*1 that appel- nóte10 on the basis National’s failure Because the not bar the action. do repurchase agreements utilize the voids prong the first of to show that lants cannot satisfied, appellants under the any obligations we need analysis has been the appellants’ guaranty. note and Because the D’Oench doctrine not decide whether repurchase agreement defense is without claims.9 appellants’ bar would merit, the district court’s award is af- pro are unable to appellants The firmed. that the re indicating duce create question purchase agreements CONCLUSION if they that claim. Even obligations the in the note that vague reference reasons, foregoing judgment For the as shown in repayment terms “[o]ther of the district court is affirmed. repurchase agreements” manufacturers AFFIRMED doctrine’s satisfy D’Oench sufficient properly requirement agreements be records, appel
reflected the bank’s produced repurchase
lants have not Marvin J.
agreements question. self-serving describing affidavit
Barnes’ repurchase agreements
the content enough to defeat National’s motion v. summary judgment. See Anderson Inc., Lobby, 477 U.S.
Liberty (holding
S.Ct. 91 L.Ed.2d for summary
that to withstand a motion non-moving party must judgment, BOOTH, Plaintiff-Appellee, A. Barbara which a rea evidence on proffer sufficient favor). find in its jury sonable could STORES, INCORPORAT WAL-MART
IV. AND ED HEALTH ASSOCIATES PLAN, as appellants appeal the district court’s WELFARE sued Wal-Mart fees, costs, Stores, Incorporated, Defendant-Ap ac- attorneys’ award provisions of the pellant. crued interest under the thereunder, and Southern Nat’l including obligor, nal See con- note. terest Citizens Lanford, 313 S.C. 443 S.E.2d temporaneously acquisition of the Bank v. with the institution, guarantor (holding depository asset party to the note and could not (C) was not a approved by the board of directors impairment defenses based on avail himself of depository institution or its loan com- Here, however, collateral). appellants mittee, approval shall be reflected in- committee, produce sufficient evidence have failed the minutes of said board or prece- dicating of a condition been, the existence (D) continuously, from the time has dent, whether the and we need not decide execution, record of the de- of its an official apply guar- precedent would to the condition pository institution. anty contract. whether, question of 9. There is also a serious representations assuming appellants’ part, provided, pertinent The note valid, agreements repurchase are ''[ujnpaid principal about the due at matu- and interest demand, repur- guaranty incorporates the rity, upon contract shall bear interest precedent agreements paid chase condition forth above until in full. the rate set maturity liability. paid at South Carolina courts have said this Note is not the event that agrees pay guarantors undersigned all costs rights duties of ... that the rights expenses makers the Holder in the collection and duties of distinct from Note, attorneys’ including guaranty payment reasonable of this of notes and origi- separate distinct from the fees.” contract *2 Booth, Plaintiff-Appellant, A. Barbara Stores, Incorporated Associ
Wal-Mart Plan, Health and sued as
ates Welfare Stores, Incorporated, De
Wal-Mart
fendant-Appellee. 98-2326,
Nos. 98-2348. Appeals,
United Court of States
Fourth Circuit.
Argued Oct. 14, 2000.
Decided Jan. *3 Abel, Ashley Bryan
ARGUED: Jack- son, Lewis, Krupman, & Schnitzler Green- Carolina, ville, Appellant. John South Heard, P.C., Heard, H. Dan- Howard John ville, BRIEF: Virginia, Appellee. ON Rademaekers, Jackson, Lewis, Iwana Dallas, Texas, Krupman, Schnitzler & Appellant. NIEMEYER, MURNAGHAN,
Before TRAXLER, Judges. Circuit Judge by published opinion. Reversed opinion, in which NIEMEYER wrote Judge Judge MURNAGHAN joined. Judge TRAXLER concurring wrote a MURNAGHAN opinion.
