 489 U.S. at 109-11, with id. at 113-15.
We follow that example. See Terry, 145 F.3d at 37 n.6 ("We agree
with then-Judge Ruth Bader Ginsburg that 'there is no need to adopt
one phrase and avoid the other.'") (citing Block v. Pitney Bowes,
Inc., 952 F.2d 1450, 1454 (D.C. Cir. 1992)).
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In the plaintiff's view, the ostensible conflict involves
MetLife's hiring of outside physicians to scrutinize the
plaintiff's medical records. To affect the standard of review,
however, a conflict of interest must be real. A chimerical,
imagined, or conjectural conflict will not strip the fiduciary's
determination of the deference that otherwise would be due. See
Doyle, 144 F.3d at 184; Mers v. Marriott Int'l Group Accid'l Death
& Dismemb. Plan, 144 F.3d 1014, 1020 (7th Cir. 1998). The conflict
that the plaintiff envisions does not pass through this screen.
Analyzing disability claims plainly requires expertise.
It is, therefore, difficult to fault a plan administrator for
seeking expert assistance (indeed, it probably would be easier to
fault a plan administrator for not seeking such assistance). We
are aware of no case holding that a plan administrator operates
under a conflict of interest simply by securing independent medical
advice to aid in the evaluation process.4 Nor do we view this as
an accident: common sense dictates that retaining outside
physicians to assist in evaluating disability claims, without more,
4
In point of fact, extrapolating from the available case law
suggests the opposite conclusion. See, e.g., Sweatman v.
Commercial Union Ins. Co., 39 F.3d 594, 603 (5th Cir. 1994)
(finding that reliance upon an independent medical record review
did not constitute an abuse of discretion); Chandler v. Raytheon
Employees Disab. Trust, 53 F. Supp. 2d 84, 90-91 (D. Mass. 1999)
(similar), aff'd, 229 F.3d 1133 (1st Cir. 2000) (table), cert.
denied, 531 U.S. 1114 (2001).
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does not constitute a conflict of interest. Here, there is no
"more" (and, thus, there is no conflict).
This conclusion is reinforced by the nature of the Plan.
The Plan is a voluntary employee-funded entity, and market forces
are at work. If MetLife denies claims that Plan participants as a
group view as valid, those employees will be inclined to withdraw
from the Plan, thus reducing MetLife's role (and, presumably, its
compensation). By the same token, if MetLife awards benefits that
are viewed as undeserved, Plan participants will experience an
increase in their premiums and thus be inclined to withdraw from
the Plan (again reducing MetLife's role and remuneration). Either
way, the structure of the Plan furnishes an incentive for MetLife
to be unbiased in its handling of claims. This is telling, for
courts should not lightly presume that a plan administrator is
willing to cut off its nose to spite its face.
The plaintiff's second ground for questioning the
standard of review is more artful. He points to the usual rule
that appellate review of an order granting summary judgment is de
novo. E.g., Plumley v. S. Container, Inc., 303 F.3d 364, 369 (1st
Cir. 2002); Suarez v. Pueblo Int'l, Inc., 229 F.3d 49, 53 (1st Cir.
2000). This means that the court of appeals must decide for itself
whether "the pleadings, depositions, answers to interrogatories,
and admissions on file, together with the affidavits, if any, show
that there is no genuine issue as to any material fact and that the
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moving party is entitled to a judgment as a matter of law." Fed.
R. Civ. P. 56(c). And in doing so, the court must take the record
"in the light most hospitable to the party opposing summary
judgment, indulging all reasonable inferences in that party's
favor." Griggs-Ryan v. Smith, 904 F.2d 112, 115 (1st Cir. 1990).5
Because the district court decided this case on summary judgment,
the plaintiff suggests that the summary judgment standard displaces
the arbitrary and capricious standard for purposes of this appeal.
We reject this suggestion.
To be sure, there is an obvious discongruence between the
two standards. The arbitrary and capricious standard asks only
whether a factfinder's decision is plausible in light of the record
as a whole, see, e.g., Pari-Fasano v. ITT Hartford Life & Accid.
Ins. Co., 230 F.3d 415, 419 (1st Cir. 2000), or, put another way,
whether the decision is supported by substantial evidence in the
record, Doyle, 144 F.3d at 184. The summary judgment standard,
however, asks whether the factfinder's decision is inevitable even
when all the evidence is marshaled in the objecting party's favor
and all reasonable inferences therefrom are shaped to fit that
5
This approach is not altered by the incidence of cross-
motions for summary judgment. "The happenstance that both parties
move simultaneously for brevis disposition does not, in and of
itself, relax the taut line of inquiry that Rule 56 imposes."
