Nielsen v. Union Security Insurance Company

Filing 43

MEMORANDUM AND ORDER: IT IS HEREBY ORDERED that Plaintiff's Motion to Determine the Applicable Standard of Review and Scope of the Administrative Record 36 is GRANTED in part. The Court will reopen the administrative record to include Plain tiffs Letter of Appeal and exhibits attached thereto. (Doc. Nos. 37-1-13) The Court will defer consideration of the standard of review until after the parties have completed their summary judgment briefing. IT IS FURTHER ORDERED on the Courts own motion that the dispositive motion deadline of November 29, 2013, be extended for an additional fourteen (14) days, up to and including Friday, December 13, 2013.. Signed by District Judge John A. Ross on 11/13/13. (LGK)

UNITED STATES DISTRICT COURT
EASTERN DISTRICT OF MISSOURI
EASTERN DIVISION

CHRISTINA NIELSEN,
Plaintiff,
v.
UNION SECURITY INSURANCE CO.,
Defendant.

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No. 4:12-CV-1698-JAR

MEMORANDUM AND ORDER
This matter is before the Court on Plaintiff’s Motion to Determine the Applicable
Standard of Review and Scope of the Administrative Record. (Doc. No. 36) The motion is fully
briefed and ready for disposition. For the following reasons, the motion will be granted in part.
Background
Plaintiff brings this action under the Employment Retirement Income Security Act
(ERISA), 29 U.S.C. § 1132(a)(1)(B), for long term disability benefits under a plan issued to her
former employer and administered by Defendant Union Security Insurance Company (USIC).
Plaintiff filed a claim for long term disability benefits in January 2012. Because USIC had not
rendered a decision on her claim within the time allowed under 29 C.F.R. 2560.503-1(g)(3),
Plaintiff filed this action on September 19, 2012. (Doc. No. 1) On September 25, 2012, USIC
denied Plaintiff’s claim. (Doc. No. 28-9) On October 4, 2012, Plaintiff filed an Amended
Complaint. (Doc. No. 3) On April 22, 2013, Plaintiff moved for judgment on the pleadings,
arguing that the appropriate remedy for resolving this matter was to remand her claim back to
USIC for a full and fair review. Because her benefits claim had been denied by the time she filed
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her amended complaint, the Court found her motion seeking remand of her claim to USIC moot
and denied the motion. (Doc. No. 35)
D i s c ussi o n
In her motion, Plaintiff requests the Court expand the administrative record to include her
response to USIC’s claim denial, and apply a de novo standard of review due to “procedural
irregularities” committed by USIC. She relies on Woo v. Deluxe Corp., 144 F.3d 1157, 1160 (8th
Cir. 1998), abrogated on other grounds by Metro. Life Ins. Co. v. Glenn, 554 U.S. 105 (2008),
which holds that de novo review of a plan administrator’s decision is appropriate when the
administrative record reflects a “serious procedural irregularity” that “caused a serious breach of
the plan administrator’s fiduciary duty.” A beneficiary claiming procedural irregularities must
show that the plan administrator, in the exercise of its power, acted dishonestly, acted from an
improper motive, or failed to use judgment in reaching its decision. Neumann v. AT & T
Communications, Inc., 376 F.3d 773, 781 (8th Cir. 2004) (citing Buttram v. Central States, S.E.
& S.W. Areas Health & Welfare Fund, 76 F.3d 896, 900 (8th Cir.1996)).
Plaintiff contends USIC’s failure to issue a decision on her entitlement to benefits within
the timeframe allotted by the Department of Labor’s Regulations governing ERISA benefit
disputes, 29 C.F.R. 2560.503-1(g)(3), constituted a procedural irregularity which deprived her of
a full and fair review of her claim. In response, USIC argues that a “brief technical delay” does
not rise to the level of a breach of a fiduciary obligation. (Doc. No. 41, p. 7) Principles of judicial
economy dictate that the Court not address these issues in a piecemeal fashion. If Plaintiff has
“material, probative evidence, beyond the mere fact of the apparent irregularity, tending to show
that [USIC] breached [its] fiduciary obligation,” Buttram, 76 F.3d at 900, then that evidence
should be submitted during summary judgment briefing.

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Regardless of which standard of review will ultimately apply, the Court finds good cause
to expand the record to include Plaintiff’s response to USIC’s claim denial. The good cause
inquiry turns on “whether the claimant had an opportunity to present the additional information
during the administrative proceedings.” Sloane v. Hartford Life & Accident Ins. Co., 475 F.3d
999, 1004 (8th Cir. 2007). See also Davidson v. Prudential Ins. Co. of Am., 953 F.2d 1093, 1095
(8th Cir.1992) (discussing factors relevant to a showing of good cause). Here, Plaintiff had no
opportunity to respond to USIC’s claim denial, issued after the complaint was filed in this
matter. Given the circumstances in this case, the Court finds Plaintiff’s supplemental information
is necessary for an adequate review of the benefits decision.
Accordingly,
IT IS HEREBY ORDERED that Plaintiff’s Motion to Determine the Applicable
Standard of Review and Scope of the Administrative Record [36] is GRANTED in part. The
Court will reopen the administrative record to include Plaintiff’s Letter of Appeal and exhibits
attached thereto. (Doc. Nos. 37-1-13) The Court will defer consideration of the standard of
review until after the parties have completed their summary judgment briefing.
IT IS FURTHER ORDERED on the Court’s own motion that the dispositive motion
deadline of November 29, 2013, be extended for an additional fourteen (14) days, up to and
including Friday, December 13, 2013.

JOHN A. ROSS
UNITED STATES DISTRICT JUDGE
Dated this 13th day of November, 2013.

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