By: Jon Karelitz and Mark Casciari
Synopsis: A recent 4th Circuit decision reiterates the importance of aligning a plan fiduciary’s administrative claim and appeal review process with the standards for a “full and fair review” under U.S. Department of Labor regulations, including disclosing all documents considered in the course of determining a claim (absent compelling reasons not to).
In Odle vs. UMWA 1974 Pension Plan, the Court of Appeals for the Fourth Circuit reversed a district court’s decision on summary judgment in favor of a pension plan’s fiduciaries (in this case, the board of trustees for a coal industry multiemployer fund). The case involved a dispute over service credit towards a deceased participant’s pension. The plan fiduciaries had denied a claim by the participant’s surviving spouse, concluding that 13.5 years of the participant’s service was actually performed in a position that was not classified as eligible under an industry-wide union agreement. The administrative record indicated that the fiduciaries based their denial, in part, on an audit of employer timesheet records that was not disclosed to the claimant. The claimant alleged as well that she requested the audit records, and the plan refused to provide them. The Fourth Circuit held that “by failing to disclose that audit during the administrative process, the Plan denied [the claimant] the ‘full and fair review’ of her claim that she was entitled to under ERISA.”
The regulations under ERISA Section 503 require that a claimant “be given reasonable access to documents relevant to her claim,” The regulations provide that documents, records and other information are “relevant” if they are “submitted, considered, or generated in the course of making the benefit determination.”
Under the Odle holding, a fiduciary should disclose all documents upon which a claim or appeal decision was based, unless there is a good reason not to. Such disclosure should provide the claimant with an opportunity to consider all relevant information, and use that information in making arguments in support of the claim. Of course, there may be compelling reasons not to disclose, under certain circumstances, and Odle does not address all possible arguments that cut against disclosure