Nancy Harrison v. Wells Fargo Bank, N.A.

Filing

PUBLISHED AUTHORED OPINION filed. Originating case number: 3:13-cv-00279-JRS. [999487908]. [13-2379]

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PUBLISHED
UNITED STATES COURT OF APPEALS
FOR THE FOURTH CIRCUIT

No. 13-2379

NANCY A. HARRISON,
Plaintiff - Appellant,
v.
WELLS FARGO BANK, N.A.; WELLS FARGO AND COMPANY DISABILITY
PLAN,
Defendants - Appellees.
------------------------------------SECRETARY OF LABOR,
Amicus Supporting Appellant.

Appeal from the United States District Court for the Eastern
District of Virginia, at Richmond.
James R. Spencer, Senior
District Judge. (3:13-cv-00279-JRS)

Argued:

October 28, 2014

Decided:

December 5, 2014

Before WILKINSON and KING, Circuit Judges, and HAMILTON, Senior
Circuit Judge.

Reversed and remanded by published opinion.
Judge Wilkinson
wrote the opinion, in which Judge King and Senior Judge Hamilton
joined.

ARGUED: Richard F. Hawkins, III, THE
Richmond,
Virginia,
for
Appellant.

HAWKINS LAW FIRM, PC,
Dana
Lewis
Rust,

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MCGUIREWOODS LLP, Richmond, Virginia, for Appellees.
Gail A.
Perry, UNITED STATES DEPARTMENT OF LABOR, Washington, D.C., for
Amicus Supporting Appellant.
ON BRIEF: Summer L. Speight,
MCGUIREWOODS LLP, Richmond, Virginia, for Appellees.
M.
Patricia Smith, Solicitor of Labor, G. William Scott, Acting
Associate Solicitor for Plan Benefits Security, Elizabeth
Hopkins, Counsel for Appellate and Special Litigation, UNITED
STATES DEPARTMENT OF LABOR, Washington, D.C., for Amicus
Supporting Appellant.
_______________

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WILKINSON, Circuit Judge:
Nancy

Harrison

brought

suit

against

her

employer

Wells

Fargo, arguing that the company improperly terminated her shortterm disability benefits while she was undergoing a series of
treatments for thyroid disease. The district court upheld Wells
Fargo’s decision, finding the plan administrator did not abuse
its

discretion

Wells

Fargo

evidence

of

in

denying

failed
which

to

it

Harrison’s

consider

was

put

on

claim.

However,

readily

available

notice,

the

because
material

review

process

failed to conform to the directives of ERISA and the Plan’s own
terms. We thus reverse and remand to the district court with
directions to return the case to Wells Fargo for a full and fair
review of Harrison’s claims.
I.
A.
Wells
Service

Fargo

hired

Representative

responsible

for

Nancy
in

assisting

Harrison
2008.

as

In

customers

an

this
with

Online

Customer

role,
a

she

was

wide

range

of

inquiries related to online financial products and services. Her
work was primarily sedentary in nature but required her to keep
up

in

a

“fast

paced

environment”

and

“adequately

maintain

service levels” for customers. J.A. 203. She was also required
to work ten hours a day for four consecutive days while sitting
for 97% of that time.
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In

May

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2011,

Harrison’s

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doctor

discovered

she

had

an

enlarged thyroid and a large mass extending into her chest that
was causing her to suffer chest pain and tracheal compression.
Harrison

underwent

a

bronchoscopy

on

June

9,

2011,

and

a

thyroidectomy on August 17, 2011. She was unable to work and
received short-term disability benefits under a plan offered by
her employer. As part of her claim, she provided documentation
and contact information for her primary care doctor, Dr. Mark
Petrizzi,

her

Himbergen,

Ear,

and

her

Nose

&

Throat

thoracic

doctor,

surgeon,

Dr.

Dr.

Daniel

Darius

Van

Hollings.

