Dаvid Tillery and his mother, Kathy Tillery, appeal the district court’s 1 grant of summary judgment upholding a plan administrator’s denial of medical benefits to David under Kathy’s employer’s self-funded employee welfare benefit plan. We affirm.
I.
On August 10, 1994, sixteen-year-old David Tillery was seriously injured in a motor vehicle accident. The accident left him a paraplegic and necessitated removal of 30 feet of intestine and resection of his bowel. In 1995, doctors referred him to *1196 the University of Minnesota where he was accepted as a candidate for experimental bowel transplant surgery. A successful bowel transplant was performed at the University of Minnesota in June, 1996.
At the time of the accident, Kathy Till-ery was employed by Hoffman Enclosures, Inc. Hoffman provided an employee welfare benefit plan (Plan), governed by the Employee Retirement Income Security Act (ERISA) 29 U.S.C. §§ 1001-1461, under which David received medical benefits. Hoffman acted as plan administrator, and Medica, Inc., was the claims administrator. Hoffman had authority to decide all questions of eligibility, to make claims decisions, and to review appeals. The Plan specifically granted the plan administrator discretion with respect to the administration, operation and interpretation of the Plan. Medica had authority and responsibility for receiving and reviewing claims for benefits, determining amounts, making disbursements, and reviewing and determining denied claims and appeals.
Before performing the bowel transplant, the University of Minnesota sought pre-approval of the costs from Medica, Health-Partners 2 and the State of Minnesota Medical Assistance. Medica received the request on or about August 21, 1995, and assigned it to a transplant case manager for review and investigation. The case manager, after conducting research into bowel transplants, determined the procedure was experimental and recommended denial to Medica’s medical director. The medical director reviewed the findings and recommended Hoffman deny benefits based upon an exclusion in the plan covering experimental procedures. Hoffman denied benefits and the procedure was paid for by Minnesotа Medical Assistance.
The notice of denial was sent to the State of Minnesota and the University of Minnesota. There is no evidence the Till-erys received a denial notice or were otherwise aware of the denial until May 19, 1997. Thereafter, the Tillerys were provided with a list of benefits denied and the basis for the denials. Approximately two years later, the Tillerys filed this action in state court alleging Hoffman had improperly denied medical benefits to David. Hoffman removed the action to federal court and successfully moved for summary judgment.
On appeal, the Tillerys contend Hoffman acted under a conflict of interest when it denied David’s claim for bowel transplant surgery. The Tillerys also argue serious procedural irregularities existed which cast doubt on the propriety of Hoffman’s denial. Finally, the Tillerys contend Hoffman’s denial of benefits to David was unreasonable.
II.
We review de novo the district court’s grant of summary judgment, viewing thе record in the light most favorable to the nonmoving party.
Woo v. Deluxe Corp.,
The district court concluded the proper standard of review was abuse of discretion. We agree. The Plan grants discretionary authority to the plan administrator to determine eligibility and to interpret the terms of the plan, and thus, the decision of the plan administrator is reviewed for an abuse of disсretion.
Schatz v. Mut. of Omaha Ins. Co.,
The Tillerys contend the less deferential standard of review enunciated in
Woo
applies. A conflict of interest may trigger a less deferential standard of review.
Woo,
Under the first part of the sliding scale analysis, a claimant seeking a less deferential standard of review must present material, probative evidence of a palpable conflict of interest or serious proсedural irregularity.
Woo,
If a claimant successfully establishes either a palpable conflict of interest or serious procedural irregularity, he must also show the conflict or irregularity caused a serious breach of the plan administrator’s fiduciary duty.
Schatz,
The Tillerys argue Hoffman had a palpable conflict because the plan was partial *1198 ly self-funded. They also claim serious procedural irregularities occurred when Hoffman failed to provide them with (1) a summary plan description (SPD), 3 (2) timely nоtice of the denial of benefits, and (3) notice of their appeal rights.