Blackie v. Maine, 75 F.3d 716, 721 (1st Cir. 1996). Thus, in the
ordinary case, the trial court "must consider each motion
separately, drawing inferences against each movant in turn." EEOC
v. Steamship Clerks Union, Local 1066, 48 F.3d 594, 603 n.8 (1st
Cir. 1995).
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party's theory of the case. See Suarez, 229 F.3d at 53; Griggs-
Ryan, 904 F.2d at 115.
There are signs that, in ERISA cases, courts have found
this dichotomy baffling. Some have glossed over it, giving lip
service to the summary judgment standard but then proceeding to
examine the evidence under the arbitrary and capricious standard.
See, e.g., Terry, 145 F.3d at 34, 37; Woo v. Deluxe Corp., 144 F.3d
1157, 1160-63 (8th Cir. 1998); Nazay v. Miller 949 F.2d 1323, 1328,
1334 (3d Cir. 1991). More recently, some of these same courts have
tended simply to ignore the discongruence, omitting any mention of
the summary judgment paradigm and focusing exclusively on whether
the fiduciary's decision passes muster under the arbitrary and
capricious test. See, e.g., Gritzer v. CBS, Inc., 275 F.3d 291,
295 (3d Cir. 2002); Vlass v. Raytheon Employees Disab. Trust, 244
F.3d 27, 29-30 (1st Cir. 2001). One court has attempted to
integrate the two approaches. See Bergt v. Ret. Plan for Pilots
Employed by MarkAir, Inc., 293 F.3d 1139, 1142-43 (9th Cir. 2002)
("[W]e review de novo whether, viewing facts most favorable to [the
plaintiff], the district court correctly held that no genuine
issues of fact exist as to whether the Committee abused its
discretion by denying [the plaintiff] benefits under the retirement
plan."). We are reluctant to enter this thicket — and we see no
need to do so in an ERISA benefit denial case brought pursuant to
29 U.S.C. § 1132(a)(1)(B) because there cannot possibly be a
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conflict between the standard of review that federal courts must
apply on summary judgment and the degree of deference that such
courts ultimately owe to plan administrators. We pause to explain
this statement.
The degree of deference owed to a plan fiduciary is an
underlying legal issue that remains the same through all stages of
federal adjudication. See Firestone, 489 U.S. at 115. By
contrast, summary judgment is a procedural device designed to
screen out cases that present no trialworthy issues. See McCarthy
v. N.W. Airlines, Inc., 56 F.3d 313, 314-15 (1st Cir. 1995). In an
ERISA benefit denial case, trial is usually not an option: in a
very real sense, the district court sits more as an appellate
tribunal than as a trial court. It does not take evidence, but,
rather, evaluates the reasonableness of an administrative
determination in light of the record compiled before the plan
fiduciary.6 See Recupero, 118 F.3d at 831; Perry v. Simplicity
Eng'g, 900 F.2d 963, 967 (6th Cir. 1990). No jury is involved.
See Recupero, 118 F.3d at 831; Sullivan v. LTV Aero. & Defense Co.,
82 F.3d 1251, 1258-59 (2d Cir. 1996); Borst v. Chevron Corp., 36
F.3d 1308, 1323-24 (5th Cir. 1994). Given this adjudicative
6
We do not foreclose the possibility that, in special
circumstances, a district court might take evidence in an ERISA
case. Cf. Vlass, 244 F.3d at 31 n.6 (leaving the question open).
We express no opinion as to what effect (if any) such
supplementation might have on the standard of review. Those
questions are not before us, as the parties here have explicitly
disclaimed any desire to supplement the record.
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framework, the plaintiff's proposal to treat the summary judgment
standard as if it permitted us to review the ingredients of the
administrative record de novo, without deference to the plan
administrator's findings, distorts the law.
The fortuity that the parties chose to use cross-motions
for summary judgment as the procedural vehicle to bring the case
forward for judicial review of the plan administrator's
determination cannot be permitted either to dilute the teachings of
Firestone or to undercut the standard of review that the Firestone
Court decreed for use in ERISA benefit denial cases. Cf. S. Shore
Hosp., Inc. v. Thompson, 308 F.3d 91, 97-98 (1st Cir. 2002) (taking
an analogous approach with respect to judicial review of decisions
of the Provider Reimbursement Review Board). This respectful
standard requires deference to the findings of the plan
administrator, and, thus, even under Fed. R. Civ. P. 56, does not
permit a district court independently to weigh the proof. Rather,
the district court must ask whether the aggregate evidence, viewed
in the light most favorable to the non-moving party, could support
a rational determination that the plan administrator acted
arbitrarily in denying the claim for benefits. This is also the
question we must ask, and answer, on appeal (affording de novo
review to the district court's appraisal).
