Opinion
Editorial Note:
This opinion appears in the Federal reporter in a table titled "Table of Decisions Without Reported Opinions". (See FI CTA9 Rule 36-3 regarding use of unpublished opinions)
Argued and Submitted April 16, 1999.
Appeal from the United States District Court for the Eastern District of California, Milton L. Schwartz, District Judge, Presiding.
Before BEEZER, TROTT and KING, Circuit Judges.
This disposition is not appropriate for publication and may not be cited to or used by the courts of this circuit except as provided by Ninth Circuit Rule 36-3.
Linda Hendrix appeals the district court's denial of her claim to recover long-term disability benefits from Standard Insurance Company ("Standard") under a group insurance policy governed by the Employee Retirement Income Security Act ("ERISA"). Hendrix contends that the district court incorrectly applied an abuse of discretion standard of review, admitted testimony regarding Standard's handling of the claim and determined that substantial evidence supported Standard's denial of additional benefits. We have jurisdiction pursuant to 28 U.S.C. § 1291 and we affirm.
I
We review de novo the trial court's choice and application of the appropriate standard of review. See Lang v. Long-Term Disability Plan of Sponsor Applied Remote Tech., Inc., 125 F.3d 794, 797 (9th Cir.1997). Both parties agree that Standard had the authority to determine eligibility for benefits and to construe the terms of the plan. Hendrix argues that because Standard had a conflict of interest, as both insurer and administrator, we should apply a heightened level of scrutiny. "We ultimately apply a traditional abuse of discretion standard to the decisions of apparently conflicted employer- or insurer-fiduciaries unless the affected beneficiary comes forward with further evidence indicating that the conflicting interest caused a breach of the administrator's fiduciary duty to the beneficiary." Atwood v. Newmont Gold Co., 45 F.3d 1317, 1322-23 (9th Cir.1995) (emphasis in original). If the affected beneficiary does not provide material, probative evidence that the fiduciary's self-interest caused a breach of the administrator's fiduciary obligations, we review for an abuse of discretion. See id. at 1323.
The district court correctly determined that Hendrix failed to produce any material, probative evidence that Standard's decision was influenced by self-interest. Dr. Bradley Fancher testified that he was employed full-time as an internist in private practice when he was hired to consult for Standard. There is no evidence that he had any financial incentive to render an opinion that was adverse to Hendrix. Additionally, there was no evidence of improper motives on the part of Linda Wheeler, the Quality Assurance Specialist who made the final decision on Hendrix's claim. She was a salaried Standard employee who had previously authorized chronic fatigue syndrome claims.
II
Hendrix argues that the district court erred by allowing additional testimony from Standard because it was beyond the scope of the administrative record. Evidentiary rulings are reviewed for an abuse of discretion. See Russian River Watershed Protection Comm. v. City of Santa Rosa, 142 F.3d 1136, 1144 n.6 (9th Cir.1998).
The testimony was necessary for the district court to determine whether Standard's self-interest affected its decision. If a benefit plan gives discretion to an administrator or fiduciary who is operating under a conflict of interest, that conflict must be weighed as a factor in determining whether there is an abuse of discretion. See Firestone Tire & Rubber Co. v. Bruch, 489 U.S. 101, 115 (1989).
We have allowed the testimony of medical experts in ERISA insurance claim cases. See Barnett v. Kaiser Found. Health Plan, Inc., 32 F.3d 413, 416-17 (9th Cir.1994) (permitting doctor to testify at deposition and trial concerning medical criteria relied on by decision maker). Here, the admission was proper because the testimony did not reach matters that had not already been set forth in the administrative record. Cf. Taft v. Equitable Life Assur. Soc., 9 F.3d 1469, 1472 (9th Cir.1994) (reversing where district court allowed doctor's testimony that was not in administrative record); Snow v. Standard Ins. Co., 87 F.3d 327, 332-33 (9th Cir.1996) (reversing where district court directed the taking of additional evidence).
III
The record contains substantial evidence supporting Standard's contention that Hendrix's history of depression precludes her from fulfilling the second criteria of a chronic fatigue syndrome diagnosis. Dr. David Franck concluded that the clinical records lack "documentation of many of the minor and physical criteria" and that a diagnosis of depression "could easily explain most, if not all, of the claimant's symptoms." Hendrix's file was also reviewed by Dr. Fancher and a neuropsychologist, both of whom concluded that a diagnosis of chronic fatigue syndrome is not supported by the medical evidence. Medical records from Hendrix's past support this conclusion by indicating that she had suffered from major depression and was represcribed anti-depressive medications around the same time that her symptoms began.
AFFIRMED.