White v. Prudential Ins. Co. of America
| Decision Date | 07 January 2005 |
| Docket Number | No. 4:03-CV-40386.,4:03-CV-40386. |
| Citation | 354 F.Supp.2d 1008 |
| Parties | Inetha WHITE, Plaintiff, v. THE PRUDENTIAL INSURANCE COMPANY OF AMERICA, Defendant. |
| Court | U.S. District Court — Southern District of Iowa |
Patricia Wengert, Des Mines, IA, for Plaintiff.
Kimberly J. Walker, Ross W. Johnson, Faegre & Benson, Des Moines, IA, for Defendant.
ORDER ON DEFENDANT'S MOTIONS TO LIMIT SCOPE OF THE RECORD, TO STRIKE, AND FOR SUMMARY JUDGMENT
This matter is before the Court on Defendant's Motion for Order to Grant Defendant's Motion to Limit the Scope of the Record (Clerk's No. 16), Defendant's Second Motion to Strike (Clerk's No. 52), and Defendant's Motion for Summary Judgment (Clerk's No. 27). Attorney for the Plaintiff is Patricia K. Wengert; attorneys for the Defendant are Ross Johnson, Paul Del Aguila,1 Daniel J. McMahon, and Jason Kuzniar. The Court finds oral argument, while requested, is not necessary based on the nature of the action and the nature of the review which must be under-taken by the Court. Accordingly, the Court considers the matter fully submitted and ready for ruling.
Plaintiff, Inetha White ("White"), commenced this action against Defendant, The Prudential Insurance Company of America ("Prudential"), in the Iowa District Court for Polk County on June 19, 2003, which Defendant then removed to this Court on July 11, 2003. Jurisdiction is proper pursuant to 28 U.S.C. § 1331, as this case arises under the Employment Retirement Income Security Act of 1974 ("ERISA"), 29 U.S.C. §§ 1001 et seq.
On June 14, 2004, Prudential filed a Motion for Summary Judgment pursuant to Federal Rule of Civil Procedure 56. White resisted Defendant's motion on July 29, 2004. In addition to the summary judgment motion, the Court must determine the scope of the record to be reviewed and whether some of Plaintiff's filings should be stricken as improper.
This matter concerns Prudential's decision to terminate long-term disability ("LTD") benefits to Inetha White under an employee welfare benefit plan ("the Plan") which is subject to ERISA. Prudential issued the Group Insurance Contract # GO-79365 ("the Policy") to Centrobe, Inc. ("Centrobe"), formerly Neodata Services, Inc., that funded the ERISA benefits at issue.
On May 31, 1998, White applied for disability benefits. In her application, White represented to Prudential that she was unable to perform the necessary duties of her position as a Material Handler as of January 27, 1998, because of a tumor. Under the Policy, an individual must be unable to perform the material and substantial duties of her occupation to meet the definition of "total disability" and be eligible for LTD benefits. Under the Policy, the definition of "total disability" changes at the end of the initial 24-month period that disability benefits are awarded. After the initial duration period, an individual must not be able to perform the material and substantial duties of any job for which she was reasonably fitted by her education, training, or experience in order to qualify for LTD benefits.
After reviewing White's medical records, Prudential determined that White was eligible to receive disability benefits for the initial 24-month period. Prudential further determined, however, that White's medical records did not indicate she was qualified for LTD benefits beyond that period. Specifically, Prudential found that White failed to provide any evidence that she was unable to perform the job functions for any occupation for which she was reasonably suited. In addition, Prudential determined, pursuant to the Policy's Benefit Limitation section, that White was no longer qualified to receive LTD benefits at the end of the 24-month period because her initial disability was caused, at least in part, by depression. Accordingly, Prudential terminated White's disability benefits at the end of the 24-month period because it determined White (1) no longer met the Policy's definition of "total disability" after the initial duration period and (2) had exhausted her LTD benefits.
White appealed the decision to terminate her LTD benefits. In so doing, White submitted additional information for Prudential's review. After reviewing the new and existing material, Prudential denied White's appeals.
Pending before the Court is Defendant's Motion for Summary Judgement. Prior to considering this motion, the Court must determine the scope of the record for review as there is some disagreement on this issue. In addition, the Court must assess whether certain filings made by Plaintiff should be stricken. Finally, the Court will then analyze the parties' contentions related to the motion for summary judgment.