Although she needed a second surgical procedure to remove the
remaining mass in her chest, her benefits were terminated on
September 10, 2011, just three weeks after her thyroidectomy.
Wells Fargo adjudged this to be the normal period of recovery
from this sort of operation.
While Harrison was facing her surgeries, her husband died
unexpectedly, triggering a recurrence of depression and posttraumatic stress disorder (PTSD) related to the death of her
mother and her children in a house fire in 2004. Her primary
care

physician,

Dr.

Petrizzi,

doubled

her

dosage

of

anti-

depressants and referred her to a psychologist, Dr. R. Glenn,
for additional treatment. After her thyroidectomy, Harrison also
reported

pain

in

her

right

shoulder

prescribed home-based physical therapy.
4

for

which

Dr.

Petrizzi

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Although the doctor was able to remove Harrison’s thyroid
during

the

August

17,

2011,

procedure,

it

was

a

difficult

surgery and he was unable to remove the entire mass in her
chest. One week after the operation, Harrison notified Wells
Fargo that she was scheduled for another more serious procedure,
a median sternotomy, on October 31, 2011, where Dr. Hollings
would

cut

open

her

chest

to

remove

the

remaining

tissue.

However, on September 10, 2011, Wells Fargo found that she had
fully recovered from the thyroidectomy, deemed her fit to return
to work, and discontinued her short-term disability benefits.
The

parties

do

not

dispute

that

Harrison

was

properly

granted benefits during the period from her bronchoscopy (June
9, 2011) through her arguable recovery from the thyroidectomy
(September 10, 2011) nor do they dispute that she would have
been eligible for benefits following the October 31st sternotomy
had she gone back to work in the interim. The only dispute is
whether Harrison was properly denied benefits from September 10,
2011, to October 31, 2011. *

*

Employees must return to work once Wells Fargo determines
they are no longer disabled in order to be eligible for future
benefits under the terms of the Plan. Because she did not return
to work after Wells Fargo found her sufficiently recovered on
September 10, 2011, Harrison was denied benefits for the October
31st surgery and subsequent recovery period. If benefits were
improperly denied for the disputed period between the surgical
procedures, the entire period from June 9, 2011, through her
recovery from the sternotomy may be considered a single period
(Continued)
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B.
The Short-Term Disability (STD) Plan (“the Plan”), provided
by Wells Fargo to its employees, entitles employees to salary
replacement

benefits

where

a

“medically

certified

health

condition” renders an employee “unable to perform some or all of
[his or her] job duties for more than seven consecutive days.”
Id.

at

477.

The

Plan

defines

a

medically

certified

health

condition as a disabling injury or illness that is “documented
by clinical evidence as provided and certified by an approved
care provider . . . includ[ing] medical records, medical test
results,

physical

prescription

therapy

records.”

notes,

Id.

at

mental

480.

Such

health

records,

condition

must

and
also

“prevent [the employee] from performing the essential functions
of [his or her] own job as regularly scheduled.” Id.
The Plan is self-funded by Wells Fargo and Liberty Life
Assurance Company of Boston serves as the claims administrator.
After

an

Liberty

employee

must

notify

submits
the

a

claim

claimant

of

for
the

disability
decision

benefits,
either

to

approve or deny benefits. At the time of a denial, Liberty must
include the reasons why the claim was denied and, if applicable,
any additional information that is needed. The Plan provides for

of disability and she may be eligible to recover benefits from
October 31, 2011, through mid-December 2011 as well.
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a two-level appeals process. Employees who believe their claims
were

improperly

denied

may

file

a

first-level

appeal

with

Liberty. If Liberty denies this appeal, claimants may file a
second-level appeal directly with Wells Fargo. If Wells Fargo
denies

the

second-level

appeal,

that

decision

is

considered

final and claimants may file suit under Section 502(a) of ERISA.
See J.A. 485-87; see also, 29 U.S.C. § 1132.
Following Liberty’s initial denial of benefits, Harrison,
acting pro se, sought a first-level appeal with Liberty, the
claims

administrator.

In

her

appeal,

she

noted

that

she

continued to have chest pain from her recent thyroid surgery and
had suffered emotional trauma from the death of her husband. Her
primary

care

physician,

Dr.

