A: A claim for disability benefits under ERISA is governed by the Employee Retirement Income Security Act of 1974 ("ERISA"), 29 U.S.C. § 101 et seq. and is brought pursuant to the Civil Enforcement Provisions of that statute. See 29 U.S.C. § 1132(a)(1)(B).
"A denial of benefits challenged under § 1132(a)(1)(B) is to be reviewed under a de novo standard unless the benefit plan gives the administrator or fiduciary discretionary authority to determine eligibility for benefits or to construe the terms of the plan." Firestone and Rubber v. Bruch, 489 U.S. 101, 115 (1989). "It is well established that a court reviewing the denial of disability benefits under ERISA initially must decide whether a benefit plan's language grants the administrator or fiduciary discretion to determine the claimant's eligibility for benefits, and if so, whether the administrator acted within the scope of that discretion." Gallagher v. Reliance STD. Life Ins. Co., 305 F.3d 264, 268 (4th Cir. 2002).
There are no specific words that must be included to preclude a de novo standard of review, but rather "[i]f the terms of a plan indicate a clear intention to delegate final authority to determine eligibility to the plan administrator, then [a] court will recognize discretionary authority by implication."
"The plan's intention to confer discretion on the plan administrator or fiduciary, however, must be clear. If a plan does not clearly grant discretion, the standard of review is de novo." Gallagher, 305 F.3d at 268 69 (citation omitted). Under the abuse of discretion standard, a decision by an administrator will not be disturbed if it "is the result of a deliberate, principled reasoning process and if it is supported by substantial evidence." Bernstein v. CapitalCare, Inc., 70 F.3d 783, 787 (4th Cir. 1995). The Supreme Court has indicated that where "a benefit plan gives discretion to an administrator or fiduciary who is operating under a conflict of interest, that conflict must be weighed as a factor in determining whether there is an abuse of discretion." Firestone Tire, 489 U.S. at 115. In such a scenario, the court must review the merits of the interpretation to determine whether it is consistent with an exercise of discretion by a fiduciary acting free of the interests that conflict with those of the beneficiaries. In short, the fiduciary decision will be entitled to some deference, but this deference will be lessened to the degree necessary to neutralize any untoward influence resulting from the conflict.
Ellis v. Metro. Life Ins. Co., 126 F.3d 228, 233 (4th Cir. 1997)