OPINION NIEMEYER, Judge: Circuit medical care for chest seeking After A. pain in late November Barbara cardiac catheteriza- Boоth received left angiography, followed coronary tion with a 75% coronary angioplasty to clear coronary artery. right in her blockage reimbursement of her filed a claim for She plan, employee benefit expenses under her had enrolled four months in which she earlier, plan performed administrator denied a left cardiac catheterization but plan’s preexisting coronary angiography con- with and left ventri- the claim under the culography on December dition exclusion. procedure Through (during which a plan Claiming that administrator small catheter is inserted into the femoral wrongfully denied benefits to she artery groin up in the and threaded into entitled, against Booth filed this action heart, allowing in the car- the arteries 502(a)(1)(B) Em- under dye diologist coronary to shoot into ployee Security Retirement Income Act of thereby spot arteries and Zak- blockages), 1132(a)(1)(B). (“ERISA”), 29 U.S.C. that the middle hary segment learned concluded, after a bench The district right coronary artery had a 75% trial, administrator had him (blockage), prompting stenosis to rec- benefits, denying abused its discretion in *4 coronary ommend Booth receive a remanded the matter to the administrator (in angioplasty which a small balloon is in light for reconsideration of the court’s blockage inflated within the in order to opinion, Booth’s for granted and motion open artery). Dr. Behar Victor S. аttorneys fees. performed coronary angioplasty we conclude that the ad- Because coronary artery right Booth’s on Decem- ministrator could not be found to have Upon discharge, ber her Booth contractually abused its conferred discre- diagnosed coronary artery was with dis- case, tion the circumstances of this angina, hyperlipidemia, ease with unstable reverse. hypertension, anxiety. sought Booth from the reimbursement I $30,887.18 Plan to cover the in medical Booth, employee Barbara A. a full-time expenses that she incurred in relation to Stores, Inc., Wal-Mart enrolled Wal- coronary angioplasty procedures. Mart’s employee self-funded bеnefit Plan claim determining denied her after (the “Plan”) 29, 1994, July on when she that her condition existed before she en- became eligible parties do so. The Plan secondary rolled or was a agree governed that the Plan by ERISA complication condition preexisting or of a “employee constitutes an welfare ben- condition and that expenses her were plan” by efit as defined 29 U.S.C. preexist- therefore excluded the Plan’s 1002(1). sponsor Wal-Mart is the provision. provision condition That Plan but does not act as the Plan trustee. reads: Plan, The “administrator” of the as that payable Benefits shall be for the 1002(16)(A), term is defined in 29 U.S.C. following:
is the Plan’s Administrative Committee. Pre-existing conditions. In late November roughly Any charges respect partic- four with any Plan, subscribing illness, months after to the ipant any injury, for symp- experienced Booth pain, chest which re- (including secondary tom conditions curred over the days. complications) course five Her medically which was general physician sent her to be examined existing, documented as or for which by Dr. Zakhary, treatment, service, Boshra G. a cardiologist, medical pre- medical who recorded that Booth scriptions expense suffered from or other medical hypertension, hypertensive cardiovascular incurred within 12 months preceding disease, (excess and hyperlipidemia fat in the effective date of these benefits as blood). pain, Because of participant, Booth’s chest to that shall be considered which was consistent with mul- angina, pre-existing eligible her not be shall tiple coronary risk factors for artery dis- for benefits under Medical this Cover- ease, EKG, Zakhary and her abnormal age, participant until the has con- been that, although none of the relevant the Medical ed covered under
tinuously (Pre- coronary diagnosed artery medical records months. Coverage 12 consecutive disease, Behar, performed who Booth’s any diag- include Dr. conditions existing condition.) coronary angioplasty, had indicated undiagnosed nosed or coronary artery Booth’s diseаse dated claim, the denial of her appealed Booth back to 1986 when she was evaluated for previ- that she had been treated asserting pain.1 during chest Allen noted that pressure and choles- blood ously high exclusionary period taking Booth was Car- heart condition. terol but not dizem, only a medicine “effective not Also, general Koplen, Dr. A. Booth’s Julian artery coronary but also dis- provided most of her medi- who physician, angina.” ease exclusionary the 12-month during cal care Plan, Administrative The Plan’s period before her enrollment August met on to consider stating Plan that he a letter to the sent postpone and decided to appeal records and fоund no reviewed Booth’s had meeting decision until its next order coronary artery preexisting file another medical review obtain explained that the abbrevia- disease. He practitioner, Dr. James H. general “PVI,” appeared his treat- tion Dr. Arkins. It made this decision because Booth, “peripher- denoted ment records of practitioner and had Koplen general was a insufficiency” (incompetent veins al venous *5 