United States District Court, W.D. Washington, Seattle
ORDER DENYING MOTION TO SUPPLEMENT THE ADMINISTRATIVE
L. ROBART UNITED STATES DISTRICT JUDGE.
the court is Plaintiff Kristen Reetz's motion to
supplement the administrative record in this action with the
Social Security Administration's (“SSA”)
determination that she is disabled and the vocational
evidence presented at the SSA hearing. (Mot. (Dkt. # 14).)
Having considered the parties' submissions, the relevant
portions of the record, and the applicable law, the court
DENIES Ms. Reetz's motion to supplement.
case arises from Defendant Hartford Life and Accident
Insurance Company's (“Hartford”) termination
of Ms. Reetz's long-term disability (“LTD”)
benefits. (Compl. (Dkt. # 1) ¶¶ 5.2-5.5.) Ms. Reetz
was at all times a participant, as defined by the Employee
Retirement Income Security Act (“ERISA”), 29
U.S.C. § 1002(7), in a Group Long Term Disability Plan
(the “Plan”) provided by Hartford (Compl.
¶¶ 4.6-4.14). The Plan is an “employee
benefit plan” as defined by ERISA. See 29
U.S.C. § 1002(3). Hartford issues benefits for those who
meet the terms and conditions of the Plan. (Compl. ¶
result of an illness that began on or about March 7, 2014,
Ms. Reetz was allegedly unable to perform one or more of the
essential duties of her job. (Id. ¶ 4.19.)
Hartford determined that Ms. Reetz was disabled within the
meaning of the Plan and began paying her LTD benefits on June
6, 2014. (Id. ¶ 4.21.)
October 24, 2014, Hartford advised Ms. Reetz that she must
apply to the SSA for Social Security Disability Insurance
(“SSDI”) benefits. (Id. ¶ 4.23.)
SSDI benefits would offset any LTD payments that Hartford
made to Ms. Reetz. (Administrative Record (Dkt. # 15)
(“AR”) at 6-7, 18, 22, 449, 459.) Hartford
provided Ms. Reetz with attorneys who assisted her in
submitting a SSDI application. (Compl. ¶ 4.24.) Although
Ms. Reetz's application was initially denied, Ms. Reetz
filed a request for reconsideration and initiated the SSA
administrative appeal process. (See Id. ¶¶
April 28, 2016, as Ms. Reetz's SSA appeal was pending,
Hartford terminated Ms. Reetz's LTD benefits, explaining
via letter that she no longer qualified as disabled under the
Plan. (Id. ¶ 4.31.) Ms. Reetz, without
representation, appealed the benefit termination in May.
(Id. ¶ 4.34.) Hartford informed Ms. Reetz that
“it is her responsibility to provide info[rmation] on
appeal and [that] she may submit whatever she chooses.”
(Id. ¶ 4.35.)
months later, on July 30, 2016, the SSA determined that Ms.
Reetz was disabled based on the testimony of a vocational
expert, Dr. Paul Prachyl. (Id. ¶ 4.36; Reetz
Decl. (Dkt. # 16) ¶¶ 9-10, Ex. 7 at 27.) Due to the
award of SSDI benefits, Ms. Reetz repaid Hartford $28, 817.99
on August 4, 2016. (AR at 538.)
August 19, 2016, Hartford denied Ms. Reetz's appeal of
the termination of benefits. (Id. at 324-29.)
Hartford stated that it considered the “SSA's
disability determination as one piece of relevant
evidence” but determined that the ultimate decision of
non-disability was “based on vocational evidence which
the SSA is not required to use in the same way.”
(Id. at 328-29.) Having exhausted her administrative
remedies, Ms. Reetz initiated this suit in federal court.
(See generally Compl.) Hartford's claim file-the
current administrative record-contains neither the SSA's
disability determination nor Dr. Prachyl's testimony.
(Crawford Decl. (Dkt. # 15) ¶ 4; see generally
Reetz moves the court to supplement the existing
administrative record with the SSA's disability
determination and Dr. Prachyl's testimony at the hearing.
(Mot. at 1.) Hartford opposes the motion and argues that Ms.
Reetz has not shown any exceptional circumstances that would
warrant supplementing the administrative record. (Resp. (Dkt.
# 24) at 1.)
parties agree that the court's review of Hartford's
benefit determination is de novo. (See Mot.
at 5-6; Resp. at 1-2; Crawford Decl. ¶ 5.) Under de
novo review, “[t]he court simply proceeds to
evaluate whether the plan administrator correctly or
incorrectly denied benefits.” Abatie v. Alta Health
& Life Ins. Co., 458 F.3d 955, 963 (9th Cir. 2006).
The administrator's decision is accorded no deference.
Kearney v. Standard Ins. Co., 175 F.3d 1084, 1090
n.2 (9th Cir. 1999). The court evaluates whether the claimant
was “entitled to benefits based on the evidence in the
administrative record and other evidence as might be
admissible under the restrictive rule of [Mongeluzo v.
Baxter Travenol Long Term Disability Benefits Plan, 46
F.3d 938, 943 (9th Cir. 1995)].” Opeta v. Nw.
Airlines Pension Plan for Contract Emps., 484 F.3d 1211,
1217 (9th Cir. 2007) (internal quotation marks omitted).
Mongeluzo, the Ninth Circuit explained that
“[i]n most cases . . . the district court should only
look at the evidence that was before the plan administrator .
. . at the time of the determination.” 46 F.3d at 944.
This restriction to the administrative record is based on the
principle that district courts “should not function
‘as substitute plan administrators, ' and that
expanding the record on appeal ‘would frustrate the
goal of prompt resolution of claims by the fiduciary under
the ERISA scheme.'” Dorsey v. Metro. Life Ins.
Co., No. 2:15-cv-02126-KJM-CKD, 2017 WL 3720346, at *10
(E.D. Cal. Aug. 29, 2017) (quoting Taft v. Equitable Life
Assurance Soc'y, 9 F.3d 1469, 1472 (9th Cir. 1993)).
Evidence outside of the administrative record is considered
“only when circumstances clearly establish that
additional evidence is ...