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Consideration of Documents Outside of Administrative Record...

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  • Consideration of Documents Outside of Administrative Record...

    Consideration of Documents Outside of Administrative Record Not a Plain Error – 11th Cir.

    Attached is an unpublished case out of the Eleventh Circuit – Lopez v. Standard Insurance Company. This case has the longest review period I have ever seen – close to 10 years. The case is before the Eleventh Circuit on plaintiff’s appeal of the district court’s adoption of the magistrate’s report and recommendation. Plaintiff asserts that the district court erred by considering evidence outside of the administrative record. The Eleventh Circuit points out that neither party objected to the report and recommendation, therefore, it reviewed the district court’s decision for plain error. The court affirmed the district court’s opinion.

    Lopez raises one issue on appeal: that the district court “erred by considering evidence generated after the administrator of an employee benefit plan made its final decision to deny disability benefits.” He says this was plain error, warranting reversal.

    It is true that “[r]eview of the plan administrator’s denial of benefits is limited to consideration of the material available to the administrator at the time it made its decision.” Blankenship, 644 F.3d at 1354. And that is what the magistrate judge did here, performing a thorough analysis of the medical evidence that was before Standard and determining that Standard’s decision denying benefits under the Any Occupation standard was not wrong. This decision was supported by three medical consultants who opined that Lopez could perform sedentary work as of December 2007. Standard’s vocational consultant also determined that particular jobs met Lopez’s restrictions and paid sufficient wages that Lopez could be expected to earn at least 60% of his predisability earnings in such positions, as required under his policy. While Lopez argued that the vocational consultant’s report would have been more accurate if she used data from 2007 rather than 2013, this does not mean that it was error for Standard to rely on its vocational consultant’s analysis. And when Lopez raised this issue in the district court, it was not plain error for the court to note that the analysis turned out the same no matter which data was used. This was not an example of an insurer initiating a post-hoc relitigation of Lopez’s claim based on new evidence. See Bloom, 917 F. Supp. 2d at 1277. Standard’s position has always been that Lopez did not meet his burden of showing that he was disabled from performing any occupation because he could perform sedentary work. The district court agreed. Plain error review is a difficult standard to meet, and we cannot say Lopez has done so here. We therefore affirm the district court’s grant of Standard’s motion for summary judgment.”
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