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III.
Analysis
We turn now to the merits of the denial of benefits. The
Plan's definition of "fully disabled" controls. That definition,
quoted above, is clear and unambiguous. As in many such instances,
however, the devil is in the details.
The basis for MetLife's determination is summarized in
a letter to the plaintiff dated March 16, 1998. That letter
reveals that MetLife premised the denial of benefits on several
sources of information, including statements and reports from the
plaintiff's treating physicians, findings gleaned from an
independent medical examination, the outcome of a functional
capacity assessment, the conclusions of two retained physicians who
reviewed the plaintiff's medical records at MetLife's behest, the
timing of the plaintiff's claim, and the Social Security
Administration's determination that the plaintiff was not disabled.
The medical evidence is extensive, and it would serve no
useful purpose to rehearse it here. Disability, like beauty, is
sometimes in the eye of the beholder. This is such a case: we
have scrutinized the record with care and conclude, without serious
question, that it is capable of supporting competing inferences as
to the extent of the plaintiff's ability to work. That clash does
not suffice to satisfy the plaintiff's burden. We have held
before, and today reaffirm, that the mere existence of
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contradictory evidence does not render a plan fiduciary's
determination arbitrary and capricious. Vlass, 244 F.3d at 30;
Doyle, 144 F.3d at 184. Indeed, when the medical evidence is
sharply conflicted, the deference due to the plan administrator's
determination may be especially great. See Fletcher-Merrit v.
Noram Energy Corp., 250 F.3d 1174, 1180 (8th Cir. 2001) (warning,
in this context, that a reviewing court "may not simply substitute
its opinion for that of the plan administrator"); Terry, 145 F.3d
at 41 (similar). For the reasons that follow, we conclude that
MetLife's determination that the plaintiff was not fully disabled
rests on substantial evidence (and, therefore, that the
determination survives review under the arbitrary and capricious
standard).
Here, the relevant definition of "full disability" harks
back to the employee's job description. It is undisputed that the
plaintiff's white-collar job did not entail operose physical tasks,
but, rather, was essentially sedentary.7 The plaintiff had been
functioning in this position prior to the layoff. MetLife's view
that he remained able to perform this job is anchored in
independent medical record reviews conducted by Dr. Robert Petrie
and Dr. Mark Moyer, respectively. Each reviewer found insufficient
7
The record indicates that the job required the plaintiff
mainly to sit. It involved standing less than 20% of the time and
walking less than 20% of the time.
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evidence to sustain a conclusion that the plaintiff was fully
disabled.
The outside reviewers' shared conclusion was buttressed
by other medical evidence. Dr. Frank F. Davidson, Jr., a treating
physician, declined just months before the asserted date of
disability to say that the plaintiff was disabled. He classified
the plaintiff's impairment as a "[m]oderate limitation of
functional capacity" and declared him capable of performing
sedentary activity that involved a mixture of sitting, standing,
and walking. The limitations that Dr. Davidson placed on those
activities fell well within the parameters of the plaintiff's job
description.
By like token, Dr. John L. Doherty, an independent
medical examiner selected by the plaintiff, stated in December of
1997 that the plaintiff could do sedentary work if accommodated.
Dr. Doherty described an appropriate accommodation as one that
allowed the plaintiff to readjust himself as needed and to move
about from time to time. The plaintiff's position as a
departmental administrator permitted this accommodation, and
Raytheon was willing to allow it.
Finally, the record is replete with other telltales on
which MetLife was entitled to rely. We mention three of them.
First, the results of a functional capacity assessment tended to
show not only that the plaintiff had the physical ability to do the
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work but also that he appeared to be overstating his limitations.
Second, the timing of the plaintiff's claim was highly suspicious.
The plaintiff had been working up until the time that Raytheon laid
him off; he did not file a disability claim until almost six months
thereafter (when his salary continuation benefits were about to
expire); and he asserted, coincidentally, that the onset date of
his disability was the day after he was furloughed. Last — but far
from least — the record reflects that the plaintiff had applied
unsuccessfully for social security disability benefits. The
rejection of his claim by the Social Security Administration, while
not dispositive of his effort to secure disability benefits under
the Plan, is some evidence that he was not fully disabled. Pari-
Fasano, 230 F.3d at 420.
The plaintiff also argues that the plan administrator
gave insufficient weight to the views of his treating physicians,
especially his principal orthopedist, Dr. William H. Harris. He
suggests that MetLife should have assiduously adhered to the so-
called "treating physician" rule, and that its failure to do so was
arbitrary and capricious.
