Hooks v. The Hartford Life and Accident Insurance Company

Filing 17

MEMORANDUM OPINION AND ORDER directing that Plaintiff's 13 Motion to Remand to Claims Administrator is DENIED, as further set out. Signed by Honorable Judge W. Harold Albritton, III on 10/19/12. (scn, )

IN THE UNITED STATES DISTRICT COURT
FOR THE MIDDLE DISTRICT OF ALABAMA
NORTHERN DIVISION

KRISTY HOOKS,
Plaintiff,
v.
THE HARTFORD LIFE AND
ACCIDENT INSURANCE COMPANY,
Defendant.

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) CIVIL ACTION NO. 2:12-cv-220-WHA
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(WO)
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MEMORANDUM OPINION AND ORDER
I. INTRODUCTION
This cause is before the court on the Plaintiff’s Motion to Remand to Claims
Administrator (Doc. #13).
The Plaintiff, Kristy Hooks, filed a Complaint against the Defendant, Hartford Life and
Accident Insurance Company, on March 7, 2012. The Complaint brings a claim for denial of
long term disability benefits under the Employee Retirement Income Security Act of 1974
(“ERISA”). The Defendant filed its original Answer on April 5, 2012, and filed an Amended
Answer and Counterclaim on July 9, 2012, which brings a claim for reimbursement of excess
disability benefits.
On August 8, 2012, the Plaintiff filed this Motion seeking a remand to the Claims
Administrator to consider the Social Security Administration’s favorable determination of the
Plaintiff’s disability, which was issued after the Defendant’s final denial of benefits. Pursuant to
the court’s Order (Doc. #14), the Defendant filed a Response (Doc. #15) as to why this matter