Petrizzi,

provided

additional

documentation to that effect. Harrison also noted that she had
an appointment to see Dr. Glenn, a psychologist, with regard to
her mental health condition and provided contact information for
Drs. Petrizzi, Hollings (her thoracic surgeon), and Glenn (her
psychologist). A nurse case manager reviewed her file, and on
November 28, 2011, Liberty upheld the denial of her claim.
Harrison, again acting pro se, filed a second-level appeal
with

Wells

Fargo

documentation

from

under
Drs.

the

terms

Petrizzi

of
and

the

Plan.

Hollings

She
as

provided

well

as

a

detailed letter from her sister who was her primary caretaker
outlining

her

continuing

pain,
7

disability,

and

severe

panic

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attacks. Wells Fargo, as part of the second-level appeal, sought
two

independent

peer

reviews

--

one

of

Harrison’s

physical

disability claims by Dr. Dan Gerstenblitt and another of her
psychological disability claim by Dr. A.E. Daniel.
Dr.
mental

Daniel

health,

referred

to

contacted
but

him

Dr.

Petrizzi

did

not

Dr.

Petrizzi.

by

contact
In

regarding

Dr.

Glenn

his

Harrison’s

despite

review,

Dr.

being
Daniel

concluded that while there was evidence in the record to suggest
that the loss of her husband could have triggered PTSD caused by
the

death

of

her

mother

and

children,

“[i]n

the

absence

of

psychiatric/psychological records or telephone conference with
her

psychologist,

an

opinion

as

to

whether

her

psychiatric

status limited her functional capacity cannot be provided.” Id.
at 394. On May 4, 2012, Wells Fargo rendered a final decision,
upholding the denial decision.
Harrison

brought

suit

under

29

U.S.C.

§

1132

of

the

Employee Retirement Income Security Act (ERISA) in the Eastern
District

of

Virginia

arguing

that

Wells

Fargo

abused

its

discretion in denying her short-term disability benefits. Wells
Fargo moved for summary judgment. The district court found there
was

insufficient

evidence

of

disability

under

the

Plan

to

conclude that Wells Fargo had abused its discretion in denying
Harrison’s claim. This appeal followed.

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Harrison contends on appeal that Wells Fargo substantively
abused

its

discretion

in

rejecting

her

claim

between

her

surgical procedures, at a time when she continued to have pain
and

other

complications

Appellant’s
Fargo’s

Br.

at

denial

administrator

31.

was

from
In

the

mass

addition,

procedurally

neither

considered

in

she

flawed
records

her

argues

chest.
that

Wells

the

plan

because
from

See

Dr.

Glenn

nor

specifically explained to her that such records were necessary
to perfect her claim.

Because we find that Wells Fargo did not

meet the “full and fair review” requirements imposed by ERISA in
29 U.S.C. § 1133, we reverse and remand to the district court
with instructions to return the case to Wells Fargo.
II.
We review the district court’s grant of summary judgment to
Wells Fargo de novo. See Williams v. Metro Life Ins. Co., 609
F.3d

622,

employed

629
by

(4th

the

Cir.

district

2010).
court

We

apply

when

the

same

considering

standards
the

plan

administrator’s decision. Id. Because the Plan language gives
the plan administrator “full discretionary authority,” J.A. 504,
we consider whether Wells Fargo abused its discretion in denying
Harrison’s claim, see Evans v. Eaton Corp. Long Term Disability
Plan, 514 F.3d 315, 321 (4th Cir. 2008).
This circuit has identified “eight nonexclusive factors for
courts to consider in evaluating whether a plan administrator
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abused its discretion.” Helton v. A.T. & T. Inc., 709 F.3d 343,
353 (4th Cir. 2013). Those factors, enunciated in Booth v. WalMart Stores, Inc. Assocs. Health and Welfare Plan are:
(1) the language of the plan; (2) the purposes and
goals of the plan; (3) the adequacy of the materials
considered to make the decision and the degree to
which they support it; (4) whether the fiduciary’s
interpretation was consistent with other provisions in
the plan and with earlier interpretations of the plan;
(5) whether the decisionmaking process was reasoned
and
principled;
(6)
whether
the
decision
was
consistent
with
the
procedural
and
substantive
requirements of ERISA; (7) any external standard
relevant to the exercise of discretion; and (8) the
fiduciary’s motives and any conflict of interest it
may have.
201

F.3d

335,

342-43

(4th

Cir.