Allen, Dr. a disputed the conclusion of blood), not pooling in legs, resulting in Koplen’s that records con- cardiologist, (insuffi- insufficiency” vascular “peripheral coronary preexisting tained evidence of resulting in supply, arterial blood cient symptoms suggest to heart disease blood to difficulty supplying oxygenated condition. limbs). records, Dr. Ar- reviewing After Booth’s Plan its denial of Booth’s The reviewed reported that he found “numerous kins and, appeal part of its normal claims of treatment for pages of documentation a medical review of its process, sought hyperlipidemia” in heart disease The Plan sent previous determination. the exclu- Booth’s medical records from to Dr. William M. Booth’s medical records sionary period. specifically pointed He Allen, who directed to cardiologist, was Koplen’s Dr. documentation of Booth’s illness, symptom, any injury or “document “HCVD,” which Arkins de- treatment for compli- conditions and including secondary coronary vascular “hypertensive fined as diag- to Booth’s cations” that were related disease,” prescription for and to Booth’s December 1994 noses in November and Plan’s Dr. Arkins advised the Cardizem. existing documented as and that had been however, Committee, that Administrative period. exclusionary the 12-month during preexisting hypo- he found no evidence of re- summarizing findings, his Dr. Allen disease, or abnormal potassemia, lung hypertensive diagnoses lated that “[t]he chemistry. blood were hyperlipidemia heart disease and Committee exclusionary The Plan’s Administrative present” during the clearly appeal Booth’s again that to review his belief met period. He also stated lung dis- сoronary hypopotassemia, determined had also been treated Booth ease, chemistry were blood period. He not- and abnormal artery during disease administrator's district court reviews attempted provide evidence to the 1. Booth episode 1986 was unre- district court that the of discretion stan- decision under the abuse dard, problems. The district court lated to heart the reasonableness of 'an assessment of evidence, properly however, consider this refused to based on decision must be the administrator’s was not before the Ad- because it ”) (quoting it at the time' the facts known to de- Committee when it made its ministrative Hosp., Travel- Sheppard Pratt Inc. v. & Enoch Corp., Lee See Elliott v. Sara terminations. 1994)). F.3d 125 Cir. ers Ins. (4th Cir.1999) ("When a disease; and that ex- treated for heart preexisting conditions Cardizem, pre- by Booth for their treat- treatment with penses incurred reconsidered for scribed for heart conditions. ment would therefore be payment. But the Plan’s Administrative cir- Booth then filed this action state again remaining denied Booth’s Committee Danville, Virginia, cuit court to recover coronary angio- relating claims to the pur- of the Plan benefits under the terms they related to plasty, finding that were 502(a)(1)(B) ERISA, suant eligible and thus not preexisting conditions 1132(a)(1)(B). re- U.S.C. Wal-Mart coverage. moved the ease to federal court. Follow- to contest the decision
Booth continued trial, bench the district issued Dr. Ko- of the Administrative Committee. 22, 1998, opinion May an and order dated plen sent a second letter on her behalf to Plan which it held that the had abused 12, 1995, on October denying its discretion Booth’s claims had evi- reiterated that Booth never Plan’s benefits. court stated coronary while she was dence disease “wrongfully Administrative Committee as- patient. He stated that he be- his also sumed may
lieved confusion have stemmed from a proof of heart disease and that treatment misunderstanding of his abbreviation proof with Cardizem was of heart disease” that, He stated while the Plan’s “HCVD.” assumptions and that these “caused the interpreted signify reviewers HCVD to weight impor- Committee to accord less disease,” “hypertensive coronary vascular tant it.” evidence before The court re- “hyper- he used the abbreviation to denote manded the matter to the Plan’s Adminis- disease,” tensive a term he cardiovascular trative Committee for reconsideration physicians loosely to asserted use describe opinion. light August its On Also, high pressure. blood on March $7,000 district court also awarded Booth *6 1996, attorney sent Plan a attorneys appeal fees. This followed. Thereafter, request appeal. for another a by he forwarded letter written Dr. Ste- II Davis, phen V. which stated Booth judicial Because the standard of review diagnosed
was neither treated for nor case, dispositive is this we turn first having coronary artery or angina disease proper judicial a standard review of prior to November 1994. Davis’ letter also plan decision to grant administrator’s or explained by that HCVD is a term used employee an benefits under welfare physicians hypertensive to denote either plan regulated by benefit ERISA. hypertensive cardiovascular or cor- disease onary vascular disease. specify Because ERISA does not
A
appropriate
judicial
subcommittee of the Plan’s Adminis-
standard of
review
decision,
trative
fiduciary
Committee reviewed Booth’s case
of a
courts are instruct
19, 1996,
law,
postponed
develop
on June
but
a decision
guid
ed
a federal common
until a
full
meeting
by principles
of the
Administrative
ed
law.
