NOT RECOMMENDED FOR FULL-TEXT PUBLICATION
File Name: 08a0556n.06
Filed: September 11, 2008
No. 07-3256
UNITED STATES COURT OF APPEALS
FOR THE SIXTH CIRCUIT
KIM ROUMELIOTE, )
) ON APPEAL FROM THE
Plaintiff-Appellant, ) UNITED STATES DISTRICT
) COURT FOR THE
v. ) SOUTHERN DISTRICT OF
) OHIO
LONG TERM DISABILITY PLAN FOR )
EMPLOYEES OF WORTHINGTON INDUSTRIES, ) MEMORANDUM
properly styled as UNUM LIFE INSURANCE ) OPINION
COMPANY OF AMERICA, )
)
Defendant-Appellee. )
BEFORE: MARTIN and NORRIS, Circuit Judges; STAMP, District Judge.*
PER CURIAM. Plaintiff Kim Roumeliote filed a complaint for declaratory judgment and
damages under the Employment Retirement Income Security Act of 1974 (“ERISA”), 29 U.S.C. §§
1001-1461, after she was denied long-term disability benefits under a plan administered by Unum
Life Insurance Company of America (“Unum”) and sponsored by her employer, Worthington
Industries. The district court granted summary judgment to Unum.1 Roumeliote v. Long Term
Disability Plan for Employees of Worthington Indus., 475 F. Supp. 2d 742 (S.D. Ohio 2007).
Plaintiff appeals, arguing that the denial of benefits was “arbitrary and capricious.”
*
The Honorable Frederick P. Stamp, Jr., United States District Judge for the Northern District of W est Virginia,
sitting by designation.
1
Technically, the plan itself is the named defendant. As its administrator, Unum represents the plan in this
litigation.
No. 07-3256
Roumeliote v. Long Term Disability Plan
This court reviews de novo a district court’s grant of summary judgment in an ERISA action,
applying the same standard used by the district court. Shelby County Health Care Corp. v. Council
of Indus. Workers Health & Welfare Trust Fund, 203 F.3d 926, 933 (6th Cir. 2000). In reviewing
the district court’s judgment, we must determine whether the district court applied the proper
standard of review in assessing the merits of the summary judgment motion. In ERISA cases, the
decisions of a plan administrator are subject to review under the “arbitrary and capricious” standard
if the plan vests discretionary authority in the administrator. Firestone Tire & Rubber Co. v. Bruch,
489 U.S. 101, 109 (1989); Wendy’s Int’l v. Karsko, 94 F.3d 1010, 1012 (6th Cir. 1996). In this case,
the plaintiff concedes that the “arbitrary and capricious” standard of review applies to her claim.
While this standard is highly deferential, and we are obliged to uphold a benefit determination if it
is rational in light of the plan’s provisions, the standard does not require us merely to rubber stamp
the administrator’s decision. Jones v. Metro. Life Ins. Co., 385 F.3d 654, 661 (6th Cir. 2004)
(quotations omitted).
This circuit has recognized that a potential conflict of interest exists when the plan is both
the “decision-maker, determining which claims are covered, and also the payor of those claims.”
Calvert v. Firstar Fin., Inc., 409 F.3d 286, 292 (6th Cir. 2005). In the instant case, the district court
indicated that the potential for such a conflict existed with respect to Unum:
In evaluating the record, . . . the Court is required to consider only the facts
known to the plan administrator at the time the final decision was made to deny
disability benefits. Moon v. Unum Provident Corp., 405 F.3d 373, 378 (6th Cir.
2005); see also Miller v. Metropolitan Life Ins. Co., 925 F.2d 979, 986 (6th Cir.
1991). The Court is also required to remain cognizant of the potential inherent
conflict of interest that arises when an insurer such as Unum acts as both the decision
maker on a claim and the potential payor of that claim. Calvert, 409 F.3d at 292
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No. 07-3256
Roumeliote v. Long Term Disability Plan
(“[t]he possible conflict of interest inherent in this situation should be taken into
account as a factor in determining whether [Unum’s] decision was arbitrary and
capricious.”).
Roumeliote, 475 F. Supp. 2d at 746 (citation omitted). This term the United States Supreme Court
re-examined the manner in which reviewing courts are to assess the effect of an inherent conflict of
interest. Metro. Life Ins. Co. v. Glenn, 128 S.Ct. 2343 (2008). Particularly in light of the fact that
the Court was reviewing a decision of this circuit, we delayed our decision in this case until we could
ascertain whether the Court intended to alter the analysis. It did not. Rather, the Court expressly
approved of the approach first enunciated in Firestone, supra, and followed by this court in Glenn:
“[W]hen judges review the lawfulness of benefit denials, they will often take account of several
different considerations of which a conflict of interest is one.” Glenn, 128 S. Ct. at 2351.
In the instant case, the district court recognized the potential for an inherent conflict of
interest and weighed it as a factor. As with so many ERISA cases involving the denial of benefits,
the record contains medical evidence to support the positions of each party. For that reason, the
standard of review plays a particularly significant role, often tipping the balance in favor of the plan
administrator’s denial. That is the case here. We have had an opportunity to review the record, the
briefs of the parties, and have heard oral argument. Although we are sympathetic to plaintiff’s
position, we agree with the district court that the plan administrator’s decision was not arbitrary and
capricious. Because our analysis does not differ in any significant form from that provided by the
district court in its published decision, a reasoned opinion on our part would serve no useful purpose.
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No. 07-3256
Roumeliote v. Long Term Disability Plan
The judgment of the district court is affirmed.
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