RUDOLPH CONTRERAS, District Judge.
Debra Lee brings this action under the Employee Retirement Income Security Act of 1974 ("ERISA"), 29 U.S.C. § 1001 et seq., claiming that her insurance company — The Hartford Life and Accident Insurance Company — wrongfully denied her claim for disability benefits. In her motion for partial summary judgment, the
Through her former employer, Debra Lee was enrolled in an insurance plan that covered claims for disability benefits. Am. Compl. ¶ 6. Hartford is the claims administrator
Ms. Lee brought suit under 29 U.S.C. § 1132(a), alleging that Hartford's internal appeals process was unfair and that Hartford suffers from a conflict of interest. Now before the court is the plaintiff's motion for partial summary judgment, in which she asks the court to supplement the record with additional documents (rather than for partial judgment in her favor). See Pl.'s Reply at 14, 15 (requesting an opportunity to respond to Dr. Brennan's report). Accordingly, the court construes the motion as a motion to supplement the record.
"ERISA is a comprehensive statute designed to promote the interests of employees and their beneficiaries in employee benefit plans." Shaw v. Delta Air Lines, Inc., 463 U.S. 85, 90, 103 S.Ct. 2890, 77 L.Ed.2d 490 (1983); see also 29 U.S.C. § 1001(b) (noting that ERISA was enacted "to protect ... employee benefit plans and their beneficiaries"). Among those plans regulated by ERISA are employer-sponsored welfare plans that provide "benefits in the event of ... disability," 29 U.S.C. § 1002(1), such as the plan that Hartford administered for Ms. Lee's benefit.
ERISA requires that a plan administrator follow certain procedures if it denies a claim for benefits. Wade v. Hewlett-Packard Dev. Co. LP Short Term Disability Plan, 493 F.3d 533, 539 (5th Cir.2007). "These procedures are set forth in 29 U.S.C. § 1133 and the regulations promulgated by the Department of Labor thereunder." Id.
After the administrator denies the individual's claim, the administrator must provide the claimant with notice of the decision. 29 C.F.R. § 2560.503-1(g)(1) ("[T]he
If the administrator ultimately denies the appeal, the regulation requires a second round of disclosures. Thus, the administrator must disclose the specific reason for the decision, the specific plan provisions upon which the decision is based, an indication that the claimant is entitled to receive all records that are relevant to the claim, and a notification that the claimant has a right to file another internal appeal (if the policy so provides) or to bring a civil action under 29 U.S.C. § 1132(a). Id. § 2560.503-1(j)(1)-(4).
In sum, the relevant regulation mandates the disclosure of relevant documents at two discrete points: (1) "relevant documents generated or relied upon during the initial claims determination must be disclosed prior to or at the outset of an administrative appeal," Metzger v. UNUM Life Ins. Co. of Am., 476 F.3d 1161, 1167 (10th Cir.2007) (citing 29 C.F.R. § 2560.503-1(h)(2)(iii)), and (2) "relevant documents generated during the administrative appeal — along with the claimant's file from the initial determination — must be disclosed after a final decision on appeal," id. (citing 29 C.F.R. § 2560.503-1(i)(5)).
The plaintiff's motion presents a narrow legal question. The parties agree that Hartford was required to provide Ms. Lee with a copy of Dr. Brennan's report, which was generated during her appeal of Hartford's initial denial of her claim to benefits. But they disagree on the timing: the plaintiff argues that she was entitled to receive a copy before her internal appeal was decided so that she could respond, otherwise the appeal cannot be considered "full and fair." Hartford argues that it was required to turn over the report after it denied Lee's appeal. The court agrees with Hartford.
Any discussion of the timing of the disclosure issue would be incomplete without first mentioning Pettaway v. Teachers Insurance and Annuity Association of America, 644 F.3d 427, 436 (D.C.Cir.2011).