trust
See Fire
Bruch,
July
Committee. On
the Plan’s
stone Tire & Rubber Co. v.
489
met,
101, 109-11,
948,
Administrative Committee
reviewed U.S.
109 S.Ct.
103
(1989).
file,
Thus,
appeal
again
the entire
general
denied L.Ed.2d 80
as a
proposition,
plans,
Booth’s heart-disease-related
claims be-
ERISA
as contractual
documents,
preexisting
cause of the existence of a
Dynamic Eng’g,
see Wheeler v.
Inc.,
(4th
634,
Cir.1995),
condition. The Administrative
62
F.3d
638
courts,
interpreted
by
based this determination on three factors:
de
novo
policy
a Plan
a
deferring
conduct their review “without
disease;
Firestone,
symptom of
party’s interpretation.”
heart
documеnta-
either
112,
indicating
tion Booth’s file
she had been
341
Inc.,
quential);
CapitalCare,
Bernstein v.
employer
or ad-
give
plan [does]
(4th Cir.1995) (same);
783,
4
authority
final
70 F.3d
787 n.
discretionary or
ministrator
terms,
Hosp.,
the court re-
Enoch Pratt
Inc. v.
Sheppard
uncertain
&
to construe
Co.,
120,
claim as it would
125 n. 4
employee’s
Travelers Ins.
32 F.3d
view^]
(4th Cir.1994)
by looking
(same);
...
other contract
Lockhart v. United
claim—
Trust,
and other manifes-
to the terms
Mine
Pension
Workers Am.1974
Cir.1993) (same).
74,
Id. at 112—
parties’
intent.”
tations of
5 F.3d
77 n. 5
Thus,
13,109
cases,
we have held that
conflicting signals
S.Ct.
we sent
other
plan provision for
deciding
whether
relationship
about
between the two
discretionary,
or
prescriptive
benefits
standards of review.
v. Phoe
See Weaver
de novo.
language
the Plan’s
Co.,
we review
nix Home
Mut. Ins.
990 F.2d
Life
Haley
(4th Cir.1993)
v. Paul Revere
See
154,
(equating
158-59
Life
(4th Cir.1996).
84,
Similarly, in
F.3d
standards, stating
two
decisions
contractually con-
determining
scope
“subject to the abuse of discretion stan
fiduciary
and whether a
ferred discretion
if they
dard ... must be affirmed
are not
act de
scope,
within that
we
has acted
arbitrary
capricious”);
Richards v.
id.
novo. See
Am. Health &
United Mine Workers of
Fund,
Retirement
135-36
When, however, plan by
its terms
(4th Cir.1990)
that,
(stating
although the
fiduciary
on a
confers discretion
“
perhaps
‘abuse of discretion’ standard is
scope
of conferred
fiduciary acts within
deferential than the ‘arbi
broader and less
discretion,
fiduciary in
defer to the
standard,
capricious’
‘arbitrary
trary and
principles
with well-settled
accordance
capricious’ definitely
encompassed
conferred
discretion is
trust law: “Where
”).
