Tremain v. Bell Industries, Inc. (1999)

Tremain, 196 F.3d at 976.

That principle is consistent with Tremain, 196 F.3d at 976-79, which permits extrinsic evidence on the question of a conflict of interest.

See Firestone Tire and Rubber Co. v. Bruch, 489 U.S. 101, 115 (1989); Tremain v. Bell Indus., Inc. , 196 F.3d 970, 976 (9th Cir. 1999).

If the burden shifts and the plan administrator does not produce evidence that the apparent conflict of interest did not affect the decision to deny benefits, we will "review the decision de novo, without deference to the administrators tainted decision." Atwood, 45 F.3d at 1323 ; see also Lang, 125 F.3d at 797-98; Tremain, 196 F.3d at 977.

If the burden shifts and the plan administrator does not produce evidence that the apparent conflict of interest did not affect the decision to deny benefits, we will “review the decision de novo, without deference to the administrators tainted decision.” Atwood, 45 F.3d at 1323 ; see also Lang, 125 F.3d at 797-98; Tremain, 196 F.3d at 977.

That principle is consistent with Tremain, 196 F.3d at 976-79, which permits extrinsic evidence on the question of a conflict of interest.

The district court concluded that a 4-hour reduction was appropriate in light of its request to file the entire administrative record, because "it [was] not at all clear . . . that any discovery was appropriate." Because an ERISA plaintiff may be permitted to supplement the administrative record with evidence of a conflict of interest on the part of the defendant, see Tremain v. Bell Industries, Inc., 196 F.3d 970, 976-77 (9th Cir.1999), we agree with Welch that some discove…

The district court concluded that a 4-hour reduction was appropriate in light of its request to file the entire administrative record, because “it [was] not at all clear ... that any discovery was appropriate.” Because an ERISA plaintiff may be permitted to supplement the administrative record with evidence of a conflict of interest on the part of the defendant, see Tremain v. Bell Industries, Inc., 196 F.3d 970, 976-77 (9th Cir.1999), we agree with Welch that some discovery…

“Our review in such a circumstance, although still for abuse of discretion, is ‘less deferential.’ ” Tremain, 196 F.3d at 976 (citations omitted).

Tremain, 196 F.3d at 975; Friedrich v. Intel Corp., 181 F.3d 1105, 1109 (9th Cir.1999).

In order to weigh a conflict more heavily, the claimant 8 must provide “material, probative evidence, beyond the mere fact 9 of the apparent conflict, tending to show that the fiduciary’s 10 self-interest caused a breach of the administrator’s fiduciary 11 obligations to the beneficiary.” Tremain, 196 F.3d at 976; see 12 also Abatie, 458 F.3d at 968 .

“Evidence that meets this standard need not satisfy the strict rules for the admissibility of evidence in a civil trial, and may be considered so long as it is relevant, probative, and bears a satisfactory indicia of reliability.” Tremain v. Bell Industries, Inc., 196 F.3d 970, 978 (9th Cir.1999). “[E]xceptional circumstances where introduction of evidence beyond the administrative record could be considered” include (1) “claims that require consideration of complex medical …

Tremain v. Bell Industries, Inc., 196 F.3d 970, 976-77 (9th Cir.1999).

As will be discussed further below, the Court finds that MET applied the wrong definition of disability, see Tremain v. Bell Industries, Inc., 196 F.3d 970, 977 (9th Cir.1999), fáiled to credit Plaintiffs substantial evidence of serious medical conditions, see Black & Decker Disability Plan v. Nord, 538 U.S. 822, 830 , 123 S.Ct. 1965 , 155 L.Ed.2d 1034 (2003), and failed to adequately investigate, the claim or request available evidence when the lack of that evidence in the …

A at 2) See Tremain, 196 F.3d at 976 (“In this case, [the plan administrator] both funds the [plan] and acts as the plan’s administrator.

That principle is consistent with Tremain v. Bell Industries, Inc., 196 F.3d 970, 976-79 (9th Cir.1999), which permits extrinsic evidence on the question of a conflict of interest.

Tremain v. Bell Industries, Inc., 196 F.3d 970, 976 (9th Cir.1999).

Tremain v. Bell Industries, Inc., 196 F.3d 970, 976 (9th Cir.1999).

Tremain v. Bell Industries, Inc., 196 F.3d 970, 976 (9th Cir.1999).

Tremain v. Bell Industries, Inc., 196 F.3d 970, 976-77 (9th Cir.1999)(“In determining whether a plan administrator’s conflict of interest affected its decision to deny benefits, evidence outside the administrative record may be considered.”).

(Tremain v. Bell Industries, Inc., 196 F.3d 970, 977 (9th Cir.1999)); [3] the plan administrator determines a material fact for which there is no supporting evidence, See Id.; [4] the plan administrator fails to follow plan procedures.

Atwood, 45 F.3d at 1323 ; Tremain, 196 F.3d at 976.

Firestone Tire & Rubber Co. v. Bruch, 489 U.S. 101, 155 , 109 S.Ct. 948, 956-57 , 103 L.Ed.2d 80 (1989); Tremain v. Bell Industries, Inc., 196 F.3d 970, 976 (9th Cir.1999).

Tremain v. Bell Industries, Inc., 196 F.3d 970, 978 (9th Cir.1999).

See Burrey, 159 F.3d at 392 (applying de novo review where there is a question of law); Tremain v. Bell Industries, Inc., 196 F.3d 970, 977-78 (9th Cir.1999) (where the plaintiff sued under ERISA and the court determined that there was a conflict of interests warranting a de novo review and decided the case by summary judgment).

