Davidson v. Prudential Ins. Co. of America

• Decision Date: 10 January 1992
• Docket Number: No. 90-2699WM,90-2699WM
• Citation: 953 F.2d 1093
• Parties: Donald L. DAVIDSON, Appellant, v. The PRUDENTIAL INSURANCE COMPANY OF AMERICA, Appellee.
• Court: U.S. Court of Appeals — Eighth Circuit

Page 1093

953 F.2d 1093

Donald L. DAVIDSON, Appellant, v. The PRUDENTIAL INSURANCE COMPANY OF AMERICA, Appellee.

No. 90-2699WM.

United States Court of Appeals Eighth Circuit.

Submitted April 11, 1991.

Decided Jan. 10, 1992.

Joseph K. Lewis, Kansas City, Mo., argued, for appellant.

Robert W. McKinley, Kansas City, Mo., argued, for appellee.

Before FAGG and BEAM, Circuit Judges, and DOTY, ^* District Judge.

FAGG, Circuit Judge.

Donald L. Davidson appeals the district court's order denying him disability benefits under a group insurance policy issued by The Prudential Insurance Company of America (Prudential). We affirm.

In 1983 Prudential issued a group insurance policy to Davidson's employer, Superior Supply Company, as part of Superior's employee benefit plan. In 1984 Davidson was injured in an automobile accident, resulting in his inability to return to work. Davidson filed a claim for long-term disability (LTD) benefits, and Prudential promptly approved Davidson's claim. The group policy covering Davidson provided that LTD benefits would be paid for twenty-four months, but after that period the benefits would be paid only if Davidson was "unable to engage in any and every gainful occupation for which he [was] reasonably fitted for by education, training or experience." For the next two years, Prudential paid Davidson LTD benefits, stayed in contact with Davidson, and monitored his recovery.

At the end of the twenty-four month period, Prudential notified Davidson that based on the information in Prudential's files, Davidson would not be eligible for continuing LTD benefits. Prudential, however, decided to investigate Davidson's claim further and continued to pay benefits beyond the initial twenty-four month period. Several months later, Prudential notified Davidson his claim for continuing LTD benefits was denied, but indicated Davidson was free to submit additional evidence and request a reconsideration of the denial.

Davidson submitted additional evidence and Prudential reinstated his benefits while the review process continued. Prudential had Davidson examined by an independent neuro-psychiatrist to evaluate certain claims Davidson made about his disability and inability to work. After considering Davidson's supplemental information and the neuro-psychiatrist's report, Prudential again denied Davidson continuing LTD benefits. Davidson, represented by counsel, asked Prudential to reconsider its denial, but did not offer any additional evidence. Prudential reviewed Davidson's case and denied the LTD benefits. Davidson then brought this action contending Prudential wrongly denied him LTD benefits in violation of the Employee Retirement Income Security Act (ERISA), 29 U.S.C. §§ 1001-1461.

As a threshold matter, the parties agree the district court and this court should review the plan administrator's fact-based decision to deny benefits de novo, that is, without giving any deference to the administrator's decision. See Firestone Tire & Rubber Co. v. Bruch, 489 U.S. 101, 110-15, 109 S.Ct. 948, 954-57, 103 L.Ed.2d 80 (1989). Davidson, however, contends the district court committed error in refusing to open the administrative record and include a vocational report prepared after litigation had started, which had not been presented to the plan administrator. See Luby v. Teamsters Health, Welfare & Pension Trust Funds, 944 F.2d 1176, 1184-85 (3d Cir.1991) (holding new evidence may be presented to district court conducting a de novo review); Moon v. American Home Assurance Co., 888 F.2d 86, 89 (11th Cir.1989) (same). Alternatively, Davidson contends the district court committed error in failing to remand this case to the administrator to consider the vocational report and a psychiatrist's report also prepared after litigation commenced. See, e.g., Berry v. Ciba-Geigy Corp., 761 F.2d 1003, 1007 (4th Cir.1985) (holding remand proper if district court believes administrator lacked adequate evidence to make decision); Wolfe v. J.C. Penney Co., 710 F.2d 388, 394 (7th Cir.1983) (holding remand proper if administrator failed to develop critical evidence bearing on benefits determination). Prudential disagrees, arguing the district court properly made its own determination of whether Davidson is entitled to benefits based on the evidence already in the administrative record. See Perry v. Simplicity Eng'g, 900 F.2d 963, 966-67 (6th Cir.1990) (holding de novo review does not require district court to consider evidence not presented to the plan administrator).

Given the circumstances in this case, we need not decide whether a district court conducting a de novo review of an ERISA plan administrator's benefits determination may consider evidence that was not part of the administrative record, or alternatively, direct the administrator to develop the record further. Davidson does not contend Prudential failed to consider proper evidence when determining his eligibility for continuing LTD benefits. Rather, Davidson contends he should be allowed to reopen the record and submit additional evidence that is more favorable to him than the evidence considered by the administrator. This additional evidence, created after litigation had begun, was known or should have been known to Davidson during the administrative proceedings. No change in Davidson's condition occurred after Prudential denied his claim, and Davidson knew what his medical limitations were when he first sought continuing LTD benefits. Indeed, the administrative record is replete with medical reports, physician's statements, vocational assessments, and other evidence bearing on Davidson's ability to work. Prudential nevertheless gave Davidson multiple opportunities to supplement the record. Thus, if Davidson believed the evidence he now offers was necessary for Prudential to make a proper benefits determination, Davidson should have obtained this evidence and submitted it to Prudential. Having failed to do so, Davidson's offer of additional evidence at this point amounts to nothing more than...