Mi
by ‘abuse of discretion’
See also
respect to the exer
upon the trustee with
Freitas, Annotation,
chael A. de
Judicial
subject
power,
is not
cise of
its exercise
Denial Health Care
Review of
Benefits
except
prevent
to control
Employee
Plan Governed
Under
Benefit
an
the trustee of his discretion.”
abuse
Security
Income
by Employee Retirement
Firestone,
“mandating]
total abandonment
documents
(3)
formulation,”
inconsistent;
‘arbitrary
capricious’
nally
and
whether the chal-
previously applied
the standard we had
interpretation
at
lenged
odds with the
of
to review benefit determinations
procedural
requirements
and substantive
under
(4)
administrators
and
fiduciaries
ERISA;
provisions
of
whether the
at
1132(a)(1)(B).
§
F.2d at 1186. We
885
applied consistently;
issue have been
and
arbitrary
capricious
and
described
(5)
fiduciary’s interpretation
whether the
fi-
standard as “more deferential” to the
contrary
language
plan.
to the clear
of the
than the
of discretion
duciary
abuse
at
recog-
See 885 F.2d
1188. We have also
application
standard and noted
adequacy
nized that the
of the record be-
the former standard “would be inconsis-
fiduciary
fore the
factor to be consid-
purposes
tent with the manifest
Bernstein,
ered.
at
See
F.3d
788.
Id. at
In reaching
[ERISA].”
law,
Drawing
principles
on
of trust
as in-
conclusions,
guided
these
we were
direct-
structed
Firestone
and
articulated
ly by Firestone’s discussion about
(Second)
187,
the Restatement
of Trusts
in the
inappropriateness
applying,
relied,
on which Firestone
we identified
context,
arbitrary
capri-
an
ERISA
factors,
five other
which were somewhat
developed
which
cious standard
had been
from,
with,
differеnt
but not inconsistent
arising
cases
under the Labor Man-
(1)
scope
those listed
de Nobel:
(“LMRA”).
agement Relations Act
See
(2)
conferred;
the discretion
the purpose
Firestone,
109-10,
343 ju- Moreover, to return discretion; purports the Plan of the exercise to dard relevant pre-Firestone/de Nobel to the dicial review any and fiduciary’s motives the and capricious.” “arbitrary and of standard may it have.2 interest of conflict in manner the Plan this interpret But to hand, we now in principles these With role of courts impinge proper on the would and decision before us the to the Plan turn establishing and enforcing in contracts to bene- Plan’s administrator by the Fire- review. Both judicial of рrinciples fits. standards de Nobel articulate stone and discretionary decisions judicial review Ill and in of ERISA the context by fiduciaries contrac- interpretation of a As with jurispru- the ERISA While purposes. its document, by examin- begin tual trust parties have broad recognizes that dence the Plan to determine language to language through contractual authority pres- of benefits provision whether scope and of benefits agree on and, if discretion- discretionary criptive or them, applying to follow procedures acted administrator ary, whether to allow understand ERISA we do not Tire & Firestone discretion. See within its standard of alter the established plan to Bruch, 489 U.S. v. Rubber Co. discretionary decisions judicial review (1989); 948, Ellis 80 L.Ed.2d 109 S.Ct. for reasonableness. Co., 126 F.3d Ins. Metropolitan Life entire Plan be- Taking into account the (4th Cir.1997); v. Paul Haley however, interpret us, we do fore (4th Co., 77 F.3d Revere Life discretionary to authorize language Plan’s Cir.1996); Corp., 885 Nobel v. Vitro de established would decisions that violate Cir.1989). This re- F.2d The Plan reasonableness. principles of de novo. view is conducted to which its benefits delineates thoroughly em- terms of the Wal-Mart express The entitled, carefully it beneficiaries Plan’s Admin- plan give the ployee benefit It requirements. eligibility benefit details “complete discretion istrative the Plan incongruous interpret to would be Plan, provisions of the interpret to additionally con- us as before documents errors, fact, correct findings of make admin- on its broad discretion ferring such of this scope And the supply omissions.” sanction determinations as to istrator Plan unusually broad. The discretion analysis using the not withstand would interpretations “All provides, decisions rec- have been factors that reasonableness good made Plan Administrator progeny its by Firestone and ognized final, be the Plan shall pursuant faith to Plan does not Circuit. the Fourth persons, all sub- binding on conclusive and make deter- its administrator authorize may procedure, claims ject only to the plain contrary to that are minations by a court found overturned unless not be Plan; frustrate language capricious.” arbitrary and to be Plan; that are goals