should not be remanded. The Plaintiff filed a Reply (Doc. #16) on September 5, 2012. The court
has federal question subject matter jurisdiction in this case because the Plaintiff seeks to recover
benefits under an employer-sponsored ERISA plan pursuant to 29 U.S.C. § 1132.
For reasons to be discussed, the Motion to Remand is due to be DENIED.
II. APPLICABLE STANDARD
In cases reviewing the denial of benefits under ERISA, the general rule in the Eleventh
Circuit is that a court should not consider evidence never presented to an ERISA plan’s
administrator, but under some circumstances might remand to the administrator for a new
determination. See Jett v. Blue Cross & Blue Shield of Ala., Inc., 890 F.2d 1137, 1140 (11th Cir.
1989). Eleventh Circuit precedent demonstrates that remand is appropriate in some, but not all,
cases. See, e.g., Levinson v. Reliance Standard Life Ins. Co., 245 F.3d 1321, 1330 (11th Cir.
2001) (affirming district court’s refusal to remand when party obtained new evidence after
litigation commenced); Shannon v. Jack Eckerd Corp., 113 F.3d 208, 210 (11th Cir. 1997)
(affirming remand to consider subsequently available evidence after district court found that
administrator’s decision was arbitrary and capricious).
III. FACTS
The submissions of the parties establish the following facts:
Kristy Hooks (“Hooks”) filed a claim for disability benefits under an insurance policy
issued by Hartford Life and Accident Insurance Company (“Hartford”), and provided to her by
her employer, GKN North America Services (“GKN”). Hooks was employed with GKN as a
composite worker when she stopped work in January 2009 due to persistent pain from various
medical conditions.
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Hooks initially received short term disability benefits through July 21, 2009, and Hartford
awarded Hooks long term disability (“LTD”) benefits from July 22, 2009 until August 3, 2010.
On that date, Hartford informed Hooks that her LTD benefits were terminated because she did
not meet the plan’s definition of disability. Hooks appealed the denial of benefits, but in a letter
dated May 16, 2011, Hartford issued its “final decision” to maintain the termination of LTD
benefits. (Doc. #1-5 at p.5). Hartford’s final appeal decision exhausted Hooks’s administrative
remedies under ERISA.
On June 27, 2011, Hooks informed Hartford that she had received a favorable disability
determination from the Social Security Administration (“SSA”) in a decision dated June 2, 2011.
Hooks requested that Hartford reopen her case to consider the social security decision. However,
Hartford refused to review the favorable decision because Hartford’s denial of benefits was
“based on a complete and final administrative record.” (Doc. #1-6 at p.3). On March 9, 2012,
Hooks filed the present action to recover benefits pursuant to 29 U.S.C. § 1132(a).
Hooks now moves to remand the matter to the claims administrator to consider the
favorable decision from the SSA.
IV. DISCUSSION
The Eleventh Circuit has recently restated the general rule 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 v. Metro. Life Ins. Co., 644 F.3d
1350, 1354 (11th Cir. 2011) (citing Jett v. Blue Cross & Blue Shield of Ala., Inc., 890 F.2d 1137,
1140 (11th Cir. 1989)). For the following reasons, Hooks’s Motion to Remand to the Claims
Administrator is due to be denied.
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Hooks cites a statement in Jett to support her motion to remand. In Jett the Eleventh
Circuit held that, as a general matter, “[w]hen conducting a review of an ERISA benefits denial
under an arbitrary and capricious standard (sometimes used interchangeably with an abuse of
discretion standard), the function of the court is to determine whether there was a reasonable
basis for the decision, based upon the facts as known to the administrator at the time the decision
was made.” Jett, 890 F.2d at 1139. The Jett court reviewed the process by which the district
court had found that the plan administrator’s decision was arbitrary and capricious, holding that
the district court did not properly limit its consideration to the evidence before Blue Cross at the
time it denied coverage, but considered later submitted evidence. Id. It remanded with
instruction to the district court to limit its review to consideration of the material before Blue
Cross at the time it made its decision, and stated that “[a]s long as a reasonable basis appears for
Blue Cross’ decision, it must be upheld . . . even if there is evidence that would support a
contrary decision.” Id. at 1140. The court, however, then went on to say, and this is the part
relied on by Hooks, that if the plaintiff wished “to present additional information that might
affect the determination of eligibility for benefits, the proper course would be to remand to Blue
Cross for a new determination.” Id.
Two Eleventh Circuit cases cited by Hooks affirm the rule in Jett; however, their
application to this case does not support remand. See Levinson v. Reliance Standard Life Ins.
Co., 245 F.3d 1321 (11th Cir. 2001); Shannon v. Jack Eckerd Corp., 113 F.3d 208 (11th Cir.
1997). In Shannon, the Eleventh Circuit affirmed the district court’s decision to remand to the
claims administrator to consider additional evidence. See Shannon, 113 F.3d at 210. The district
court directed remand, however, only after fully reviewing the record and finding that the
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administrator’s denial of benefits was arbitrary and capricious because the administrator did not
evaluate submitted conclusions that a medical procedure was “investigational” and did not obtain
additional relevant information. See id. Because this court has yet to consider the substance of
Hooks’s claim, Shannon does not apply.
In Levinson, the Eleventh Circuit upheld the district court’s refusal to remand to the
claims administrator, reasoning that if the party requesting remand desired new evidence to be in
the administrative record, it should have acquired that evidence before the appeals process ended.
See Levinson, 245 F.3d at 1328 (citing Davidson v. Prudential Ins. Co. of Am., 953 F.2d 1093,
1095 (8th Cir. 1992)). Although in the present case, the SSA’s favorable decision did not
become available until shortly after Hartford issued its final denial of benefits, Hooks could have
alerted Hartford to the pending SSA determination before the appeals process closed. As the
court understands the evidence before it, she did not. See Torrey v. Qwest Commc’ns Int’l, Inc.,
838 F. Supp. 2d 1201, 1205 (D. Colo. 2012) (SSA decision considered on remand when the
plaintiff alerted administrator to pending SSA decision before his final appeal was denied).
Regardless, the Eleventh Circuit ultimately agreed with the district court that in cases “where the
administrator considered all of the record evidence and reached a conclusion,” remand is not
appropriate. Levinson, 245 F.3d at 1327.
Another district court in this circuit addressed the applicability of Levinson and Shannon
in a case similar to the one at hand. See Ray v. Sun Life & Health Ins. Co., 752 F. Supp. 2d 1229
(N.D. Ala. 2010). The plaintiff in Ray suggested that Eleventh Circuit precedent requires the
plan administrator to continually consider new evidence even after the administrative process has
concluded. See id. at 1234. The court disagreed, stating that if this proposition were true, “the
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process of deciding each claim for benefits under ERISA could continue ad infinitum, or as long
as the plaintiff . . . chose to submit additional documents for consideration.” Id. (emphasis in
original). The court went on to state that neither Levinson, Shannon, nor Jett required a district
court to remand solely for consideration of new evidence. See id. This court agrees with the
reasoning in Ray—Eleventh Circuit precedent does not bind a district court to remand to the plan
administrator when the plaintiff has acquired additional evidence after completion of the claims
process. The decision to remand to a plan administrator is discretionary with the district court,
see Levinson, 245 F.3d at 1328, and the analysis must be tailored to the facts of each case.
Hooks cites a recent Supreme Court case, Kappos v. Hyatt, 132 S. Ct. 1690 (2012),
however, to support her argument that a district court should consider new evidence of disability
after administrative review. In Kappos, a patent case arising under 35 U.S.C. § 145, the Supreme
Court ordered remand so that the district court could consider evidence submitted for the first
time during litigation, as well as the administrative record. Id. at 1697. This involved a different
statute and different case law. To apply the Kappos decision to this case would undercut
longstanding precedent in ERISA jurisprudence, and, as acknowledged by Hooks in brief, would
require “a reassessment of the entire regime of ERISA litigation.” The court finds Kappos to be
inapplicable to this case.
V. CONCLUSION
The question of remand for consideration of additional evidence is one which requires an
analysis of all facts in an ERISA case, after consideration of the full record before the claims
administrator. Remand is not called for before that stage, simply because the claimant has
decided that she wants to submit additional evidence which she had, but did not submit, to the

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administrator before a decision to deny was made. For the reasons discussed, the court concludes
that remand to the claims administrator is not appropriate at this time. Accordingly, it is hereby
ORDERED that
Plaintiff’s Motion to Remand to Claims Administrator (Doc. #13) is DENIED.
DONE this 19th day of October, 2012.

/s/ W. Harold Albritton
W. HAROLD ALBRITTON
SENIOR UNITED STATES DISTRICT JUDGE

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