But, claims suits can still be won and a recent unpublished decision of the Ninth Circuit (a Circuit that, itself, can be a path of disadvantage) illustrates how straightforward the path to victory can be. In Ibrahim v. Bayer Corporation Disability Plan, the court upheld the denial of long-term disability benefits, despite the "structural conflict of interest" presented by an in-house decision maker and the court's recognition that "the administrator could have done a better job communicating to Ibrahim what kind of evidence was requested of her and the exact reasons for its denial of benefits," both of which are requirements under the Department of Labor's claims regulations.
The court concluded that there was no abuse of discretion (that's the "deference" standard), because there was "sufficient evidence in the record to allow the administrator to conclude that [the participant] could perform her job duties and thus was not disabled under the terms of the Plan." The court also concluded that the structural conflict did not appear improperly to have influenced the decision.
In this case, there were competing physician reports (one from the doctor that the plan retained and one from the participant's treating physician). While the specific analysis wasn't laid out in the opinion, it appears that the administrator considered both reports and stated why it credited one over the other. As the court said, "the administrator did not, moreover, fail to consider any of the relevant evidence that Ibrahim provided."
There are two important points for most plans to take from this opinion. The first is (as I've said in other contexts) "show your work." That is, make sure that your formal claim or appeal decision reviews the evidence and gives reasons for why you are crediting or discrediting each item (or why you've dismissed some of the evidence without deciding whether it's worth weighing). The second applies where a third party administrator is preparing the decision for your in-house administrator's signature. Many TPA-prepared decisions do not go into the kind of detail that would satisfy a court like the one deciding Ibrahim. Your fiduciaries need to be reading those draft decisions hyper-critically, to ensure that the kind of information that will win the claim suit is added to the decision.