The treating physician rule originated in the social
security setting and has been formalized by regulation in that
context. See 20 C.F.R. §§ 404.1527(d)(2), 416. 927(d)(2). The
rule requires that the factfinder (there, the administrative law
judge) weigh more heavily the opinions of the claimant's treating
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physicians in determining his or her eligibility for benefits. The
rationale for the rule is said to be that treating physicians have
the best opportunity "to know and observe the patient as an
individual." Morgan v. Comm'r of Soc. Sec. Admin., 169 F.3d 595,
600 (9th Cir. 1999).
The calculus of decision in social security cases differs
significantly from that employed in ERISA cases. In the former
instance, Congress and the Secretary of Health and Human Services
have established a specific framework for determining disability.
See Shaw v. Chater, 221 F.3d 126, 132 (2d Cir. 2000) (summarizing
the five-step progression under 20 C.F.R. §§ 404.1520, 416.920).
Goodermote v. Sec. of HHS, 690 F.2d 5, 6-7 (1st Cir. 1982)
(similar). This framework entails specially promulgated standards,
a shifted burden of persuasion, restricted discretion, and agency
involvement. The treating physician rule addresses this peculiar
combination of factors and forces the agency to pay particular heed
to the medical professionals who are in charge of a particular
claimant's case. No comparable combination of factors exists in
ERISA cases: there is no specially promulgated set of criteria, no
shifted burden of persuasion, no restricted discretion, and no
agency involvement. The fiduciary's decision is constrained only
by the language of the particular plan at issue and by a judge-made
adjudicative standard.
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Several other courts of appeals, when faced with the
question of whether the treating physician rule should be extended
to ERISA cases, have expressed grave doubt. See, e.g., Turner v.
Delta Family-Care Disab. & Survivorship Plan, 291 F.3d 1270, 1274
(11th Cir. 2002); Sheppard & Enoch Pratt Hosp., Inc. v. Travelers
Ins. Co., 32 F.3d 120, 126 (4th Cir. 1994); Salley v. E.I. DuPont
de Nemours & Co., 966 F.2d 1011, 1016 (5th Cir. 1992) (dictum).
There is, however, respectable authority to the contrary. See
Regula v. Delta Family-Care Disab. Survivorship Plan, 266 F.3d
1130, 1139 (9th Cir. 2001) (2-to-1 decision).
This court has not yet taken a definitive position as to
the applicability vel non of the treating physician rule in ERISA
cases,8 and we see no need to do so today. Even if we assume, for
argument's sake, that the opinions of the plaintiff's treating
physicians should be accorded special weight, the plaintiff cannot
prevail in this case. While some of his doctors (Dr. Harris, for
example) stated that he was fully disabled, others (Dr. Davidson,
for example) took a different view. Moreover, even Dr. Harris
wavered. Although he originally expressed an opinion that the
8
We note, however, that our decisions reflect at least a tacit
reluctance to apply the treating physician rule in the ERISA
context. See, e.g., Vlass, 244 F.3d at 30-32 (upholding summary
judgment for defendant even though treating physician's reports
supported a finding of disability); Doyle, 144 F.3d at 186-87
(reversing the entry of summary judgment for plaintiff
notwithstanding treating physician's opinion that plaintiff was
disabled). These cases, however, do not explicitly discuss (and,
thus, do not foreclose) the issue.
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plaintiff was fully disabled, he agreed, in a subsequent
conversation with Dr. Moyer, that it was possible for the plaintiff
to return to work so long as he could move about from time to time.
Given the contours of the plaintiff's job, this freedom easily
could have been arranged — and Raytheon was willing to make the
accommodation (in point of fact, the record contains evidence that
the plaintiff already had received permission to move about
freely).
We add, finally, that even where the treating physician
rule holds sway, it is not an absolute. When other evidence
sufficiently contradicts the view of a treating physician, that
view appropriately may be rejected. See Regula, 266 F.3d at 1140
(collecting cases). Here, the administrative file contains a
plenitude of evidence which, if credited, rebuts a conclusion of
full disability.
The short of it, then, is that the plan administrator's
determination, though not inevitable, was solidly grounded.
Whether or not the treating physician rule applies in ERISA cases
— a question that we expressly reserve — the denial of benefits
here passes muster.
IV.
Conclusion
We need go no further. Given the contents of the record,
MetLife's finding of no full disability cannot be labeled
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unreasonable, unsupported, or contrary to the clear weight of the
medical evidence. The ensuing denial of benefits was, therefore,
neither arbitrary nor capricious.
Affirmed.
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