of the purposes and or earli- provisions with other it inconsistent language, contractual From this Plan; that are interpretations of the attempt er the Plan is might argued be un- arbitrary or pursuant rendered limit their review ing to courts decisionmaking processes; i.e., circumstances, informed whether narrowest of procedural with the faith. are inconsistent administrator acted bad necessary interest, extent discretionaiy decision addition fiduciary’s conflict 2. A *9 influence result untoward serving a factor in reasonableness to "neutralize to 87; Doe, deference at may operate to 3 F.3d inquiry, reduce conflict.” that from 233; discretionаry Ellis, that fidu- decision given to a Bedrick v. at 126 F.3d see also court, presented (4lh that a ciary. We held have Cir. Travelers interest, may fiduciary's conflict of with a 1996). fiduciary’s given to lessen deference ERISA; benefits, requirements of finding substantive or Booth’s claim for that the that are made in furtherance of an interest employ committee “failed to a rational and that conflicts with that of the Plan benefi- approach principled wrongfully when it as- ciaries. hypertension sumed that evidence of was proof of heart disease and with treatment Accordingly, we conclude that the Plan proof Cardizem was of heart disease.” in provides this case its administrator with The court concludеd that these errors interpret discretion to Plan language and “caused the to Committee accord less grant deny in benefits accordance weight it,” important evidence before interpretations, with these but we will en- warranting reversal of the committee’s de- only force the if administrator’s decisions cision. reasonable, they are applying the factors previously that we have identified. ad- reveals, however, A review of the record dition, we conclude that the Administrative (1) process by which the Adminis- in interpreting Committee the Plan’s trative Committee its reached decision was provision
preexisting-condition
and in de-
(2)
reasoned,
principled and
its conclu-
nying
pаrt
Booth’s claim for benefits
supported by
sions were
the evidence be-
acted within the scope of discretion con-
fore it. While a
administrator could
by
ferred
the Plan documents.
conceivably
unreasonably
act
thus
—and
Because the
given
administrator was
policy
abuse its
following
discretion —
discretion to make the decisions under re-
contrary
dictated a result
to the evi-
view
this case and acted within the
it,
dence before
this is not such a case.
discretion,
scope of this
we will not disturb The
sought
Administrative Committee
nu-
the administrator’s decision if it is reason-
doctors;
merous
by independent
reviews
able, even if we independently would have
considered all the records аnd letters sub-
come to a different conclusion. See Fire-
Booth,
Koplen,
mitted
Dr.
and Dr.
stone,
Ellis,
948;
489 U.S.
109 S.Ct.
Davis; and arrived at a determination
IV its reasoning process unprincipled. The court, In the district Booth chal Administrative Committee relied on other lenged the decision of the Plan’s Adminis factors which alone supported could have trative part Committee to her its decision. It telling is also benefits, implicating claim two factors Administrative partially re- in our inquiry “reasonableness” under the respect claim, versed itself with to Booth’s abuse of discretion standard of review: awarding benefits to Booth to cover her degree to which the materials before treatment relating hypopotassemia, lung decision, supported disease, committee its chemistry. abnormal blood process by which the decision was We can find no the record made. The district court supporting reversed the Ad a conclusion that the Adminis- partial ministrative Committee’s denial of trative Committee came to its decision *10 with the that conflicted trative Committee or unprincipled was that process a through and Allen reviewing Drs. opinions of unreasonable. disputed that letter Koplen’s Dr. Arkins. Ad- before the Moreover, the evidence coro- preexisting from had suffered Booth de- supported its Committee ministrative suggest symptoms or nary heart disease preexisting- Plan’s that termination Koplen con- Dr. disease. coronary heart claim Booth’s excluded provision condition misin- were his abbreviations that tended preexisting-condi- The Plan’s for benefits. represented that “HCVD” terpreted broad, excluding quite provision tion He disease.” cardiovascular “hypertensive for only conditions not coverage from prescribed Cardizem that he also stated during the was treated beneficiary a which Dr. hypertension. Booth’s merely to treat any symptom also period, but exclusionary abbreviation stated that Davis a