Kathy Dine v. Metropolitan Life Insurance Co

MEMORANDUM

Kathy Dine brought this ERISA action against Metropolitan Life Insurance Company (“MetLife”), the administrator of her former employer’s long-term disability benefits plan. She contends the plan abused its discretion by terminating her long-term disability benefits. We agree and reverse and remand for further proceedings.

It is undisputed that MetLife’s denial of benefits is reviewed for abuse of discretion, and that MetLife has a structural conflict of interest because it “both evaluates claims for benefits and pays benefits claims.” Metropolitan Life Ins. Co. v. Glenn, 554 U.S. 105, 112 , 128 S.Ct. 2343 , 171 L.Ed.2d 299 (2008). When structural conflict exists “the court must consider numerous case-specific factors, including the administrator’s conflict of interest, and reach a decision as to whether discretion has been abused by weighing and balancing those factors together.” Montour v. Hartford Life & Accident Ins. Co., 588 F.3d 623, 630 (9th Cir.2009). “[A] higher degree of skepticism is appropriate where the administrator has a conflict of interest.” Salomaa v. Honda Long Term Disability Plan, 642 F.3d 666, 676 (9th Cir.2011). The administrator has the burden…