Tremain v. Bell Industries, Inc., 196 F.3d 970, 976-77 (9th Cir.1999); Abatie, 458 F.3d at 970 .

The Court finds that these documents lack the indicia of reliability required under Tremain, 196 F.3d at 978, and it declines Plaintiffs request.

Tremain v. Bell Industries, Inc., 196 F.3d 970, 976-77 (9th Cir.1999).

Tremain v. Bell Industries, Inc., 196 F.3d 970, 976-77 (9th Cir.1999).

MetLife both administers the plan and pays the benefits; this creates a “structural conflict of interest.” Abatie, 458 F.3d at 965 , citing Tremain v. Bell Industries, Inc., 196 F.3d 970, 976 (9th Cir.1999).

Tremain v. Bell Industries, Inc., 196 F.3d 970, 978 (9th Cir.1999).

The Ninth Circuit cited to its earlier decision in Mongeluzo v. Baxter Travenol Long Term Disability Benefit Plan, 46 F.3d 938 (9th Cir. 1995) and advised that a district court should admit evidence outside the record when that evidence “ ‘is necessary to conduct an adequate de novo review of the benefit decision.’ ” Tremain, 196 F.3d at 978 (citations omitted and emphasis added).

Tremain v. Bell Industries, Inc., 196 F.3d 970, 976 (9th Cir.1999); see also Nord v. Black & Decker Disability Plan, 356 F.3d 1008, 1010 (9th Cir.), cert. denied, - U.S. - — , 125 S.Ct. 62 , 160 L.Ed.2d 20 (2004) (same); Alford v. DCH Foundation Group Long-Term Disability Plan, 311 F.3d 955, 957 (9th Cir.2002) (same).

Tremain v. Bell Industries, Inc., 196 F.3d 970, 976 (9th Cir.1999) (quoting Lang v. Long-Term Disability Plan of Sponsor Applied Remote Technology, Inc., 125 F.3d 794, 798 (9th Cir.1997)).

Id. (citing Tremain v. Bell Industries, Inc., 196 F.3d 970, 976 (9th Cir.1999)).

See, e.g., Tremain v. Bell Indus., Inc., 196 F.3d 970 , 976 (9th Cir.1999) (when a claimant produces evidence that a plan administrator’s self-interest caused a breach of the administrator’s fiduciary obligations to the claimant, a rebuttable presumption arises in favor of the claimant and the plan bears the burden of proving that a conflict of interest did not affect its decision to deny or terminate benefits). 2 We clearly limited this burden-shifting approach to abuse-of-…

See Tremain v. Bell Indus., Inc., 196 F.3d 970 , 976 (9th Cir.1999).

See, e.g., Tremain v. Bell Indus., Inc., 196 F.3d 970 , 975-76 (9th Cir.1999).

Taft v. Equitable Life Assurance Soc’y, 9 F.3d 1469, 1472 (9th Cir.1993); see also Tremain v. Bell Indus., Inc., 196 F.3d 970 , 976-77 (9th Cir.1999).

See Tremain v. Bell Industries, Inc., 196 F.3d 970, 978 (9th Cir.1999).

Co., 458 F.3d 955, 970 (9th 25 Cir. 2006); see also Tremain v. Bell Industries, Inc., 196 F.3d 970 , 976–79 (“In determining 26 whether a plan administrator’s conflict of interest affected its decision to deny benefits, evidence 27 outside the administrative record may be considered.”). 28 /// 1 Here, the crux of Plaintiff’s argument is that there were structural and procedural conflicts 2 of interest, as Defendant’s administrator worked in the termination decision and the a…

See Tremain v. Bell Industries, Inc., 196 F.3d 970, 977 (9th Cir. 26 1999). 1 Plaintiff argues that any such delegation, to the extent it was effective, did not extend to 2 the IRO who provided the external review in this case.

See Tremain v. Bell Industries, Inc. , 196 F.3d 970 , 978 (9th Cir. 1999) (evidence "need not satisfy the strict rules for the admissibility of evidence in a civil trial, and may be considered so long as it is relevant, probative, and bears a satisfactory indicia of reliability.").

See Tremain v. Bell Indus., Inc., 196 F.3d 970 , 978 (9th Cir. 1999).

See Tremain v. Bell Indus., Inc., 196 F.3d 970 , 978 (9th Cir.1999).

If the plan fails to carry this burden, then the Court will review the denial of benefits de novo. 8 Id.; see also Tremain v. Bell Indus., 196 F.3d at 976.

“The district court may, in its discretion, consider evidence outside the administrative record to decide the nature, extent, and effect on the decision-making process of any conflict of interest .... ” Abatie, 458 F.3d at 970 ; see also Tremain v. Bell Indus., 196 F.3d 970 , 976-77 (9th Cir.1999). 3.

See Tremain, 196 F.3d at 977 (9th Cir.1999) (characterizing whether the plan administrator’s conflict of interest affected its decision to deny benefits as a “threshold issue” that must be decided before a court can determine the applicable standard of review, and explaining that evidence of conflict of interest found outside the administrative record may be considered to determine if the plan administrator’s decision was affected by such conflict).

See, e.g., Tremain, 196 F.3d at 977; Lang, 125 F.3d at 799.

See, e.g., Tremain v. Bell Industries, 196 F.3d 970 (9th Cir.1999).