2000).

In

considering

these

factors, we hold that Wells Fargo failed to meet its statutory
and Plan obligations to Harrison as a beneficiary. By failing to
contact

Dr.

Glenn

when

it

was

on

notice

that

Harrison

was

seeking treatment for mental health conditions and when it had
his

contact

forms

from

information,
Harrison,

the

as

well

plan

as

properly

administrator

signed
chose

to

release
remain

willfully blind to readily available information that may well
have confirmed Harrison’s theory of disability.
III.
The Employee Retirement Income Security Act of 1974 (ERISA)
governs the short-term benefits plan offered by Wells Fargo. In
29 U.S.C. § 1104 Congress charged plan administrators to act as
fiduciaries for purposes of “providing benefits to participants
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and their beneficiaries” and for “defraying reasonable expenses
of

administering

the

plan.”

29

U.S.C.

§

1104(a)(1)(A).

Plan

administrators like Wells Fargo thus have a fiduciary duty to
beneficiaries like Harrison. Id. As part of this duty, ERISA
requires a balance between “the obligation to guard the assets
of the trust from improper claims, as well as the obligation to
pay legitimate claims.” LeFebre v. Westinghouse Elec. Corp., 747
F.2d 197, 207 (4th Cir. 1984) overruled by implication on other
grounds by Black & Decker Disability Plan v. Nord, 538 U.S. 822
(2003); see also Evans, 514 F.3d at 326 (“For more than thirty
years,

then,

courts

have

balanced

the

need

to

ensure

that

individual claimants get the benefits to which they are entitled
with the need to protect employees . . . from a contraction in
the total pool of benefits available.”).
A.
However, Congress did not leave the process of balancing
these interests solely to the judgment of plan administrators.
Rather,

ERISA

requirements

imposes

relevant

on
to

trustees

the

denial

a
of

number
claims.

of

procedural

For

example,

section 1133 requires plan administrators, where any claim for
benefits under the plan is denied, to set forth “the specific
reasons

for

such

denial.”

29

U.S.C.

§

1133(1).

In

addition,

ERISA requires that plans provide claimants with a “reasonable
opportunity . . . for a full and fair review by the appropriate
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named fiduciary of the decision denying the claim.” 29 U.S.C.
§ 1133(2).
While

the

primary

responsibility

for

providing

medical

proof of disability undoubtedly rests with the claimant, a plan
administrator cannot be willfully blind to medical information
that may confirm the beneficiary’s theory of disability where
there is no evidence in the record to refute that theory. See
Gaither v. Aetna Life Ins. Co., 394 F.3d 792, 807 (10th Cir.
2004).

ERISA

does

not

envision

that

the

claims

process

will

mirror an adversarial proceeding where “the [claimant] bear[s]
almost all of the responsibility for compiling the record, and
the

[fiduciary]

bears

little

or

no

responsibility

to

seek

clarification when the evidence suggests the possibility of a
legitimate

claim.”

necessary,

some

Id.

back

Rather,
and

forth

the

law

between

anticipates,
administrator

where
and

beneficiary.
An administrator is also “required to use a deliberate,
principled reasoning process and to support its decision with
substantial evidence.” McKoy v. Int’l Paper Co., 488 F.3d 221,
223 (4th Cir. 2007). A complete record is necessary to make a
reasoned decision, which must “rest on good evidence and sound
reasoning; and . . . result from a fair and searching process.”
Evans, 514 F.3d at 322-23. A searching process does not permit a
plan administrator to shut his eyes to the most evident and
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accessible

