BOWMAN, Circuit Judge.
Mary L. Schatz appeals the denial by the District Court
We turn first to discerning the proper standard under which to review Mutual's decision to deny Schatz's claim for benefits under the long-term disability plan (Plan) it administered. In general, when a long-term disability plan governed by the Employee Retirement Income and Security Act of 1974 (ERISA)
Even so, we have held that some less deferential standard of review is triggered where the claimant presents "material, probative evidence demonstrating that (1) a palpable conflict of interest . . . existed, which (2) caused a serious breach of the plan administrator's fiduciary duty to her." Woo, 144 F.3d at 1160. It is only after a claimant clears this initial "two-part gateway requirement," that we apply the "`sliding scale' approach" of determining just how much less deferential the nature of the plan administrator's conflict warrants our being to the plan administrator's decision to deny benefits. Id. at 1161.
In applying Woo and its progeny, the District Court determined that there was a palpable conflict of interest, in satisfaction of the first part of the Woo gateway, because Mutual was both "the insurer and an affiliate of the plan administrator." Memorandum Opinion and Order at 10. Nonetheless, determining that Schatz had made no showing that this conflict caused a serious breach of the plan administrator's fiduciary duty to her, the District Court concluded that the second part of the Woo gateway was not satisfied and, accordingly, that the sliding scale (and some less deferential standard of review) was not triggered. We review de novo the District Court's determination of the appropriate standard of review. See Woo, 144 F.3d at 1160.
We consider first the question of whether Mutual was laboring under a palpable conflict of interest given its role as both plan administrator and insurer.
Here, Mutual argues that Schatz makes "no showing of any actual bias or conflict of interest." Brief of Appellee Mutual at 18 (emphasis added).
This conclusion, however, does not end our inquiry. The mere fact of an "unameliorated" structural conflict of interest does not necessarily warrant a less deferential standard of review. Accordingly, we must next determine whether Schatz has satisfied the second part of the Woo gateway by presenting material, probative evidence that this palpable conflict of interest actually caused a serious breach of the plan administrator's fiduciary duty to her. We have noted that "Woo's second prong presents a considerable hurdle for plaintiffs." Barnhart, 179 F.3d at 588 n. 9. "The evidence offered by the claimant must give rise to `serious doubts as to whether the result reached was the product of an arbitrary decision or the plan administrator's whim.'" Id. at 589 (quoting Layes v. Mead Corp., 132 F.3d 1246, 1250 (8th Cir.1998)).
Schatz suggests that Mutual seriously breached its fiduciary duty to her by improperly rejecting the opinions of her treating physicians that she suffers from chronic pain syndrome, by failing to give sufficient credence to her own subjective reports of pain, by neglecting to develop a record on the physical duties of her position, by failing to inform her that it had reopened consideration of her claim, and by improperly interpreting the definition of "disability" in the Plan. In essence, Schatz posits that Mutual's decision was made without "`proper judgment.'" Brief of Appellant Schatz at 32-34 (quoting Woo, 144 F.3d at 1161). After a careful review, we are persuaded that all of Schatz's contentions either do not properly characterize the record or, even if true, would not as a matter of law qualify as serious breaches of Mutual's fiduciary duty.
There is no dispute that Schatz has suffered from chronic back pain for many years, including the time when she was employed by Mutual as a medical review nurse. The question is whether heightened review is warranted because Mutual's institutional bias as both plan administrator and plan insurer caused it to seriously breach its fiduciary duty in determining that Schatz's medical problems were insufficient to entitle her to benefits under the
Having reviewed the record carefully, we are satisfied that Mutual exercised proper judgment in determining that Schatz was not disabled under the terms of the Plan and that, in the circumstances of this case, Mutual did not commit a serious breach of fiduciary duty caused by its structural bias. Cf. Barnhart, 179 F.3d at 589 ("The mere fact that [defendant] reached a decision contrary to [plaintiff's] medical evaluators, when it based this decision on substantial evidence in the record, reports of outside medical reviewers, and conflicting evidence in [plaintiff's] own submissions to the record, does not raise doubts in the mind of this Court that [defendant's] decision was arbitrary or capricious."). Because Schatz fails to traverse the Woo gateway, Mutual's decision is not subject to less deferential review and the abuse of discretion standard applies.
In determining whether Mutual abused its discretion (that is, made a decision that was arbitrary and capricious), we ask whether the decision to deny Schatz benefits was supported by substantial evidence, meaning more than a scintilla but less than a preponderance. See Donaho, 74 F.3d at 898-901. Provided the decision "is supported by a reasonable explanation, it should not be disturbed, even though a different reasonable interpretation could have been made." Cash v. Wal-Mart Group Health Plan, 107 F.3d 637, 641 (8th Cir.1997); accord Donaho, 74 F.3d at 899 (explaining that plan administrator's decision "is reasonable if a reasonable person could have reached a similar decision, given the evidence before him, not that a reasonable person would have reached that decision").
In making this assessment, "[w]e consider only the evidence that was before the administrator when the claim was denied." Farley, 147 F.3d at 777. Although Mutual's consideration of Schatz's claim came in several stages, we
Having reviewed all of Schatz's arguments, and finding no basis for reversal, we affirm the judgment of the District Court.