Beth Cosey v. The Prudential Insurance Company
735 F.3d 161
4th Cir.2013Background
- Plaintiff Beth Cosey, a BioMerieux employee, claimed short-term (STD) and long-term (LTD) disability benefits administered by Prudential; Prudential approved short payments then denied continued benefits for insufficient evidence.
- Medical records were mixed: some treating physicians supported disability; Prudential medical reviewers found no objective impairment; surveillance suggested active ability to work.
- Cosey exhausted administrative appeals; the plan administrator upheld denials and declared her ineligible for LTD.
- District court applied abuse-of-discretion review and granted summary judgment to Prudential, alternatively stating that even under de novo review Cosey lacked required objective proof.
- Fourth Circuit considered whether plan language (“submit proof of continuing disability satisfactory to Prudential”) unambiguously confers discretionary authority and whether plans require objective evidence of disability.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether LTD plan language (“proof satisfactory to Prudential”) grants administrator discretionary authority under ERISA | Cosey: language is ambiguous; should be reviewed de novo | Prudential: phrase unambiguously vests discretion; abuse-of-discretion review applies | Phrase is ambiguous; does not unambiguously confer discretion; de novo review required |
| Whether STD (ERISA-exempt) plan grants administrator discretion under applicable state contract law | Cosey: identical/similar “satisfactory proof” language is ambiguous; construable against insurer | Prudential: ASA or other documents confer discretion; STD plan gives administrator authority | STD plan language ambiguous; no discretionary grant; de novo review required |
| Whether district court correctly required objective evidence of disability | Cosey: plans do not require an “objective component”; subjective complaints may be considered | Prudential: proof language implies objective proof is required to deny subjective claims | Court erred: neither plan imposes an objective-proof requirement; denial cannot rest on lack of objective evidence alone |
| Whether the district court’s summary judgment should stand despite standard error | Cosey: incorrect standard and objective-proof requirement vitiate summary judgment | Prudential: alternative de novo analysis purportedly supports same outcome | Reverse: district court used incorrect standard and improper objective-proof rule; judgment vacated and remanded for de novo review |
Key Cases Cited
- Firestone Tire & Rubber Co. v. Bruch, 489 U.S. 101 (establishing deferential review if plan grants discretion)
- Gallagher v. Reliance Standard Life Ins. Co., 305 F.3d 264 (4th Cir.) (requires clear grant of discretion in plan language)
- Feder v. Paul Revere Life Ins. Co., 228 F.3d 518 (4th Cir.) (discretion must be expressly created)
- DuPerry v. Life Ins. Co. of N. Am., 632 F.3d 860 (4th Cir.) (plan without objective-proof bar permits reliance on subjective complaints)
- Williams v. Metro. Life Ins. Co., 609 F.3d 622 (4th Cir.) (discussing Firestone standard)
- Diaz v. Prudential Ins. Co. of Am., 424 F.3d 635 (7th Cir.) (holding “satisfactory to us” language ambiguous)
- Kinstler v. First Reliance Standard Life Ins. Co., 181 F.3d 243 (2d Cir.) (construing similar language narrowly)
- CIGNA Corp. v. Amara, 131 S. Ct. 1866 (Supreme Court) (summary plan descriptions do not themselves alter plan terms)