BARBARA D. HOLMES, Magistrate Judge.
Pending before the Court is the Motion to Supplement the Administrative Record (THE "Motion to Supplement") (Docket No. 29), filed by Plaintiff Christine Carlson (the "Plaintiff" or "Carlson"). Defendant Reliance Standard Life Insurance Company (the "Defendant" or "Reliance Standard") opposes the Motion to Supplement. See Docket Nos. 30 and 33.
Plaintiff brought suit against Defendant alleging that Defendant failed to pay benefits owing to Plaintiff under a group life insurance policy covering Plaintiff's late husband, Barak Carlson, in violation of the Employer Retirement Income Security Act of 1974 ("ERISA").
The following facts relevant to the pending Motion to Supplement are undisputed.
On October 20, 2012, Mr. Carlson died from a gunshot wound while hunting with a family member. Amended Complaint and Answer at ¶ 11-15. The initial final report by the Metro Nashville Police Department (the "MNPD"), who responded to the scene and the office of the Medical Examiner (the "OME") stated Mr. Carlson's cause of death as suicide. Amended Complaint and Answer at ¶ 16-17.
On March 15, 2013, Plaintiff made a claim for voluntary risk benefits under the group life policy. AR0001 (Docket No. 20 at 1).
On November 21, 2013, Plaintiff requested additional time to submit additional information. AR0141 (Docket No. 20-1 at 41). In response, Defendant allowed Plaintiff until December 13, 2013, to provide any additional information, again stating that after that date, Defendant would "move forward with [its] review." AR0049 (Docket No. 20 at 49). By letter dated December 13, 2013, Plaintiff provided additional information to Defendant, but noted that her investigation was ongoing with an anticipated completion date of "the middle of January 2014." AR0144 (Docket No. 20-1 at 44). Plaintiff's December 13, 2013 correspondence further stated that she would "continue to send information as acquired" with a request that Defendant send notice that it was "keeping this matter in an open status." Id. There does not appear to have been a response specifically directed to this December 13, 2013 letter. However, on January 14, 2014, Defendant sent an "update" letter to Plaintiff, notifying her that Defendant had elected to take the allowed additional 60 days (beyond the original 60 days from the date of the appeal) in which to make a final decision. AR0050 (Docket No. 20 at 50). The January 14 correspondence further stated that Defendant was still in the process of completing its review. Id.
On January 16, 2014, Defendant notified Plaintiff that it would be submitting the claim for review by an independent physician. AR0155 (Docket No. 20-1 at 55). By letter dated January 25, 2014, Defendant requested specific additional information—incident photographs, autopsy photographs and any information regarding testing of the gun—from Plaintiff. AR0159 (Docket No. 20-1 at 59).
Following this letter, the requested information was provided beginning on January 27, 2014, with the last information provided on February 24, 2014, and received by Defendant on February 28, 2014. AR0651 through AR0673 (Docket No. 20-9 at 1-23) and AR0764 (Docket No. 20-11 at 14). On March 21, 2014, Defendant notified Plaintiff that its review of the denial of benefits was complete and of its determination that its original decision to deny benefits was appropriate. AR0054 (Docket No. 20 at 54) and AR0775 (Docket No. 20-11 at 25).
Plaintiff alleges that Defendant failed to reasonably and properly review all relevant information. Specifically, Plaintiff asserts that Defendant was aware of Plaintiff's ongoing investigation and stated intent to submit additional information, but arbitrarily closed the appeal before Plaintiff had submitted all of the additional information. The precise information that Plaintiff contends Defendant failed to consider are an amended OME report revising the cause of Mr. Carlson's death to "could not be determined" and a final investigative report with statements of witnesses with knowledge of the circumstances surrounding Mr. Carlson's death.
In the ERISA context, the district court's review of the correctness of a benefits determination made by the administrator or fiduciary is ordinarily limited to the administrative record. Perry v. Simplicity Engineering, a Div. of Lukens General Indus., Inc., 900 F.2d 963, 966 (6th Cir. 1990). However, the recognized exception to this rule is when the "evidence is offered in support of a procedural challenge to the administrator's decision, such as lack of due process afforded by the administrator or alleged bias on its part." Wilkins v. Baptist Healthcare System, Inc., 150 F.3d 609, 619 (6th Cir. 1996). The extent to which allegations of procedural defects are enough to allow evidence outside the administrative record is, as noted by Judge Trauger, uncertain at best. Kinsler v. Lincoln Nat. Life Ins. Co., 660 F.Supp.2d 830, 836 (M.D. Tenn. 2009) (alleged lack of due process or alleged bias are enough to establish that the evidence is relevant, and therefore discoverable).
The Johnson v. Connecticut General Life Ins. Co. case relied upon by Defendant adds little clarity to this question. In that case, the Sixth Circuit expressly declined to require a threshold evidentiary showing of bias as a prerequisite to application of the Wilkins exception. Johnson v. Connecticut General Life Ins. Co., 324 Fed.Appx. 459, 2009 WL 928590 at *6 (6th Cir. 2009). The Johnson court did however intimate that something more than mere allegations may be required. Id.
Here, the gravamen of Plaintiff's action is that she notified Defendant of additional information, which it arbitrarily failed to take into account, and under the plain language of the ERISA claims procedures, that failure prevents a finding that Defendant provided Plaintiff with a reasonable opportunity for a full and fair review. See 29 C.F.R. § 2560.503-1(h)(2)(iv). Plaintiff also claims that Defendant deliberately disregarded this information so that it could close her claim without payment of any benefits, which Plaintiff alleges was in bad faith and demonstrates bias. Plaintiff seeks to supplement the administrative record with the additional information she intended to submit to Defendant, but was precluded from doing so by Defendant's decision on her appeal. If Johnson requires a heightened showing of a colorable procedural challenge, it has been met in this case. Thus, on the limited issue of Plaintiff's request to supplement the administrative record, the Court finds the requested supplementation is appropriate.
Defendant argues that the OME's Amendment Report is irrelevant because it is not binding on Defendant. The Court disagrees as to relevancy.
For purposes of supplementation of the record, Plaintiff has offered enough to support her procedural challenges. Whether or not Plaintiff can prevail on the merits of her claims is a determination left for another day.
Plaintiff has made a sufficient showing for the Court to consider the offered evidence. Plaintiff shall therefore be permitted to supplement the administrative record. Within thirty (30) days of the date of this Order, Plaintiff shall supplement the administrative record in this proceeding with (i) the OME Amendment Report and (ii) the final investigative report prepared on behalf of Plaintiff, including witness statements.
Any party objecting to this decision may file a motion for review by the District Judge in accordance with Fed.R.Civ.P.72(a) and Local Rule 72.02(b). The motion for review shall be served and filed in accordance with Rules 5 and 7 of the Fed.R.Civ.P. and applicable local rules. The motion for review shall be filed within fourteen (14) days after entry of this Memorandum and Order. The motion for review shall state with particularity that portion of this Memorandum and Order for which review is sought and shall be accompanied by sufficient documentation to apprise the District Judge of the basis for the appeal. Any other party wishing to respond shall file a response within fourteen (14) days after served with a copy of the motion for review.
It is SO ORDERED.