The parties agree that all of the documents produced by Defendant (PIC0001 to PIC0829) are to be considered by the Court in connection with its review of the propriety of Defendant's decision with respect to Plaintiff's claim. There is, however, disagreement as to whether additional documentation should be considered by the Court. Specifically, Plaintiff asserts the Court should consider the medical records of Iowa Lutheran Hospital (Pl.Doc. Nos.619-678), and workers' compensation medical records (Pl.Doc. Nos.818-1172).
Prudential objects to the introduction and review of these additional documents because they were not considered by Defendant in connection with making its decision with respect to Plaintiff's claim. According to Prudential, these documents were not submitted to Prudential by Plaintiff, and these documents are not part of Defendant's claim file.
In conducting a review of the reasonableness of a benefits decision under the abuse of discretion standard, the Court normally is confined to a review of the information before the administrator at the time of the claim decision. Ferrari v. Teachers Ins. & Annuity Ass'n, 278 F.3d 801, 807 (8th Cir.2002); Schatz v. Mutual of Omaha Ins. Co., 220 F.3d 944, 949 (8th Cir.2000); Farley v. Ark. Blue Cross & Blue Shield, 147 F.3d 774, 777 (8th Cir.1998); Layes v. Mead Corp., 132 F.3d 1246, 1251 (8th Cir.1998); Cash v. Wal-Mart Group Health Plan, 107 F.3d 637, 641 (8th Cir.1997). This limitation is imposed to "`ensure expeditious judicial review of ERISA benefit decisions and to keep district courts from becoming substitute plan administrators.'" Cash, 107 F.3d at 641-42 (quoting Donatelli v. Home Ins. Co., 992 F.2d 763, 765 (8th Cir.1993)).
Likewise, under a de novo review, while the Court "has more discretion to allow the parties to introduce evidence in addition to that submitted to the plan decision-maker," McKeehan v. Cigna Life Ins. Co., 344 F.3d 789, 793 (9th Cir.2003), it should not normally consider new evidence that could have been offered to the plan administrator. Conley v. Pitney Bowes, 176 F.3d 1044, 1049 (8th Cir.1999); see also Cash, 107 F.3d at 641 () (citations omitted); Donatelli, 992 F.2d at 765 ( ) (citations omitted).
The Court may admit additional evidence in a review of denial of benefits under ERISA if the Plaintiff shows good cause for the Court to do so. Brown v. Seitz Foods, Inc., Disability Benefit Plan, 140 F.3d 1198, 1200 (8th Cir.1998); see also Ferrari, 278 F.3d at 807. If Plaintiff is unable to show "good cause," the Court should refuse to consider any evidence that was not before the plan administrator. Brown, 140 F.3d at 1201. Moreover, if the disputed materials are neither particularly helpful nor persuasive, then there has not been a breach of fiduciary duty and the materials need not be entered into the administrative record. Phillips-Foster v UNUM Life Ins. Co. of America, 302 F.3d 785, 798 (8th Cir.2002).
Prudential asserts that White has failed to come forward with any explanation as to why this Court should consider evidence beyond that which was considered by the Plan administrator. Defendant contends that White had a full and fair opportunity to submit all evidence in support of her claim to Prudential and that she has failed to explain why she failed to submit the contested documents to Defendant. Accordingly, Prudential asserts that White has not shown good cause for consideration of the documents in question and moves to exclude those documents and limit the scope of the record to the documents in the administrative claim file.
The Court finds it is compelled to limit the record to the materials contained in Prudential's claim file for White. This was the material Prudential relied on in making its benefits determination, which is the subject of this Court's review. White had ample opportunity to present additional evidence over a series of multiple reviews/appeals spanning nearly five years, and in fact did submit some additional material. The Court is now constrained from admitting even more material because White has not provided good cause for so doing. As a result, the Court must grant Defendant's motion to limit the scope of the record; and the Court will only consider the material contained in Prudential's claim file for White.
Rule 56 of the Federal Rules of Civil Procedures provides that summary judgment should be rendered,
if the pleadings, depositions, answers to interrogatories, and admissions on file, together with the affidavits, if any, show that there is no genuine issue as to any material fact and that the moving party is...
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