Court Allows Additional Evidence at Trial in ERISA Disability Case

The Administrative Record

In most cases, when a lawsuit is filed to secure long term disability benefits under an ERISA governed policy the only information that a Judge can consider at trial is what is contained in the Administrative Record. The Administrative Record consists of all the information you supply to the insurance company in support of your claim, and all the information generated and collected by the insurance company to evaluate your claim. The Administrative Record typically closes after an insurance company renders a final denial of benefits.

What does this mean? It means that you are precluded from adding any additional information to your file that could support your entitlement to benefits after a final denial has been rendered. However, a recent order entered by a federal court Judge in the Northern District of California in the case of Oldoerp v. Wells Fargo & Company Long Term Disability Plan; Metropolitan Life Insurance Company demonstrates that the Administrative Record does not always close following a final denial of benefits under an ERISA governed disability policy.

When additional information can be added to the Administrative Record

First and foremost, it is important to note that the ruling entered in Oldoerp is predicated upon a de novo standard of review at trial. If your lawsuit is being decided under the arbitrary and capricious standard of review then the arguments and rulings contained in the order entered by the Court in Oldoerp would not apply.

In this case Ms. O was attempting, amongst other evidence, to have the favorable ruling from the Social Security Administration admitted into evidence for the Judge’s consideration at trial. MetLife opposed the entry of this information as the Social Security ruling was made one month after MetLife had entered a final denial of benefits. Attorneys for MetLife argued that the information contained in the SSDI claim file would not be probative in determining whether MetLife made an erroneous decision to deny benefits, as the ruling did not exist at the time of MetLife’s final denial. The Court disagreed and noted that under certain circumstances new evidence may be admitted “to enable the full exercise of informed and independent judgment.” Citing applicable case law in the 9th Circuit, the Court went on to state that, “[E]xtrinsic evidence is appropriate when “circumstances clearly establish” that additional evidence is necessary to conduct an adequate de novo review of the benefits decision.” What constitutes an “exceptional circumstance?” According to the Court and 9th Circuit case law, it would include, in part:

With respect to getting the Social Security file into evidence, attorneys for Ms. O, argued it was the last circumstance that applied. The Court agreed with her attorneys and noted that the ruling by the SSA was based on an in-person evaluation as well as a review of medical records and as such could shed new light on Ms. O’s condition during the relevant time period. The Court further stated that the SSDI evidence “potentially bears on whether she experienced functional limitations” during the time MetLife was reviewing her claim, and thus whether MetLife was correct to deny her claim for benefits. As such the Court determined that the SSA record is necessary for an adequate de novo review.

What does this mean for you?

This ruling demonstrates that in very limited situations additional evidence outside of the Administrative Record can be argued at trial. The analysis of the information to be proffered, the applicable standard of review, and the jurisdiction of the court all must be evaluated to determine if the right to add information outside of the Administrative Record exists.

Attorneys Dell & Schaefer have not represented Oldoerp at any stage of her claim. If your claim has been denied on appeal and your only option is to bring civil suit under ERISA, please feel free to contact our Office for a free consultation.

There is one comment so far

  • Thank u so much, I just hope I live long enough to implement this. Would also like to be able to improve my mothers quality of life. All dependent of money coming in for me.

    Lumpy ;-) Jul 14, 2020  #1

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We represent MetLife clients nationwide and we encourage you to contact us for a FREE immediate phone consultation with one of our experienced disability insurance attorneys.

Can you help with a MetLife disability insurance policy?

Our disability insurance lawyers help policy holders seeking short or long term disability insurance benefits from MetLife. We have helped thousands of disability insurance claimants nationwide with monthly disability benefits. With more than 40 years of disability insurance experience we have helped individuals in almost every occupation and we are familiar with the disability income policies offered by MetLife.

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Our lawyers help individuals that have either purchased a MetLife long term disability insurance policy from an insurance company or obtained short or long term disability insurance coverage as a benefit from their employer.

Our experienced lawyers can assist with MetLife:

  • ERISA and Non-ERISA Appeals of Disability Benefit Denials
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Yes. We are a national disability insurance law firm that is available to represent you regardless of where you live in the United States. We have partner lawyers in every state and we have filed lawsuits in most federal courts nationwide. Our disability lawyers represent disability claimants at all stages of a claim for disability insurance benefits. There is nothing that our lawyers have not seen in the disability insurance world.

What are your fees?

Since we represent disability insurance claimants at different stages of a disability insurance claim we offer a variety of different fee options. We understand that claimants living on disability insurance benefits have a limited source of income; therefore we always try to work with the claimant to make our attorney fees as affordable as possible.

The three available fee options are a contingency fee agreement (no attorney fee or cost unless we make a recovery), hourly fee or fixed flat rate.

In every case we provide each client with a written fee agreement detailing the terms and conditions. We always offer a free initial phone consultation and we appreciate the opportunity to work with you in obtaining payment of your disability insurance benefits.

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No. For purposes of efficiency and to reduce expenses for our clients we have found that 99% of our clients prefer to communicate via telephone, e-mail, fax, sessions, or Skype. If you prefer an initial in-person meeting please let us know. A disability company will never require you to come to their office and similarly we are set up so that we handle your entire claim without the need for you to come to our office.

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When you call us during normal business hours you will immediately speak with a disability attorney. We can be reached at 800-682-8331 or by email. Lawyer and staff must return all client calls same day. Client emails are usually replied to within the same business day and seem to be the preferred and most efficient method of communication for most clients.

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They told me that it would be another month before they could get back to me. At this point I felt the situation was hopeless. I contacted Dell & Schaefer, they immediately responded and quickly contacted the insurance carrier via letter. Two weeks later I was approved. I have had excellent experience with the firm. They keep me informed and always respond in a timely manner. They are proactive and provide great support when I need to respond to any requests from my insurance carrier.

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