Roggenkamp v. Morgan Stanley Medical Plan

── Roggenkamp v. Morgan Stanley Medical Plan ── Court: Court of Appeals for the Ninth Circuit Date: June 05, 2026 Category: General NOT FOR PUBLICATION FILED UNITED STATES COURT OF APPEALS JUN 5 2026 MOLLY C. DWYER, CLERK U.S. COURT OF APPEALS FOR THE NINTH CIRCUIT MARC ROGGENKAMP, No. 24-7864 D.C. No. Plaintiff - Appellant, 2:23-cv-05531-WLH-AGR v. MEMORANDUM* MORGAN STANLEY MEDICAL PLAN, Defendant - Appellee. Appeal from the United States District Court for the Central District of California Wesley L. Hsu, District Judge, Presiding Submitted May 18, 2026** Pasadena, California Before: LEE, BUMATAY, and SUNG, Circuit Judges. Marc Roggenkamp sued Morgan Stanley Medical Plan (“MS Plan”) to recover benefits under the Employee Retirement Income Security Act (“ERISA”), 29 U.S.C. § 1132(a). Cigna, the administrator of his plan, denied * This disposition is not appropriate for publication and is not precedent except as provided by Ninth Circuit Rule 36-3. ** The panel unanimously concludes this case is suitable for decision without oral argument. See Fed. R. App. P. 34(a)(2). Roggenkamp’s pre-authorization request for a two-level artificial disc replacement surgery (“two-level ADR”). Roggenkamp appeals the district court’s judgment in favor of MS Plan after a bench trial. We have jurisdiction under 28 U.S.C. § 1291. “We review de novo a district court’s choice and application of the standard of review to decisions by fiduciaries in ERISA cases. We review for clear error the underlying findings of fact.” Abatie v. Alta Health & Life Ins. Co., 458 F.3d 955, 962 (9th Cir. 2006) (en banc) (citation omitted). We affirm in part, and reverse and remand in part. 1. The district court correctly concluded that Cigna did not operate under a conflict of interest. We review an administrator’s decision for abuse of discretion when “the benefit plan gives the administrator or fiduciary discretionary authority to determine eligibility for benefits.” Saffon v. Wells Fargo & Co. Long Term Disability Plan, 522 F.3d 863, 866 (9th Cir. 2008) (quoting Firestone Tire & Rubber Co. v. Bruch, 489 U.S. 101, 115 (1989)). If the administrator operates under a conflict of interest, “that conflict must be weighed as a ‘facto[r] in determining whether there is an abuse of discretion.’” Firestone Tire & Rubber Co., 489 U.S. at 115 (citation omitted) (alteration in original). A conflict exists when an administrator both determines eligibility and pays for benefits. Metro. Life Ins. Co. v. Glenn, 554 U.S. 105, 108 (2008); Abatie, 458 F.3d at 965. The plaintiff bears the burden “to produce evidence of a financial conflict sufficient to warrant a 2 24-7864 degree of skepticism.” Deer v. IBM Corp. LTD Plan, 835 F.3d 893, 902 (9th Cir. 2016). The parties agree that the MS Plan grants decision-making discretion to Cigna, so the abuse of discretion standard applies. But the parties dispute whether there was a conflict that should have resulted in less deference to Cigna’s decision. As the administrator of the plan, Cigna adjudicated Roggenkamp’s claims and determined eligible expenses, while Morgan Stanley funded the plan. Roggenkamp has provided no evidence of a financial conflict, as he cannot show that Cigna both determines eligibility and pays for benefits. Roggenkamp’s allegations that Cigna delayed during the administrative and legal process, repeated the same conclusory language in its denial letters, a