Terri Gatti v. Reliance Standard Life Insurance Company, Terri Gatti v. Reliance Standard Life Insurance Company

AMENDED OPINION

Reliance Standard Life Insurance Company (“Reliance”) appeals the district court’s summary judgment in favor of Terri Gatti in her action brought under the Employee Retirement Income Security Act (“ERISA”) for reinstatement of long term disability benefits. The district court reviewed Reliance’s decision to terminate Gatti’s benefits de novo, because it interpreted an ERISA regulation as placing a temporal limitation on the administrator’s discretion and because it found Reliance to have a serious conflict of interest. The district court erred in applying de novo review. We reverse and remand.

I

Appellant Reliance, which provided long term disability coverage for employees of Paine Webber Group, approved appellee Gatti for long term disability benefits effective May 24, 1993, based on complications related to Hepatitis B. Almost seven years later, in April 2000, Reliance concluded that Gatti was no longer suffering from complications related to Hepatitis B, but that her disability was caused by a mental disorder. Reliance apparently *981 based this determination on tests indicating that Gatti’s Hepatitis B was inactive as of 1997, and on physicians’ reports that…

concurring in part and in the judgment:

I agree that we must reverse because of the intervening reversal of the “treating physician rule” in Black & Decker Disability Plan v. Nord, 538 U.S. 822 , 123 S.Ct. 1965 , 155 L.Ed.2d 1034 (2003). However, while I understand the majority’s basis for distinguishing Jebian v. Hewlett-Packard, 349 F.3d 1098 (9th Cir.2003), I am hard-pressed to say that “deemed denials” can mean one thing if embedded in a Plan and another if established by regulation. I therefore part company on this issue.

415 F.3d 978 Terri GATTI, Plaintiff-Appellee, v. RELIANCE STANDARD LIFE INSURANCE COMPANY, Defendant-Appellant. Terri Gatti, Plaintiff-Appellee, v. Reliance Standard Life Insurance Company, Defendant-Appellant. No. 03-15562. No. 03-16183. United States Court of Appeals, Ninth Circuit. Argued and Submitted October 6, 2004. Submission Deferred October 8, 2004. Resubmitted May 31, 2005. Filed May 31, 2005. Amended Opinion and Concurrence Filed July 22, 2005. COPYRIGHT MATERIAL OMITTED Joshua Bachrach, Rawle & Henderson, LLP, Philadelphia, PA, for the appellant. Barry Kirschner, Waterfall, Economidis, Caldwell, Hanshaw & Villamana, P.C., Tuscon, AZ, for the appellee. Appeal from the United States District Court for the District of Arizona, Frank Zapata, District Judge, Presiding. D.C. No. CV-01-00175-FRZ. Before: RYMER, TALLMAN, and BEA, Circuit Judges. AMENDED OPINION TALLMAN, Circuit Judge. 1 Reliance Standard Life Insurance Company ("Reliance") appeals the district court's summary judgment in favor of Terri Gatti in her action brought under the Employee Retirement Income Security Act ("ERISA") for reinstatement of long term disability benefits. The district court reviewed…