Jewell v. Life Insurance Co. of North America

508 F.3d 1303, 2007 U.S. App. LEXIS 27832, 2007 WL 4218919
CourtCourt of Appeals for the Tenth Circuit
DecidedNovember 30, 2007
Docket06-1272, 06-1288
StatusPublished
Cited by46 cases

This text of 508 F.3d 1303 (Jewell v. Life Insurance Co. of North America) is published on Counsel Stack Legal Research, covering Court of Appeals for the Tenth Circuit primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Jewell v. Life Insurance Co. of North America, 508 F.3d 1303, 2007 U.S. App. LEXIS 27832, 2007 WL 4218919 (10th Cir. 2007).

Opinion

McCONNELL, Circuit Judge.

The Life Insurance Company of North America (“LINA”) appeals an order granting Lynn Jewell’s claim for long-term disability benefits under the Employee Retirement Income Security Act of 1974, 29 U.S.C. § 1001 et seq., (“ERISA”), arguing that the district court should not have considered three exhibits from outside the administrative record. Mr. Jewell cross-appeals, seeking an award of attorney’s fees and an earlier date for the accrual of prejudgment interest. Because we hold that the district court abused its discretion in admitting and considering the extra-record exhibits, we reverse its judgment in LINA’s appeal. Mr. Jewell’s cross-appeal issues are therefore moot, and his appeal is dismissed.

I. FACTUAL AND PROCEDURAL HISTORY

A. Proceedings Before the Plan Administrator

Lynn Jewell was hired by Sprint Telecommunications Venture as a Director of National Sales and began work on April 21, 1997. Sprint’s employee health benefits plan, in which Mr. Jewell participated, is underwritten and administered by LINA. Precisely a year later, on April 22, 1998, Mr. Jewell filed a claim for disability benefits, stating that he was “[u]nable to perform [his] job due to severe head pain, dizziness, misspelling, panic attacks where unable to do anything, unable to lead people. Depressed. On medications.” App. 566. LINA determined that he was disabled, paid him short-term benefits of $7003 per month from April 1998 until they ended in October 1998, and then agreed to pay him long-term benefits. Under the terms of the plan, if Mr. Jewell’s disability was the result of physical injury or illness, his long-term benefits would last until age 65. If, however, the disability was “caused or contributed to by” depression or mental illness, they would expire after two years. App. 129.

In July 1999, LINA informed Mr. Jewell that it was paying under the mental illness limitation and that his benefit payments would end on October 18, 2000. LINA terminated Mr. Jewell’s benefits on that date, and Mr. Jewell did not challenge the decision to do so. Nearly two years later, *1307 around the time his wife abandoned him and left him penniless, Mr. Jewell requested reconsideration of his benefit termination and reinstatement of the benefit payments, writing that “[tjhose benefits ended due to a mis-diagnosis, from day one. I should have been diagnosed with physical, organic and traumatic brain injuries, and I had a stroke. This is the actual cause of the cognitive difficulties and symptoms, which have caused me to be disabled.” App. 373. He submitted additional medical information, but LINA denied his appeal on January 31, 2003. Mr. Jewell submitted a second appeal on September 15, 2003, along with a list of head injuries he claims he had suffered in the past. LINA denied that appeal on November 7, 2003.

B. Proceedings in Federal Court

Mr. Jewell then brought suit against LINA in state court in El Paso County, Colorado, for breach of contract and bad faith. On January 23, 2004, LINA removed the action to federal court, where it was converted to an ERISA claim arising under 29 U.S.C. § 1132(a)(1)(B). LINA moved for “judgment on the administrative record” on June 7, 2004. 1 Seeking to supplement the record beyond what LINA had compiled during the claim administration process, Mr. Jewell then moved for permission “to augment the record at the time of hearing with expert testimony.” App. 658. The district court reserved ruling until specific evidence was presented, and on February 14, 2005, Mr. Jewell submitted three exhibits he sought to have included in the record.

The first exhibit was a February 7, 2005, letter from Bruce H. Peters, M.D., Mr. Jewell’s neurologist, to Mark H. Kane, his attorney. The second was a February 9, 2005, letter from David U. Caster, M.D., Mr. Jewell’s psychiatrist, to Mr. Kane. The third was an affidavit executed by Mr. Jewell on February 11, 2005. The district court accepted briefing from both parties on the admission of this extra-record evidence, and issued a written opinion on December 14, 2005. In its opinion, the court began by stating the applicable test for admission of extra-record evidence in de novo ERISA benefit denial reviews as put forth in our decision in Hall v. UNUM Life Insurance Co. of America, 300 F.3d 1197 (10th Cir.2002). It found that the doctors’ letters and Mr. Jewell’s affidavit “do appear to include some information not contained in the administrative record that could assist the Court in understanding the medical issues in this case.” App. 786. The district court then decided to admit the disputed exhibits.

On March 9, 2006, the district court held a hearing on the case, and granted judgment for Mr. Jewell. The court’s oral opinion relied heavily on the letters of Drs. Peters and Caster. LINA then took this appeal, arguing that the extra-record exhibits should not have been admitted under the Hall standard and that the district court’s consideration of them tainted its judgment, requiring reversal. We begin with a discussion of Hall and the rules it *1308 provides for admission of extra-record evidence and then consider, first, whether the doctors’ letters should have been admitted; second, whether Mr. Jewell’s affidavit should have been admitted.

II. DISCUSSION

A. Standard for Admission of Extra-Record Evidence

ERISA, a “comprehensive and reticulated statute,” Nachman Corp. v. Pension Benefit Guar. Corp., 446 U.S. 359, 361, 100 S.Ct. 1723, 64 L.Ed.2d 354 (1980), governs employee benefit plans, including disability benefit plans such as LINA’s. When an individual covered by the plan makes a claim for benefits, the administrator gathers evidence, including the evidentiary submissions of the claimant, and determines under the plan’s terms whether or not to grant benefits. If the administrator denies the claim, the claimant may bring suit “to recover [the] benefits due to him under the terms of his plan.” 29 U.S.C. § 1132(a)(1)(B). Federal court is the exclusive forum for such suits, as ERISA preempts state laws relating to nearly all private employee benefit plans. Id. § 1144(a).

Where, as here, a plan administrator did not have “discretionary authority to determine eligibility for benefits or to construe the terms of the plan,” district courts will review a benefit denial de novo. Firestone Tire & Rubber Co. v. Bruch, 489 U.S. 101, 115, 109 S.Ct. 948, 103 L.Ed.2d 80 (1989).

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508 F.3d 1303, 2007 U.S. App. LEXIS 27832, 2007 WL 4218919, Counsel Stack Legal Research, https://law.counselstack.com/opinion/jewell-v-life-insurance-co-of-north-america-ca10-2007.