[DO NOT PUBLISH]
IN THE UNITED STATES COURT OF APPEALS
FOR THE ELEVENTH CIRCUIT
________________________ FILED
U.S. COURT OF APPEALS
No. 09-10695 ELEVENTH CIRCUIT
OCTOBER 2, 2009
Non-Argument Calendar
THOMAS K. KAHN
________________________
CLERK
D. C. Docket No. 04-02831-CV-2-IPJ
SUSAN KEITH,
Plaintiff-Appellant,
versus
THE PRUDENTIAL INSURANCE COMPANY OF AMERICA,
d.b.a. Prudential Financial,
Defendant-Appellee.
________________________
Appeal from the United States District Court
for the Northern District of Alabama
_________________________
(October 2, 2009)
Before MARCUS, WILSON and ANDERSON, Circuit Judges.
PER CURIAM:
This case comes before us a third time. Susan Keith again appeals the
district court’s decision ruling in favor of the defendant Prudential Insurance
Company of America (“Prudential”) in Keith’s action for long-term disability
benefits. The background facts are detailed in our first opinion remanding this
case. See Keith v. Prudential Ins. Co. of Am., 256 F. App’x 347 (11th Cir. 2007)
(“Keith I”). On October 23, 2008, we remanded Keith’s case a second time for the
district court to consider her claim as to steps three and six with the benefit of our
decisions in Oliver v. Coca Cola Co., 497 F.3d 1181, vacated in part on petition
for reh’g, 506 F.3d 1316 (11th Cir. 2007), and Doyle v. Liberty Life Assurance Co.
of Boston, 542 F.3d 1352 (11th Cir. 2008). See Keith v. Prudential Ins. Co. of Am.,
297 F. App’x 879 (11th Cir. 2008) (per curiam) (“Keith II”). Having throughly
considered the record and the parties’ briefs, we now affirm.
A. Step 3
We have required courts to employ a six-step analysis “for use in judicially
reviewing virtually all ERISA-plan benefit denials.” Williams v. BellSouth
Telecomms., 373 F.3d 1132, 1137-38 (11th Cir. 2004). We have described step 3
of the six-step analysis as follows: “If the administrator’s decision is ‘de novo
wrong’ and he was vested with discretion in reviewing claims, then determine
whether ‘reasonable’ grounds supported it (hence, review his decision under the
more deferential arbitrary and capricious standard).” Id. at 1138.
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No question exists that Prudential had discretionary authority to determine
eligibility or to construe the terms of the Plan. The Plan expressly and
unambiguously states that Prudential “has the sole discretion to interpret the terms
of the Group Contract, to make factual findings, and to determine eligibility for
benefits.” In addition, the policy expressly state that Prudential’s decision “shall
not be overturned unless arbitrary and capricious.”
In Oliver, we held that “[u]nder the arbitrary and capricious standard of
review, the plan administrator’s decision to deny benefits must be upheld so long
as there is a ‘reasonable basis’ for the decision.” 497 F.3d at 1195 (citation
omitted). “The district court’s review of the plan administrator’s denial of benefits
should be limited to consideration of the material available to the administrator at
the time it made its decision.” Id. (internal quotations, citation, and alteration
omitted). We held that “we begin with the language of the Plan itself” in
determining whether a plan administrator’s denial of benefits was arbitrary and
capricious. Id. (citing 29 U.S.C. § 1104(a)(1)(D)).
Prudential’s policy defines “disabled” as “when Prudential determines that:
you are unable to perform the material and substantial duties of your regular
occupation due to your sickness or injury; and you have a 20% or more loss in
your indexed monthly earnings due to that sickness or injury.” The policy also
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requires that a claimant may have to submit “proof” of continuing disability
“satisfactory to Prudential,” including: (1) that the claimant is under the regular
care of a doctor; (2) the appropriate documentation of the claimant’s monthly
earnings; (3) the date the disability began; (4) appropriate documentation of the
disabling disorder; (5) the extent of the disability, including restrictions and
limitations that prevent the claimant from performing his or her regular occupation;
(6) the name and address of any hospital or institution where the claimant received
treatment, including all attending doctors; and (7) the name and address of any
doctor the claimant has seen.
Applying Oliver in light of our remand order, the district court found that
unlike the plan administrator in Oliver, Prudential never refused to consider
subjective evidence of Keith’s disability. Instead, Prudential determined that
Keith’s complaints were no different than they had been during the time that Keith
was able to successfully perform her job duties with reasonable accommodations
from her employer. After a thorough review of the policy and the medical
evidence, the district court concluded that Prudential’s decision was neither
arbitrary nor unreasonable. We agree.
