Russann H. Hall v. Unum Life Insurance Company of America

300 F.3d 1197, 28 Employee Benefits Cas. (BNA) 2441, 2002 U.S. App. LEXIS 17174, 2002 WL 1902881
CourtCourt of Appeals for the Tenth Circuit
DecidedAugust 20, 2002
Docket01-1237
StatusPublished
Cited by106 cases

This text of 300 F.3d 1197 (Russann H. Hall v. Unum Life Insurance Company of 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
Russann H. Hall v. Unum Life Insurance Company of America, 300 F.3d 1197, 28 Employee Benefits Cas. (BNA) 2441, 2002 U.S. App. LEXIS 17174, 2002 WL 1902881 (10th Cir. 2002).

Opinion

LUCERO, Circuit Judge.

UNUM Life Insurance Company of America (“UNUM”) appeals the district court’s judgment for plaintiff Russann H. Hall. Hall filed suit against UNUM under the Employee Retirement Income Security Act (“ERISA”), 29 U.S.C. §§ 1001-1461, because it terminated her disability benefits. UNUM’s principal argument is that the district court improperly considered evidence outside of the administrative record relied upon by UNUM when it terminated Hall’s benefits. We have jurisdiction pursuant to 28 U.S.C. § 1291 and affirm.

I

In 1993, Hall injured her left shoulder in a bicycle accident. At the time, she was a Regional Vice President of Sales for Nova Information Systems, Incorporated (“Nova”), and she was a participant in Nova’s group long-term disability insurance plan. Under that plan, she was entitled to benefits from UNUM if she was disabled and unable to perform “the material duties of [her] regular occupation.” (1 Appellant’s App. at 60.) Hall’s injury required multiple surgeries in 1993 and 1994, and she was unable to permanently return to her job at Nova. In January 1994, UNUM concluded that Hall was disabled and approved the payment of long-term disability benefits to her. In the summer of 1995, a UNUM employee reviewed Hall’s claim file and began to investigate whether Hall remained disabled within the terms of the UNUM policy. UNUM offered Hall a lump-sum payment to resolve all claims under the policy, an offer that Hall refused. The company then proceeded to reevaluate Hall’s medical condition and whether that condition prevented her from pursuing her occupation; the reevaluation included surreptitious video surveillance of Hall. Based on this reevaluation, UNUM concluded that Hall was no longer disabled because the restrictions on her physical activities did not prevent her from undertaking work as a vice-president of sales. On April 24, 1996, UNUM terminated disability payments to Hall, and her subsequent internal appeal was denied in November 1996.

After the termination of disability payments, Hall worked for a short time for another corporation as a sales manager but was terminated from that job in 1998. Throughout 1997, Hall received additional *1200 medical treatment due to continuing pain in her left shoulder. A physician diagnosed her condition as “thoracic outlet syndrome,” a condition in which the nerves to the arm are constricted. In 1998, Hall underwent two additional surgeries in an attempt to treat the thoracic outlet syndrome. Hall informed UNUM of the additional medical treatment in June 1997 when she sought to have the termination of disability payments reconsidered, but UNUM was never subsequently informed of the additional surgeries.

Hall filed suit against UNUM in August 1997, alleging that UNUM had violated ERISA by improperly terminating her disability payments. UNUM moved for judgment on the administrative record in September 1998, arguing in part that the court was limited to considering the materials compiled by UNUM in the course of its management and termination of Hall’s disability claims. The district court characterized this as a motion for summary judgment and denied it on August 24, 1999, ruling that it would consider evidence beyond the administrative record. A bench trial was held August 28-30, 2000. The district court entered findings, conclusions, and an order in December 2000, determining that UNUM had breached its duty to Hall under ERISA. The court held that UNUM owed Hall past-due benefit payments and that Hall was entitled to mandatory injunctive relief for future benefits “so long as her disability continues.” 1 (1 Appellant’s App. at 74.) In supplemental findings, conclusions, and an order for judgment, the district court ordered that UNUM pay pre-judgment interest and attorney’s fees to Hall.

UNUM timely appeals, arguing that the district court erred in allowing admission of evidence outside the administrative record and awarding Hall attorney fees. Our review is limited to those issues, and thus, we are not asked to address the district court’s disability decision on the merits.

II

ERISA provides a detailed and comprehensive set of federal regulations governing the provision of benefits to employees by employers, including disability benefits. ERISA specifically gives a plan beneficiary the right to federal court review of benefit denials and terminations. See 29 U.S.C. § 1132(a). However, the statute does “not establish the standard of review for such decisions.” Chambers v. Family Health Plan Corp., 100 F.3d 818, 824-25 (10th Cir.1996).

In Firestone Tire & Rubber Co. v. Bruch, 489 U.S. 101, 109 S.Ct. 948, 103 L.Ed.2d 80 (1989), the Supreme Court established the basic framework for determining the standard of review in ERISA cases that challenge the denial or termination of benefits. 2 The Court held that “a denial of benefits challenged under § 1132(a)(1)(B) is to be reviewed under a de novo standard unless the benefit plan gives the administrator or fiduciary discretionary authority to determine eligibility for benefits or to construe the terms of the plan.” Firestone, 489 U.S. at 115, 109 S.Ct. 948. If discretionary authority ex *1201 ists, then the proper standard of review is abuse of discretion. Id. UNUM does not challenge the district court’s determination that the de novo standard applies to judicial review of its decision.

However, Firestone left open the issue of what evidence may be considered by a federal court in an action under § 1132(a)(1)(B) when de novo review is required. This Circuit, along with the majority of other federal courts of appeals, has held that in reviewing a plan administrator’s decision for abuse of discretion, the federal courts are limited to the “administrative record” — the materials compiled by the administrator in the course of making his decision. Sandoval v. Aetna Life & Cas. Ins. Co., 967 F.2d 377, 380-81 (10th Cir.1992); Woolsey v. Marion Labs., Inc., 934 F.2d 1452, 1460 (10th Cir.1991); see also Miller v. United Welfare Fund, 72 F.3d 1066, 1071 (2d Cir.1995) (compiling cases and stating that “[m]ost circuits have declared that, in reviewing decisions of plan fiduciaries under the arbitrary and capricious standard, district courts may consider only the evidence that the fiduciaries themselves considered”).

Free access — add to your briefcase to read the full text and ask questions with AI

Related

Cite This Page — Counsel Stack

Bluebook (online)
300 F.3d 1197, 28 Employee Benefits Cas. (BNA) 2441, 2002 U.S. App. LEXIS 17174, 2002 WL 1902881, Counsel Stack Legal Research, https://law.counselstack.com/opinion/russann-h-hall-v-unum-life-insurance-company-of-america-ca10-2002.