condition. such secondary condition among confusion often causes “HCVD” could provision this While breadth evidence was no and that there doctors sur- unwary beneficiaries take well treated for that Booth was records Booth’s valid contractual is a it nonetheless prise, her enroll- prior to artery disease coronary provision. benefit employee in the Wal-Mart ment had be- Committee Administrative The that opinion his gave Davis Dr. plan. Allen, a cardiolo- of Dr. report fore it symptoms of development of rapid Booth’s diagnoses “[t]he that gist, who stated consistent artery disease was coronary hyperli- heart disease hypertensive which rapid process often with the during clearly present” were pidemia can devel- arteries person’s a blockages in Allen stated Dr. exclusionary period. high blood characterized He also op. he believed period same during that for, symp- a not a risk factor as pressure artery coronary treated for was also Booth of, coronary artery disease. tom letter received a Plan also disease. Arkins, practitioner, general Dr. from of conflict this record with Confronted of documenta- detailing pages “numerous within the discretion it was ing opinion, disease for heart of treatment tion it Committee—indeed the Administrative from in Booth’s records hyperlipidemia” body resolve duty of that was —to conditions These exclusionary period. recog conflicts, previously have and we exclusionary period during the observed for discretion nized, abuse of “it not an sought later Booth for which the same where ... benefits fiduciary the indica- pointed to Arkins Dr. benefits. present reports were conflicting medical was treated Booth records that in the tion 190 F.3d Corp., Lee v. Sara ed.” Elliott abbreviation “HCVD,” interpreting Cir.1999) (4th v. Met (citing Ellis 601, 606 coronary vascular “hypertensive mean ropolitan Life Allen Both Drs. Arkins disease.” Cir.1997) of discre (finding no abuse was treated Booth it significant found beneficia where in denial benefits tion Cardizem, Allen indicated Dr. with finding оf provider’s medical primary ry’s but only “is effective of inde reports with conflicted disability angina.” artery disease coronary also suffi panel)). Because medical pendent file Booth’s Moreover, Arkins reviewed Dr. record evidence contained cient Administrative time after the a second Booth determination support the Booth’s from a letter received Committee period exclusionary during treated in- Arkins’ disputing practitioner general treated later the same condition either notation the “HCVD” terpretation or second symptom 1994 or November his earli- records, affirmed and he thereof, the district ary condition opinions. er Plan’s concluding that cleаrly erred dis its abused Administrative Dr. Booth, Koplen, and Dr. from Letters light Booth benefits. denying cretion to the Adminis- presented Davis *11 principled this evidence process by reasoned Administra- America, UNITED STATES of decision, tive Committee rendered its Plaintiff-Appellee, there no basis to conclude that Ad- ministrative Committee abused its discre- part tion when it denied in Booth’s claim. HAMMOND, Richard Allison Accordingly, we the judgment reverse Defendant-Appellant.
the district court as well as its award of attorneys fees. No. 98-20821.
REVERSED. Appeals, United States Court MURNAGHAN, Fifth Circuit. Judge, Circuit concurring. Dec. I concur in Judge Niemeyer’s majority opinion. The Plan’s preexisting-condition
provision allows the Administrative Com- condition,
mittee to benefits for a or
symptom, secondary thereof, condition
for which beneficiary dur- treated period. the exclusion Because there
was evidence before the Administrative
Committee that Booth was hy- treated for
pertension during period, the exclusion
and because is a well-known
risk factor and arguably a secondary con- coronary artery disease,
dition to por-
tion of the Administrative Committee’s de-
cision which found that Booth was treated symptom
for a or secondary condition of
coronary artery during disease the exclu- period
sion was reasonable. alone,
For that reason I would find that
the Administrative Committee acted rea-
sonably. I am nevertheless troubled way in which the Administrative Com- ignored
mittee the statements
own doctors that Booth was not treated for
coronary artery disease itself during the period.
exclusion I agree cannot that it is
reasonable for a administrator to ig-
nore credible presented by
claimant’s own rely doctors instead on
the conflicting opinions of reviewing doc-
tors who have never treated the claimant
and who have no basis for correctly inter-
preting ambiguous or possibly mistaken
notations in the claimant’s medical records.