Although the D.C. Circuit's opinion in Pettaway is not directly on point to Ms. Lee's claim — that she was entitled to review and rebut Dr. Brennan's report before her appeal was decided — every other circuit to consider the issue has squarely rejected her argument. See Shedrick v. Marriott Intern., Inc., 500 Fed.Appx. 331, 339 (5th Cir.2012) ("Further, there does not appear to be relevant case law or regulations for the proposition that Aetna violated ERISA's full and fair review requirement by failing to consider evidence submitted after Shedrick's appeal was closed or by not allowing Shedrick to rebut the report by Dr. Wallquist."); Midgett v. Wash. Group Int'l Long Term Disability Plan, 561 F.3d 887, 896 (8th Cir.2009) ("[T]he full and fair review to which a claimant is entitled ... does not include reviewing and rebutting, prior to a determination on appeal, the opinions of peer reviewers solicited on that same level of appeal.");
Notwithstanding this line of precedent, Ms. Lee argues that the "full and fair"
The regulation also states that disclosure is required after an internal appeal is denied: Id. § 2560.503-1(j)(3) (requiring an administrator to provide "a statement that the claimant is entitled to receive, upon request and free of charge, reasonable access to, and copies of, all documents, records, and other information relevant to the claimant's claim for benefits" if it denies a claimant's appeal). This provision would be redundant or superfluous if disclosure was already required beforehand. Glazer, 524 F.3d at 1245; Tyson v. Pitney Bowes Long-Term Disability Plan, 2009 WL 2488161, at *4 (D.N.J. Aug. 11, 2009).
The plaintiff tries to evade this line of cases by citing to Abram v. Cargill, Inc., 395 F.3d 882 (8th Cir.2005), but that opinion is no longer good law. See Midgett, 561 F.3d at 895 (recognizing Abram's abrogation). The plaintiff in Abram brought suit before the Department of Labor amended its regulations in 2000. Landes v. Intel Corp.'s Long Term Disability Plan, 2010 WL 3155869, at *3 (N.D.Cal. Aug. 9, 2010) (noting that "the Eighth Circuit has itself recognized that the holding of Abram regarding the scope of a full and fair review is no longer applicable in light of amendments to the Department of Labor regulations that were not yet in effect when the claim in that case was decided"). Ms. Lee filed her suit after the new regulations took effect, and Abram is therefore inapplicable.
The plaintiff also cites to precedent suggesting that it would be unfair for an administrator to sandbag the claimant by conjuring some entirely new reason on appeal to justify the denial of her claim. See Clark v. Feder Semo & Bard, P.C., 895 F.Supp.2d 7, 32-33 (D.D.C.2012); Laub v. Aetna Life Ins. Co., 549 F.Supp.2d 571 (S.D.N.Y.2008). But that is not what happened here: Hartford claims that it merely used Dr. Brennan's medical report to reaffirm the accuracy of its initial denial of Ms. Lee's claim based on her failure to meet the new contractual definition of "disabled": i.e., that she was not "continuously unable to engage in any occupation" for which she was qualified, and that she was able to perform some work. Am Compl. ¶¶ 9, 12. The plaintiff does not contest this sequence of events. If so, there is no reason to assume that Hartford violated ERISA's requirements. See Pettaway, 644 F.3d at 436 ("The results of the additional tests and reviews did not provide a new basis for terminating [the plaintiff's] benefits, but merely supplemented its initial reasoning.").
Resolving the plaintiff's motion thus becomes a simple matter. The plaintiff wishes to supplement the record with additional documents, ostensibly because she had the right to do so under the Department of Labor's "full and fair" review requirement. But her right to a "full
Here, the plaintiff has not shown that Hartford violated her right to a "full and fair" internal review. Because "[c]ourts review ERISA-plan benefit decisions on the evidence presented to the plan administrators, not on a record later made in another forum," Heller v. Fortis Benefits Ins. Co., 142 F.3d 487, 493 (D.C.Cir. 1998) (citing Block v. Pitney Bowes Inc., 952 F.2d 1450, 1455 (D.C.Cir.1992)), the court denies the plaintiff's motion to supplement the record.
For the aforementioned reasons, the court will deny the plaintiff's motion to supplement the record. An order consistent with this memorandum opinion is separately issued this 5th day of March, 2013.