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sources

of

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information

that

might

support

a

successful claim. As the Tenth Circuit explained, “[a]n ERISA
fiduciary presented with a claim that a little more evidence may
prove valid should seek to get to the truth of the matter.”
Gaither, 394 F.3d at 808.
It is not asking too much that, in the course of a “full
and fair review,” see 29 U.S.C. § 1133, administrators notify a
claimant

of

specific

information

that

they

were

aware

was

missing and that was material to the success of the claim. A
similar and limited rule has been recognized by a number of our
sister circuits. See Harden v. Am. Express Fin. Corp., 384 F.3d
498, 500 (8th Cir. 2004) (“In the limited circumstances of this
case, we conclude that [the plan administrator’s] failure to
obtain Social Security records amounted to a serious procedural
irregularity

that

raises

significant

doubts

about

[the]

decision.”); Quinn v. Blue Cross and Blue Shield Assoc., 161
F.3d 472, 476 (7th Cir. 1998) (“We agree that [trustee] was
under

no

obligation

to

undergo

a

full-blown

vocational

evaluation of [claimant’s] job, but she was under a duty to make
a

reasonable

inquiry

into

the

types

of

skills

[claimant]

possesses and whether those skills may be used at another job.”)
abrogated on other grounds by Hardt v. Reliance Standard Life
Ins. Co., 560 U.S. 242 (2010); Booton v. Lockheed Med. Benefits
Plan, 110 F.3d 1461, 1463 (9th Cir. 1997) (“In simple English,
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what this regulation calls for is a meaningful dialogue between
ERISA plan administrators and their beneficiaries.”).
We
possess

do,

of

course,

limited

constraints

on

recognize

resources,
their

and

ability

that
that

to

plan

administrators

there

are

investigate

the

practical
volume

of

presented claims. The rule is one of reason. Nothing in our
decision requires plan administrators to scour the countryside
in

search

of

evidence

to

bolster

a

petitioner’s

case.

The

Gaither decision was similarly cautious. See 394 F.3d at 804
(“[N]othing in ERISA requires plan administrators to go fishing
for evidence favorable to a claim when it has not been brought
to their attention that such evidence exists.”); see also Vega
v. Nat’l Life Ins. Servs., Inc., 188 F.3d 287, 298 (5th Cir.
1999) (en banc) (declining to place “the burden solely on the
administrator

to

generate

evidence

relevant

to

deciding

the

claim”), overruled on other grounds by Metro. Life Ins. Co. v.
Glenn, 554 U.S. 105 (2008).
The law in this circuit has likewise been clear that there
is

no

open-ended

over. . . for
medical

a

duty

for

plan

doctor

reports

whose

from

reliable

administrators

testimony

might

physicians

to

“look

all

contradict

the

that

ha[ve]

been

submitted.” LeFebre, 747 F.2d at 208. In Berry v. Ciba-Geigy
Corp., 761 F.2d 1003, 1008 (4th Cir. 1985), we also noted that
plan

trustees

are

not

“under
14

any

duty

to

secure

evidence

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supporting a claim for disability benefits when those trustees
had in their possession reliable evidence that a claimant was
not, in fact, disabled.” And in Elliott v. Sara Lee Corp., 190
F.3d 601, 608 (4th Cir. 1999), we held that a claimant who did
not submit supplemental evidence to disprove the existing record
showing that she was not disabled, “[could not then] prevail on
an argument that [her employer] had insufficient evidence to
make a reasoned decision.”
In these cases, however, there was sufficient evidence in
the existing record to refute claimant’s theory of disability.
In LeFebre, there was evidence that the plaintiff, who claimed
total disability due to blindness, was nonetheless driving on
his own and able to perform most of his job duties. 747 F.2d at
205. In Berry, the plan administrator “possessed letters from
claimant, claimant’s lawyer, and claimant’s doctor stating that
[he] was ready to resume his employment.” 761 F.2d at 1008.
Similarly, in Elliott, claimant’s treating physicians submitted
statements that “her degree of impairment was 35 to 55 percent
and that she was capable of clerical or administrative activity”
and thus did not meet the plan’s definition of totally disabled.
190 F.3d at 604. We agree that a plan administrator is not
“under any duty to secure evidence [to the contrary]” under such
circumstances. Berry, 761 F.2d at 1008.

