’ " Miller v. Am. Airlines, Inc., 632 F.3d 837, 845 (3d Cir. 2011), quotingPost v. Hartford Ins. Co., 501 F.3d 154, 162 (3d Cir.2007). "[W]hen an insurance company both funds a benefits plan and possesses the discretion to determine eligibility under the terms of that plan, as is the case here, courts must take into account the inherent structural conflict of interest." Boyles v. Am. Heritage Life Ins. Co., 226 F.Supp.3d 497, 502 (W.D. Pa. 2016) ; see alsoGuthrie v. Prudential Ins. Co. of Am., 625 Fed.Appx. 158, 161 (3d Cir. 2015). This Court recognizes that Defendant has a structural conflict of interest, and duly weighs this conflict in its analysis.
And, it concluded there was no evidence that a Prudential officer had signed or endorsed the SPD. Likewise, this same language appears in the group contract here, (Szyba Decl. Ex. A, PRU -0008), and the SPD contains no evidence of signature or endorsement by a Prudential officer. Prudential cites Guthrie v. Prudential Insurance Co. of America to suggest that the SPD may be considered together with the group contract and certificate of insurance to confer discretion on Prudential. No. CIV.A. 12-7358 JLL, 2014 WL 3339549, at *8 (D.N.J. July 8, 2014), aff'd, 625 F. App'x 158 (3d Cir. 2015). It is true that the Guthrie court acknowledged that the SPD was part of the operative insurance plan, but it apparently did so by agreement of the parties.
Such a conflict arises where the plan administrator plays a "dual role" and acts "as both claim payer and claim evaluator." Guthrie v. Prudential Ins. Co. of Am., 625 F. App'x 158, 161 (3d Cir. 2015). The Supreme Court has held that "a reviewing court should consider that conflict as a factor in determining whether the plan administrator has abused its discretion in denying benefits; and that the significance of the factor will depend upon the circumstances of the particular case.