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Post-Lawsuit Administrative Appeals: E.D. La.

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  • Post-Lawsuit Administrative Appeals: E.D. La.

    In a recent case out of Louisiana, the court untangles a very messy timeline of administrative appeals and suits. By way of brief background, the Plaintiff (an attorney) filed a claim for LTD in April 2014, which was denied in October 2014. She appealed in January 2016, and that appeal was denied in May of the same year with the option for a second appeal. The Plaintiff appealed a second time in June of 2015 and was denied a month later in July. The Plaintiff then submitted a favorable SSD decision, and asked the Defendant to reconsider. The Defendant then granted a 24 month mental disability award, and the Plaintiff's counsel provided updated medical records. The Defendant then cut off benefits, and provided 180 days to appeal the decision. The Plaintiff then sued, and subsequently requested an appeal. Unum agreed to an appeal, and moved to have the suit dismissed for failure to exhaust administrative remedies. Before the court could consider the motion, Unum rendered its decision. A month later, Unum moved to submit the "disputed administrative record" in an effort to include information after the lawsuit was filed.
    Wittmann moves to strike from the administrative record all documents generated after September 22, 2017, the date on which she filed suit, while Unum seeks partial summary judgment that the documents generated as a result of the post-litigation administrative appeal are part of the administrative record, or in the alternative, summary judgment dismissing the suit for failure to exhaust administrative remedies. The Court first considers the parties’ contentions as to their competing motions about the administrative record.
    Wittmann contends that, because this lawsuit challenges Unum’s October 2014, May 2015, and July 2015 denials, the administrative record for purposes of considering those decisions closed as of the date she filed suit. To support her contention that the administrative record is limited to relevant information presented to the plan administrator before the claimant files suit, she invokes Vega v. Nat’l Life Ins. Servs., 188 F.3d 287, 300 (5th Cir. 1999) (en banc); Hamburg v. Life Ins. Co. of N. Am., No. 10-3071, U.S. Dist. LEXIS 841142, at *5 (E.D. La. Aug. 1, 2011) (Feldman, J.); and Roig v. Ltd. Long Term Disability Program, No. 99-2460, 2000 U.S. Dist. LEXIS 11379, at *22-23 (E.D. La. Aug. 4, 2000) (Vance, J.). Wittmann places special emphasis on Roig, No. 99-2460, 2000 U.S. Dist. LEXIS 11379 (“Roig I”), in which another Section of this Court addressed a plan administrator’s attempt to include within the administrative record two reports of a medical expert who was not retained until after the plaintiff filed suit. In declining to consider those post-suit reports as part of the administrative record, Judge Vance, in Roig I, reasoned that to do so “would permit ERISA plan administrators to drag their feet until they are sued and then allow them to belatedly bolster the administrative record in their favor.” Id. at *23. Wittmann contends that this is exactly what Unum is attempting to do here. Although she filed suit on September 22, 2017, Unum has nonetheless included within the administrative record, filed under seal with this Court, documents generated months after that date. Most notably, she submits, Unum seeks to include a “peer review” report of Dr. Benjamin Kretzmann, its retained rheumatologist, which concludes that years old diagnoses other than fibromyalgia – such as hysterectomy, appendectomy, and cervical discectomy – could somehow explain Wittmann’s symptoms of diffuse joint and muscle pain, severe fatigue, and cognitive problems. Wittmann maintains that this report, dated February 22, 2018, is a self-serving, long-after-the-fact attempt by Unum to justify its October 3, 2014 denial of Wittmann’s claim for long-term disability benefits. Accordingly, Wittmann argues, Vega and Roig I instruct that this report, as well as all other documents dated or generated after September 22, 2017, must be excluded from the administrative record to be considered by this Court.
    The defendant, obviously opposed the reasoning above. Ultimately, the court found for the Plaintiff and granted her motion. The full opinion is attached below.
    Attached Files