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Harrison’s

claim,

Pg: 16 of 21

however,

is

distinguishable

from

the

above cases. Here, as Dr. Daniel, the independent peer reviewer
commissioned by Wells Fargo to assess Harrison’s claim, stated,
the

record

was

incomplete

and

his

“opinion

as

to

whether

[Harrison’s] psychiatric status limited her functional capacity
[could not] be provided.” J.A. 394. Wells Fargo was repeatedly
put on notice that Harrison was seeking psychiatric treatment.
In fact, it even commissioned an independent reviewer to assess
whether her mental condition prevented her from returning to
work. That very reviewer made clear to the plan administrator
that the record was not sufficient to render a decision. At the
time it commissioned the review, Wells Fargo had been notified
that

Harrison

was

seeking

mental

health

treatment

from

Dr.

Glenn. Wells Fargo had Dr. Glenn’s contact information, but it
only provided Dr. Daniel with Dr. Petrizzi’s information. Dr.
Daniel contacted Dr. Petrizzi, Harrison’s primary care physician
who

referred

However,

him

Dr.

to

Dr.

Glenn

for

Daniel

did

not

additional

take

the

documentation.

additional

step

of

contacting Dr. Glenn directly.
Unlike
Harrison’s

our

earlier

claim

of

cases,

disability.

the
To

record
the

did

contrary,

not

refute

Harrison’s

medical records for her thyroid condition alone present a close
case.

She

was

undergoing

multiple

surgical

procedures

for

a

large mass in her chest that was causing her pain and tracheal
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compression. One week after her first surgery she notified Wells
Fargo that she needed a second and significantly more serious
operation to completely remove the mass from her chest. The fact
of and need for these medical procedures Wells Fargo does not
dispute.

In

the

midst

of

it

all,

Harrison

suffered

the

unexpected loss of her husband who had been a source of support
after the earlier deaths of her mother and children. Her sister
provided

a

statement

that

claimant

was

unable

to

care

for

herself. In addition, her primary care doctor noted her chest
pain

was

made

worse

by

anxiety

and

stress.

In

between

her

surgeries, and before the mass had been fully removed from her
chest, it was hardly unlikely that Harrison would be unable to
return to work. On such a close record, Wells Fargo’s process
was

simply

not

the

collaborative

undertaking

that

ERISA

envisions. A denial on such a basis cannot satisfy ERISA’s full
and fair review requirements.
B.
Here,

the

Plan

documents

are

consistent

with

ERISA

provisions –- including the requirement that notification of a
denial must “state the reasons why [the] claim was denied and
reference the specific STD Plan provision(s) on which the denial
[was] based.” J.A. 486.

The Plan requires claimants to submit

proof of disability, which may include “medical records, test
results, or hospitalization records.” Id. at 479. However, it
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authorizes

Liberty,

Pg: 18 of 21

once

a

release

has

been

signed,

to

“contact [a claimant’s] physician to obtain medical information
concerning
that

[the]

Liberty

disability.”

notify

Id.

The

claimants

Plan

requires

sufficient

where

likewise

medical

information is lacking and “describe the additional information
needed and explain why such information is needed.” Id. at 486.
The

Plan

further

“responsibility

[of

and
the

properly
claimant]

provides
to

that

ensure

it

that

is

the

Liberty

receives requested medical proof.” Id. at 481. Here, the plan
administrator

contends

Harrison

defaulted

on

that

obligation

because she was told to submit all necessary medical information
and she failed to provide any records from Dr. Glenn.
And yet, Harrison did in fact submit proper documentation
authorizing Liberty to contact her treating physicians on June
23, 2011, and Liberty relied on that release to contact Drs.
Petrizzi,

Van

process.

