By: Amanda Sonneborn and Jules Levenson
Seyfarth Synopsis: Court excludes evidence of Social Security disability award issued after the final decision issued on plaintiff’s claim for plan disability benefits. The decision accentuates the importance of fighting to limit the evidence before a Court on review of a plan administrator’s decision.
Just like football is a game of inches, a recent case from the Northern District of Ohio reminds us that the outcome of a denial-of-benefits appeal can sometimes turn on quirks of timing. In Folds v. Liberty Life Assurance Co., the Plaintiff had successfully sought benefits for his Crohn’s disease under his own-occupation disability plan and had been receiving benefits for 10 months when Defendant questioned his continuing eligibility and ultimately determined that he was no longer eligible for benefits. No. 15-CV-00354, 2016 WL 5661615 (N.D. Ohio September 30, 2016).
Plaintiff unsuccessfully then appealed twice, with his second appeal being decided only four days before the Social Security Administration awarded him benefits. Id. at *6. He then sued claiming that the denial of benefits was arbitrary and capricious, based in part on the failure to consider the SSA decision, as well as a host of other reasons, including failure to conduct an independent medical exam, reliance on Defendant’s own physicians’ file review, failure to consider a letter from Plaintiff’s primary care physician and failure to consider a vocational report.
In a significant victory for Defendant, the Court struck the SSA decision because it had been issued after the conclusion of the appeal process and was therefore not part of the administrative record. In light of this ruling, the Court refused to consider the SSA decision, which had been submitted by Plaintiff to “show how a neutral body would analyze the very same set of facts,” holding that that the decision was not properly before the Court. Id.
This case serves as a victory for plan administrators who often engage in heated battles with plaintiffs who seek to ever expand the scope of administrative records. The decision here can be used by administrators as strong support for the proposition that courts should only consider the evidence before the administrators at the time of decision when reviewing those administrator’s decisions.