Nagy v. Group Long Term Disability Plan For Employees of Oracle America, Inc. et al

Filing 70

ORDER REGARDING SOCIAL SECURITY ADMINISTRATION DETERMINATION. Signed by Judge Haywood S. Gilliam, Jr. on 6/2/2015. (ndr, COURT STAFF) (Filed on 6/2/2015)

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UNITED STATES DISTRICT COURT

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NORTHERN DISTRICT OF CALIFORNIA

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DAVE NAGY,

Case No. 14-cv-00038-HSG

Plaintiff,
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ORDER REGARDING SOCIAL
SECURITY ADMINISTRATION
DETERMINATION

v.
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GROUP LONG TERM DISABILITY PLAN
FOR EMPLOYEES OF ORACLE
AMERICA, INC., et al.,

Re: Dkt. No. 66

United States District Court
Northern District of California

Defendants.
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The Court conducted a bench trial in this action on April 13, 2015. At the very end of that

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proceeding, counsel for Plaintiff Dave Nagy (“Nagy”) alerted the Court to the existence of a

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January 28, 2015 decision by the Social Security Administration (“SSA”) finding him totally

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disabled from any work as of February 8, 2012. Nagy now moves the Court for leave to submit

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the SSA’s decision in support of his position he is unable to work in “Any Occupation” as defined

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by the ERISA plan at issue in this case. See Dkt. No. 66 (“Mot.”). Defendants Group Long Term

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Disability Plan for Employees of Oracle America, Inc. and Hartford Life and Accident Insurance

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Company (“Defendants”) oppose Nagy’s request, arguing that the SSA decision may not be

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considered as extrinsic evidence under the standard articulated by the Ninth Circuit in Opeta v.

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Northwest Airlines Pension Plan for Contract Employees, 484 F.3d 1211 (9th Cir. 2007). See

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Dkt. No. 68 (“Opp.”).

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When a district court reviews an administrator’s denial of benefits under an ERISA plan

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under the de novo standard of review, “extrinsic evidence [may] be considered only under certain

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limited circumstances.” Id. at 1217 (citation omitted). “[A] district court should not take

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additional evidence merely because someone at a later time comes up with new evidence . . . .” Id.

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(citation omitted). “In most cases, only the evidence that was before the plan administrator at the

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time of determination should be considered.” Id. (citation and quotation marks omitted). The

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district court should “exercise its discretion to consider evidence outside the administrator record

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only when circumstances clearly establish that additional evidence is necessary to conduct an

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adequate de novo review of the benefit decision.” Id. (citation and quotation marks omitted).

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The Ninth Circuit has adopted the Fourth Circuit’s non-exhaustive list of exceptional

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circumstances where the introduction of evidence beyond the administrative record could be

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considered necessary:

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United States District Court
Northern District of California

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claims that require consideration of complex medical questions or
issues regarding the credibility of medical experts; the availability of
very limited administrative review procedures with little or no
evidentiary record; the necessity of evidence regarding interpretation
of the terms of the plan rather than specific historical facts; instances
where the payor and the administrator are the same entity and the
court is concerned about impartiality; claims which would have been
insurance contract claims prior to ERISA; and circumstances in
which there is additional evidence that the claimant could not have
presented in the administrative process.

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Id. (citation omitted). However, the fact that a case implicates even several of these circumstances

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does not automatically justify the admission of extrinsic evidence. The Court must still find that

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the presence of these exception circumstances renders consideration of the particular extrinsic

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evidence sought to be admitted necessary to conduct de novo review of the benefit decision. Id.

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The Court agrees with Nagy that this case involves several of the exceptional

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circumstances listed above. However, Nagy has made no argument concerning why admission of

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the SSA decision he seeks to introduce is necessary to the adequate de novo review of the benefit

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decision. Accordingly, Nagy is ORDERED to lodge the SSA decision with the Court no later

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than June 5, 2015. Nagy and the Defendants may file 5-page briefs discussing the import of that

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decision no later than June 19, 2015, as well a 5-page reply brief no later than June 26, 2015.

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The Court will consider the admissibility of the SSA decision after briefing is complete.

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IT IS SO ORDERED.
Dated: 6/2/2015
______________________________________
HAYWOOD S. GILLIAM, JR.
United States District Judge
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