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2nd Cir. ¨C Unreturned Phone Call Does Not Trigger De Novo

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  • 2nd Cir. ¨C Unreturned Phone Call Does Not Trigger De Novo

    Here¡¯s a new case out of the Second Circuit, Marybeth M. Donlick v. Standard Insurance Company, fka Stanorp Financial Group, Inc. It is a relatively short and not very legally interesting opinion. The plaintiff was in a motorcycle accident and had her right leg amputated below the knee and left ankle was fractured among other injuries. Standard paid her her LTD benefits for 2 years and then denied her claim alleging that she was not disabled under the any occupation standard. The plaintiff brought suit and lost at District Court. She now challenges the District Court¡¯s decision at the Second Circuit arguing several different positions. The only two of interest are as follows. First, the plaintiff argues that because Standard failed to return her phone call at some point, a de novo review should be triggered. The court disagrees.

    Donlick also suggests that de novo review is appropriate because Standard violated Department of Labor (ʺDOLʺ) regulations, specifically 29 C.F.R. § 2560.503-1(f)(2)(iii)(B), when a Standard employee failed to return a phone call from Donlick. Though ʺa planʹs failure to comply with the [DOLʹs] claims©\procedure regulation, 29 C.F.R. § 2560.503-1, will result in that claim being reviewed de novo,ʺ the regulation cited by Donlick pertains only to group health plans, not disability benefit plans. Halo v. Yale Health Plan. Dir. of Benefits & Records Yale Univ., 819 F.3d 42, 57-58 (2d Cir. 2016). Moreover, we are not persuaded that Standardʹs alleged failure to return a phone call would violate 29 C.F.R. § 2560.503-1(f)(2)(iii)(B), especially in light of Standardʹs evidence that it sent numerous notices to Donlick and her lawyer. Donlick also suggests generally that Standard insufficiently communicated with her while evaluating her claim, but cannot point to any regulation that Standard violated or explain why this lack of communication should alter the standard of review.
    Next, the plaintiff argues that evidence outside of the record should be considered. Again, the court disagrees.

    Donlick next contends that the district court should have considered outside records she submitted instead of limiting its review to the administrative record. Though the district court has discretion to consider evidence from outside the administrative record, ʺthe presumption is that judicial review ʹis limited to the record in front of the claims administrator unless the district court finds good cause to consider additional evidence.ʹʺ Muller v. First Unum Life Ins. Co., 341 F.3d 119, 125 (2d Cir. 2003) (quoting DeFelice v. Am. Intʹl Life Assurance Co. of N.Y., 112 F.3d 61, 67 (2d Cir. 1997)). A conflicted administrator does not necessitate a finding of good cause. Locher v. Unum Life Ins. Co. of Am., 389 F.3d 288, 296 (2d Cir. 2004). Donlick failed to demonstrate good cause -- rather, she simply suggests in a conclusory manner that Standard is conflicted and that the strength of the evidence outside the record is itself enough to constitute good cause.
    The opinion is attached below.
    Attached Files
    Last edited by Nathan Bax; 03-07-2018, 11:48 AM.
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