Because Hoffman’s plan was partially self-funded there was potential for a conflict of interest. Further, it is undisputed the Tillerys were not provided notice of the denial and of their appeal rights as required by ERISA. Thus, we will assume, without deciding, thаt the Tillerys have met the first part of the
Woo
test.
See Barnhart,
The Tillerys first claim Hoffman failed to prepare an SPD. Their claim, however, is contradicted by the record. The Tiller-ys include in their appendix twо copies of Hoffman’s SPD. While they question whether this is the actual SPD, they provide no evidence to contradict Hoffman’s assertions to the contrary.
See Barnhart,
Nеxt, the Tillerys argue the SPD conflicts with the Plan. The SPD does not contain language excluding coverage for experimental procedures, and they contend the broader coverage, implied by omission of the exclusion from the SPD, controls over the Plan language. The Till-erys are mistaken. Although the provisions of an SPD prevail over conflicting provisions contained in the actual plan,
Jensen v. SIPCO, Inc.,
The Tillerys also question whether they ever received a copy of the SPD. Assuming they did not, they fail to explain how such an oversight affected their substantive rights or the decision of the plan administratоr.
See Schatz,
Finally, the Tillerys argue Hoffman’s failure to provide them with timely notiсe of the denial and of their appeal rights gives rise to serious doubts as to whether the denial was the product of an arbitrary decision or the plan administrator’s whim.
Schatz,
When Medica received the request for coverage of the small bowel transplant it was assigned for review and investigation to а transplant case manager. She researched small bowel transplants through several outside sources and by reviewing current medical literature. She determined bowel transplants were experimental, and presented her findings to a physician who conducted an independent review and assessment. Only thеn did Medica contact Hoffman and recommend denial based upon the exclusionary language contained in the Plan. Given the investigation conducted by Medica, and the lack of any credible evidence suggesting small bowel transplants were not experimental in 1996, we conclude the procedurаl irregularity did not so undermine the decision of the plan administrator as to render it suspect.
Because the Tillerys have failed to meet the two-part test established in Woo, we conclude the district court was correct when it reviewed the plan administrator’s decision for an abuse of discretion.
Under the abuse of discretion standard, “the proper inquiry is whether the plan administrator’s decision was reasonable, i.e., supported by substantial evidence.”
Donaho v. FMC Corp.,
First, the stated purpose of the Plan is to promote the health and welfare of all covered persons through a comprehensive payment of medical benefits. At the same time, the Plan, in order to maximize benefits to all covered persons, limits or excludes payment for some procedures. Exclusion of payments for experimental *1200 procedures has the advantage of providing better coverage for more people.
Second, Hoffman’s interpretation does not render any of the Plan’s language meaningless or internally inconsistent. The Tillerys argue the term “medically necessary” is rendered meaningless by the “experimental surgery” exclusion. The two terms are easily reconciled. The Plan covers treatment which is medically necessary but limits treatment to that which is not experimental. The Tillerys also argue the surgery should have been considered “reconstructive” instead of “experimental.” This argument suggests reconstructive surgery can nevеr be experimental. Calling the bowel transplant reconstructive surgery would not have made it less experimental.
Third, the denial does not conflict with any substantive or procedural requirements imposed by ERISA. While Hoffman concedes the Tillerys did not get timely notice, denial of procedural rights does not of itself сreate a substantive right to benefits.
See Curtiss-Wright Corp. v. Schoonejongen,
The fourth and fifth factors have also been met. This was the first and only request for a transplant under the Plan. There is no evidence Hoffman previously or subsequently interpreted the Plan language differently. And, the Plan expressly excluded procedures deemed experimental. Thus, the decision was not contrary tо the clear language of the plan.
III.
The district court’s order granting summary judgment is affirmed.
Notes
. The Honorable David S. Doty, United States District Judge for the District of Minnesota.
. David’s father was covered under a separate plan administered by HealthPartners.
. ERISA requires an employer to provide all of the participants and beneficiaries with an accurate and comprehensive summary plan description. 29 U.S.C. §§ 1022 & 1024.