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New 10th Circuit Decision Further Restricts Review of Relevant Evidence in ERISA Cases

December 26, 2007

On November 30, 2007, the 10th Circuit Court of Appeals issued the decision in Jewell v. Life Ins. Co. of North America, 2007 WL 4218919. In this case, Mr. Jewell was seeking long term disability benefits through a group policy purchased with LINA (CIGNA) on behalf of the employees of Sprint Telecommunications. Mr. Jewell was suffering from severe headaches, dizziness, panic attacks, and depression. His benefits were denied under the policy’s mental illness limitation. After the lawsuit was transferred to federal court, the attorney for Plaintiff sought to introduce two additional opinions from Plaintiff’s physicians. Whether or not additional evidence can be presented following the insurance company’s determination of a claim is dependent upon the standard of review the court is to apply. If discretionary authority has been granted to the insurance company, the “arbitrary and capricious” standard of review will be applied by the trial court. If discretion has not been granted, the court’s review is “de novo” (of new). The Jewell decision addresses the admissibility of evidence in a de novo proceeding, and, in clarifying a previous decision in Hall v. Unum Life Insurance Co. of America, 300 F.3d 1197 (10th Cir. 2002), narrowly defines the limited circumstances in which additional evidence can be reviewed by the trial court. The Jewell case effectively makes it much more difficult to introduce relevant evidence for a judge’s review even in these de novo cases.

The Jewell case follows prior 10th Circuit decisions which have essentially concluded that all ERISA cases brought to court are mere “administrative reviews” of an insurance company’s denial. In this author’s opinion, neither the ERISA statutes nor regulations can be interpreted to conclude that the typical rights of a litigant and the applicability of the Rules of Civil Procedure have been stripped away, but that is exactly what it appears the Jewell decision has done. A restriction of the court’s review to the “administrative record” as it existed at the time of the insurance company’s final denial should, at best, only exist under the more deferential “arbitrary and capricious” standard of review. The Jewell decision makes it that much more difficult for a district court to review evidence even in a de novo review situation. Importantly, the Jewell and Hall decisions of the 10th Circuit are in direct conflict with the approach taken by some of the other circuits in this country. Those other decisions make it clear that the district courts are not reviewing anything under a “de novo” review but rather “making an independent decision about the employee’s entitlement to benefits.” See Diaz v. Prudential Ins. Co. of America, 499 F.3d 640 (7th Cir. 2007). In this Seventh Circuit decision, the Diaz court concluded that the district court “can and must come to an independent decision on both the legal and factual issues that form the basis of the claim.” Another circuit has ruled that, in a de novo review, the court may in its discretion take whatever additional evidence it deems necessary for it to conduct an adequate de novo review. Mongeluzo v. Baxter Travenol Long Term Disability Ben. Plan, 46 F.3d 938, 943-44 (9th Cir. 1995). In Mongeluzo, the court “held that a district court should admit evidence outside the administrative record when that evidence ‘‘is necessary to conduct an adequate de novo review of the benefit decision.’’ Id. at 944 (quoting Quesinberry v. Life Ins. Co. of North America, 987 F.2d 1017, 1025 (4th Cir. 1993)). Evidence that meets this standard need not satisfy the strict rules for the admissibility of evidence in a civil trial, and may be considered so long as it is relevant, probative, and bears a satisfactory indicia of reliability. See Mongeluzo, 46 F.3d at 941, 943 n.2 (doctor’s report and two affidavits admissible)

The Jewell case is just another example of the ever changing law of ERISA. If your claim for long term disability or life insurance benefits under a group insurance policy has been denied, it is crucial to obtain advice and representation of an experienced ERISA long term disability lawyer. At the Law Office of Shawn E. McDermott, LLC, we have committed a large portion of our time and legal practice to understanding and pursuing ERISA governed claims on behalf of claimants in Colorado, Kansas, Missouri, Arizona, Wyoming, Montana and other states.

Categories: Disability, ERISA Claims, Insurance

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