Absent

perfectly

Himbergen,
notice

reasonable

to

for

and

Hollings

the

throughout

contrary,

Harrison

to

it

assume

would
that

the

claims

have

been

the

plan

administrator had done the same with Dr. Glenn, especially since
she provided Wells Fargo with his contact information in her
request for appeal. See id. at 134-35. Yet, notwithstanding the
release and contact information, neither Liberty nor Wells Fargo
got in touch with Dr. Glenn’s office for records or evidence
regarding her mental disability claim.
18

Appeal: 13-2379

Doc: 44

Furthermore,

Filed: 12/05/2014

if

an

initial

Pg: 19 of 21

claim

is

denied,

the

Plan

requires that where additional information is needed “the claims
decision [must] describe the additional information needed and
explain why such information is needed.” Id. at 486. Wells Fargo
failed to comply with this requirement of the Plan. Although
Wells Fargo was on notice that Harrison was receiving treatment
for potentially debilitating psychological trauma, it never made
clear to her that records from Dr. Glenn were missing and needed
-- noting only vaguely and deep into a long letter that she
should provide relevant medical information without ever once
mentioning Dr. Glenn by name. See id. at 56-57. The Plan itself
recognizes that, consistent with ERISA, the claims process must
be collaborative not adversarial, especially in light of the
fact that claimants must often proceed without the aid of legal
counsel. Wells Fargo should have made clear that records from
Dr. Glenn were absent from the record and necessary to perfect
Harrison’s claim. It was not appropriate under the circumstances
to require that the claimant wonder and guess.
Ultimately,
undergoing

as

difficult

we

have

earlier

diagnostic

tests

mentioned,
and

Harrison

repeated

was

surgeries

when she suffered the sudden loss of her husband just several
years after the loss of her mother and children in a house fire.
There was a real possibility under the terms of the Plan that
she could have demonstrated a medically certified condition that
19

Appeal: 13-2379

Doc: 44

Filed: 12/05/2014

Pg: 20 of 21

prevented her from returning to work in between her surgeries.
The record at hand provides evidence of claimant’s mental and
physical distress. Dr. Petrizzi, Harrison’s treating physician,
referenced
increased

her
her

relevant

psychological
dosage

timeframe,

of
and

condition

in

anti-depressant
her

sister’s

his
drugs

records,

and

during

the

statement

detailed

debilitating panic attacks. Wells Fargo was put on notice that
Harrison

was

seeking

treatment

for

psychological

ailments

in

addition to thyroid disease and yet failed to undertake the same
minimal effort to obtain records from Dr. Glenn that it properly
took with regard to records from Drs. Petrizzi, Van Himbergen,
and

Hollings.

incomplete

Instead,

record.

A

it

denied

plan

Harrison

administrator

benefits

cannot

on

an

decline

to

undertake the most nominal efforts to obtain readily available
information that was made known to the Plan, that was plainly
material to the claim, and that could well have provided the
proof crucial to Harrison’s success. At least, under the terms
of the Plan here, Wells Fargo should have instructed Harrison
plainly and specifically that additional records from Dr. Glenn
were needed to perfect her claim.
IV.
It

bears

repeating

that

the

primary

responsibility

for

providing medical evidence to support a claimant’s theory rests
with the claimant. See Berry, 761 F.2d at 1008. Claimants are
20

Appeal: 13-2379

more

Doc: 44

Filed: 12/05/2014

familiar

with

their

Pg: 21 of 21

medical

history

and

their

treating

physicians and are far better suited to provide the evidence
necessary to support a claim for disability. However, once a
plan administrator is on notice that readily-available evidence
exists that might confirm claimant’s theory of disability, it
cannot shut its eyes to such evidence where there is little in
the record to suggest the claim deficient.
Like
principle

our
–

sister

narrow

circuits,

because

it

we

now

adopt

this

does

not

undercut

narrow

claimant’s

responsibility to provide medical information nor impose a duty
on plan administrators to fish for medical information on the
mere possibility that it may be helpful in some remote way.
Here, however, Wells Fargo breached the fiduciary duty owed to
Nancy Harrison when it neither sought readily available records
from

Dr.

Glenn

that

might

have

confirmed

her

theory

of

disability nor informed her in clear terms that those records
were

necessary.

Even

absent

those

records,

this

was

a

close

case. The judgment must be reversed and remanded to the district
court with instructions to return this case to Wells Fargo for
proceedings consistent with this decision.
REVERSED AND REMANDED

21