Aberle v. Integrity Life Insur. Co., 1999 U.S. App. LEXIS 29473 (9th Cir. November 4, 1999)

Aberle v. Integrity Life Insur. Co., 1999 U.S. App. LEXIS 29473 (9th Cir. November 4, 1999) (unpublished)-Aberle claimed on appeal that UNUM gave insufficient reasons for its denial of disability benefits.  Aberle also argued that the district court incorrectly allowed UNUM to raise new arguments not included in its letters of denial. UNUM cross-appealed that the district court incorrectly applied a de novo standard of review.

This court found that the district court correctly applied a de novo standard of review since the benefit plan did not “give the administrator or fiduciary discretionary authority to determine eligibility for benefits or to construe the terms of the plan.” An ERISA plan administrator only has discretion where such discretion was "unambiguously retained" by the administrator, Bogue v. Ampex Corp., 976 F.2d 1319, 1325 (9th Cir. 1992). Furthermore, "the default is that the administrator has no discretion." Kearney v. Standard Insurance Co., 175 F.3d 1084, 1089 (9th Cir. 1999)(en banc).

The district court properly concluded that the reasons given by UNUM in its denial letters were sufficient, where UNUM raised issues regarding Aberle's credibility, inconsistencies between his observed activities and a diagnosis of disabling chronic fatigue syndrome, the subjective nature of the medical evidence, and medical opinions that Aberle was not disabled under the terms of the policy.

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