United States Ninth Circuit

In plaintiff's suit against his insurer for disability benefits, claiming that in calculating plaintiff's earnings the insurer included only the monthly salary, and not the annual bonus, the district court's judgment in favor of the insurer is affirmed in part, reversed in part, and remanded where the district court: 1) correctly determined that the applicable standard of review is abuse of discretion; 2) correctly held that because the insurer was responsible for both evaluating benefits claims and paying them, it operated under a conflict of interest, which must be weighed as a factor in determining whether there is an abuse of discretion; 3) failed to apply the traditional rules of summary judgment to its analysis of whether and to what extent a conflict of interest impacted the insurer's benefits determination; 4) incorrectly held that certain internal memoranda between the insurer's claim analyst and its in-house counsel were not discoverable; and 5) did not take into account substantial evidence that the insurer's conflict of interest infiltrated the entire decision-making process, and therefore ought to be accorded significant weight.

Appellate Information

• Decided 09/12/2012
• Published 09/12/2012

Judges

• Berzon

Court

• United States Ninth Circuit

Counsel