Daniel Demer v. IBM Corp Ltd Plan

FOR PUBLICATION

UNITED STATES COURT OF APPEALS

FOR THE NINTH CIRCUIT

DANIEL G. DEMER, No. 13-17196 Plaintiff-Appellant, D.C. No. v. 4:11-cv-00441-JGZ

IBM CORPORATION LTD PLAN;

METROPOLITAN LIFE INSURANCE OPINION

COMPANY,

Defendants-Appellees.

Appeal from the United States District Court for the District of Arizona Jennifer G. Zipps, District Judge, Presiding

Argued and Submitted December 11, 2015 San Francisco, California

Filed August 26, 2016

Before: Jay S. Bybee and Morgan Christen, Circuit Judges, and Edward M. Chen, District Judge.*

Opinion by Judge Chen; Partial Concurrence and Partial Dissent by Judge Bybee

* The Honorable Edward M. Chen, United States District Judge for the Northern District of California, sitting by designation. SUMMARY**

Employee Retirement Income Security Act

The panel reversed the district court’s summary judgment in favor of the defendants in an action under the Employee Retirement Income Security Act, challenging the denial of a claim for long-term disability benefits.

The panel held that Metropolitan Life Insurance Company (“MetLife”),…

Partial Concurrence and Partial Dissent by Judge BYBEE

OPINION

Plaintiff-Appellant Daniel G. Demer filed suit, pursuant to the Employee Retirement Income Security Act of 1974 (“ERISA”), against Defendants-Appellees IBM Corporation LTD Plan (the “Plan”) and Metropolitan Life Insurance Company (“MetLife”). Mr. Demer claimed that Met-Life, the claim administrator and insurer for the Plan, improperly denied his claim for long-term disability (“LTD”) benefits. See 29 U.S.C. § 1132 (a)(1)(B) (providing that “[a] civil action may be brought ... by a participant or beneficiary ... 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”). The district court denied Mr. Dem-er’s motion for summary judgment, granted Defendants’ cross-motion, and entered judgment in favor of Defendants.

We reverse the district court’s entry of judgment in Defendants’ favor and remand to the district court with instructions to *896 remand this ease to MetLife to re-evaluate the merits of Mr. Demer’s LTD claim.

I.

A. Mr. Demer’s Claim for LTD Benefits

Mr. Demer was an employee of…

dissenting from Part II.B, but concurring in the judgment:

An ERISA plan administrator has a structural conflict of interest where it “both funds the plan and evaluates the claims.” Metropolitan Life Ins. Co. v. Glenn, 554 U.S. 105, 112 , 128 S.Ct. 2343 , 171 L.Ed.2d 299 (2008); see also Abatie v. Alta Health & Life Ins. Co., 458 F.3d 955, 965 (9th Cir. 2006) (en banc). The federal courts have offered at least two ways that such conflicts “should prove less important (perhaps to the vanishing point).” Metro. Life, 554 U.S. at 116 , 128 S.Ct. 2343 . First, administrators may “wall[] off claims administrators from those interested in firm finances.” Id.; Abatie, 458 F.3d at 969 & n.7 (an administrator may show that “any conflict did not influence its decisionmak-ing process” by showing that “its employees do not have incentives to deny claims”); Davis v. Unum Life Ins. Co. of Am., 444 F.3d 569, 575-76 (7th Cir. 2006) (holding that absent evidence of “any specific incentive [for the in-house doctors] to derail [a] claim,” such as giving the doctors “some specific stake in the outcome of [a] case,” the theoretical argument that “in-house doctors have an inherent conflict in every…