Contrary to Keith’s contention, the Oliver policy and the policy here differ
significantly in terms of their requirements for disability. In Oliver, the plan
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merely required a disabled participant to submit “a written application on a form
provided by his employer” as well as a “medical certification” of his disability for
the claimant to receive benefits. Oliver, 497 F.3d at 1196. We specifically noted
that no provision of the Oliver plan required “objective evidence” of disability. Id.
Here, however, the plan requires a claimant to present “proof” of her claim,
including the “appropriate documentation of the disabling disorder” as well as the
“extent of [the claimant’s] disability, including restrictions and limitations
preventing [the claimant] from performing [her] regular occupation or gainful
occupation.” The plan further provides that such proof must be “satisfactory to
Prudential.” These requirements are not per se unreasonable. See Wangenstein v.
Equifax, Inc., 191 F. App’x 905, 913-14 (11th Cir. 2006) (it is not unreasonable for
the plan administrator to demand objective evidence where the plan administrator
has discretion to determine what it considers adequate “proof” of disability).
Further, unlike in Oliver, Prudential did not “ignore” or “disregard” certain
evidence. Prudential has never disputed any of Keith’s conditions. Rather,
Prudential recognized that Keith had the conditions for many years and had
managed to perform her job despite the conditions. Indeed, Keith herself stated
that her condition had not deteriorated since she stopped working and she did not
expect it to. The opinions of Keith’s six medical examiners and two chiropractors
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included a wide-range of medial diagnoses—from a “normal” physical
examination to noting that Keith “looked great” to extremely tender trigger points.
As the district court noted in its thorough recount of the medical evidence,
Prudential had this evidence reviewed by a registered nursed, a board-certified
medical consultant, and an independent medical professional, all of whom reached
the same conclusion—that the evidence did not support a claim of disability.
In any event, the record does not indicate that Prudential denied benefits
based on Keith’s failure to offer objective medical evidence. To the contrary,
Prudential considered Keith’s subjective complaints. Relying on the opinions of
three medical professionals, Prudential denied benefits because all of the record
evidence, including Keith’s subjective complaints of pain, did not support a finding
that she could not perform sedentary work. Like the district court, we cannot
conclude that Prudential’s decision was arbitrary or unreasonable.1
B. Step 6
In Doyle, we held that the Supreme Court’s decision in Metropolitan Life
Ins. Co. v. Glenn, 128 S. Ct. 2343, 2350 (2008), abrogated the burden-shifting,
heightened arbitrary and capricious standard of review that we had previously
1
As the district court also noted, whether we agree with Prudential is irrelevant. The
issue before us is only whether the plan administrator reached its decision in a reasonable and
non-arbitrary manner. If so, we must affirm the decision. Williams, 373 F.3d at 1138.
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applied in ERISA benefits cases. Doyle, 542 F.3d at 1359. We held “that the
existence of a conflict of interest should merely be a factor for the district court to
take into account when determining whether an administrator’s decision was
arbitrary and capricious.” Id. at 1360. We further held that
while the reviewing court must take into account an
administrative conflict when determining whether an
administrator’s decision was arbitrary and capricious, the
burden remains on the plaintiff to show the decision was
arbitrary; it is not the defendant’s burden to prove its
decision was not tainted by self-interest.
Id.
The district court, following our direction in the remand order, specifically
considered Keith’s claim as to step 6 in light of Glenn and Doyle. The district
court found that Prudential was vested with discretion, that Prudential’s decision
was reasonable, and that Prudential operated under a conflict of interest. Because
the court found that Prudential’s denial of benefits was not arbitrary or
unreasonable, the only remaining question was whether Prudential’s conflict of
interest tainted its decision. See id.
Keith submits that Doyle is inapposite here because the Doyle policy
required objective proof of disability while the policy at issue here did not. This
argument is misplaced. Nonetheless, Keith maintains that Prudential’s
independent reviewers failed to consider all of the relevant evidence by specifically
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ignoring Keith’s subjective evidence of pain. We are unpersuaded.
The district court found, for a third time, that no evidence existed to show
that Prudential was influenced by the conflict. We agree. At each level of review,
Prudential considered Keith’s evidence. It obtained the opinions of three different
medical professionals regarding Keith’s disability. When Keith asked for
reconsideration of Prudential’s denial, Prudential again considered the evidence
and sought further evidence, including investigating the previous accommodations
made for Keith by her supervisor. The evidence shows that Prudential thoroughly
investigated Keith’s claim.
Like the plaintiff in Doyle, Keith had substantial medical problems—no
party disputes that. However, because Prudential was vested with discretion to
determine eligibility, the courts owe deference to Prudential’s determination. And
as in Doyle, we cannot say that Prudential abused its discretion in denying Keith
benefits. Accordingly, we affirm the district court’s judgment in favor of
Prudential.
AFFIRMED.
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