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Supplementing the Administrative Record: D. Mass.

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  • Supplementing the Administrative Record: D. Mass.

    In a recent case from Massachusetts, the court ruled on a motion to supplement the administrative record. The Plaintiff sought to add portions of the Claims Manuel, documents referencing quality compliance, and vocational resource material. In ruling, the court seemed particularly interested with the Plaintiff's position that the "Evaluation of Subjective Symptoms" portion of the Claims Manuel be admitted:

    In the court’s view, Plaintiff’s final contention as to the Claims Manual stands on a different footing. Plaintiff alleges continuing disability based on subjective claims of pain and resulting functional limitations. Unum denied Plaintiff’s appeal from the discontinuation of benefits in significant part because objective medical findings in the record did not appear consistent with her complaints of chronic pain (Dkt. No. 18-1 at 3-4). Unum’s Claims Manual includes a section entitled “Evaluation of Subjective Symptoms” which outlines the process a disability benefits specialist should follow in making a disability determination when the primary symptoms supporting the claim are subjective (Dkt. No. 28 at 43-47). According to Plaintiff, this section of the Claims Manual “is a road map of how [Plaintiff] sustained her burden of proof as to continuing disability” (Dkt. No. 26 at 8). In Glista, the First Circuit held that where the claimant did not seek to add new factual material to the record, “the plan administrator’s own documents . . . providing the standard for evaluation of the facts presented” should be included in the administrative record. 378 F.3d at 122; see also Tebo v. Sedgwick Claims Mgmt. Servs., Inc., 848 F. Supp. 2d 39, 48-49 (D. Mass. 2012) (including in the administrative record training materials that reflected the plan administrator’s interpretation of its obligations under the Plan); Cannon v. Unum Life Ins. Co. of Am., 219 F.R.D. 211, 214 (D. Me. 2004) (Unum’s internal policies that instructed claims handlers how to handle the mental illness limitation in its policies would be relevant to the question of whether Unum acted arbitrarily and capriciously in its handling of the plaintiff’s claim). Supplementing the A.R. with Unum’s own documents directing claims handlers how to evaluate a disability claim that depends to a large extent on subjective claims of pain is consistent with the First Circuit’s ruling in Glista. Accordingly, Plaintiff is entitled to supplement the A.R. with pages 43-47 of Unum’s Claims Manual.
    With respect to the Quality Compliance Criteria, the court found:

    Plaintiff has not met her burden of showing a very good reason for supplementing the A.R. with QCC standards that Unum may apply generally in LTD cases or with additional QCC documents, if any exist, related to the denial of Plaintiff’s claim under her individual disability policy. See Liston, 330 F.3d at 23; Kamerer v. Unum Life Ins. Co. of Am., 251 F. Supp. 3d 349, 353 (D. Mass. 2017) (to reach outside of the administrative record related to a specific decision, a claimant must have a meaningful challenge to the procedure used by the claims administrator) (citing Orndorf, 404 F.3d at 520); Warming, 663 F. Supp. 2d at 19. For these reasons, the court denies Plaintiff’s request to compel production of QCC documents, records or information, and denies the request to supplement the A.R. with such documents, records or information.
    Finally, the court ruled that any request to add new vocational material would be denied. The opinion is attached below.
    Attached Files