Free Motion in Limine - District Court of Arizona - Arizona

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L AW OF F I C E S M O H R , H A C K E T T, P E D E R S O N , B L A K L E Y & R A N D O L P H , P . C .
2800 NORTH CENTRAL AVENUE, SUITE 1100 P H O E N I X , A R I Z O N A 8 5 0 0 4 -1 0 4 3 T E L E P H O N E ( 6 0 2 ) 2 4 0 -3 0 0 0 F A C S I M I L E ( 6 0 2 ) 2 4 0 -6 6 0 0 (AZ BAR FIRM NO. 0046600)

Robert C. Hackett (AZ Bar No. 001588) ([email protected]) Daniel P. Beeks (AZ Bar No. 012628) ([email protected])

Attorneys for Defendant Metropolitan Life Insurance Company

IN THE UNITED STATES DISTRICT COURT FOR THE DISTRICT OF ARIZONA

) ) Plaintiff, ) ) v. ) ) American Express Company, (MetLife), ) a New York Corporation, and ) ) Metropolitan Life Insurance Co., a ) Tennesssee Company, ) ) Defendant. ) )

Sybol Terrell-Sims, a married woman,

No. CV 03-1340 PHX SRB DEFENDANT METLIFE'S MOTION IN LIMINE REGARDING EVIDENCE OUTSIDE THE ADMINISTRATIVE RECORD

Defendant Metropolitan Life Insurance Company ("MetLife") requests that this Court not admit any evidence beyond that contained in the administrative record in this disability insurance dispute governed by ERISA. This motion is supported by the following memorandum of points and authorities. MEMORANDUM OF POINTS AND AUTHORITIES Plaintiff originally sued both MetLife and American Express Company ("American Express"). In her second amended complaint dated December 12, 2003, plaintiff only asserts claims against MetLife based on the the Employee Retirement Income Security Act ("ERISA") and the Family Medical and Leave Act ("FMLA") .

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Because the American Express Long Term Disability ("LTD") Plan provided that MetLife had discretionary authority to decide benefit claims, the Court is limited to reviewing the documentary evidence in the administrative record that was before MetLife when it denied Plaintiff's claim. Even if the Court somehow decides to review MetLife's decision to deny benefits to Plaintiff de novo, it still would not be appropriate to consider evidence outside the administrative record. Evidence Outside the Administrative Record is not Admissible Under the Abuse of Discretion Standard The summary plan description for the American Express LTD plan provides that MetLife is the designated "Claims Fiduciary" for LTD benefits.1 It also provides that as the Claims Fiduciary, MetLife has "discretionary authority . . . under ERISA to make claim determinations and to provide a full and fair review of appealed claims including determining any final appeals of claim." 2 The plan documents further provide that MetLife's decisions regarding LTD benefits "are conclusive and binding on all parties and are not subject to further review." 3 Where, as here, an ERISA plan vests the administrator with discretionary authority to determine benefit eligibility, the district court reviews the administrator's determinations for abuse of discretion. Banuelos v. Constr. Laborers' Trust Funds for S. Cal., 382 F.3d 897, 904 (9th Cir. 2004), citing, Firestone Tire & Rubber Co. v. Bruch, 489 U.S. 101, 115 (1989). As the Banuelos court recognized, the Ninth Circuit has "clearly established that the abuse of discretion standard permits the district court to review only the evidence presented to the plan trustees." 382 F.3d at 904. See also Medford v. Metro. Life Ins. Co., 244 F. Supp. 2d 1120, 1128 (D. Nev. 2003) ("When a district court is reviewing a plan administrator's decision for abuse of discretion, the review is strictly limited to the
See Exhibit "A" at AMEXST01569. See Exhibit "A" at AMEXST01564. See Exhibit "A" at AMEXST01564. Document 65 2 Filed 12/05/2005 Page 2 of 6

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evidence in the record."); Thomas v. Continental Casualty Co., 7 F. Supp. 2d 1048, 1055 (C.D.Cal.1998) ("In most abuse of discretion cases, evidence outside the administrative record is completely inadmissible."). "Permitting a district court to

examine evidence outside the administrative record would open the door to the anomalous conclusion that a plan administrator abused its discretion by failing to consider evidence not before it." Taft v. Equitable Life Assurance Soc'y, 9 F.3d 1469, 1473 (9th Cir. 1994). Because the abuse of discretion standard applies in this case, evidence outside of the administrative record cannot be considered. Even Applying De Novo Review, Evidence Outside the Administrative Record Should not be Considered Even if de novo review is held to apply, evidence beyond the administrative records still should not be admitted. Under very limited circumstances, courts can sometimes review ERISA benefit denials de novo despite plan documents granting discretion to the plan fiduciaries, if the plan fiduciary has an apparent conflict of interest arising from its dual roles in both administering and funding the benefits. In order to obtain de novo review in these circumstances, however, a plaintiff has the burden of showing material, probative evidence, beyond the mere fact of an apparent conflict of interest, tending to show that the fiduciary's self-interest caused a breach of its fiduciary obligations to the beneficiary. Abatie v. Alta Health & Life Ins. Co., 421 F.3d 1053, 1061 (9th Cir. 2005). If de novo review is applicable, a district court then has discretion to allow evidence outside the administrative record under carefully circumscribed conditions. Mongeluzo v. Baxter Travenol Long Term Disability Ben. Plan, 46 F.3d 938, 943 (9th Cir. 1995). Plaintiff has not disclosed any evidence tending to show that MetLife's apparent conflict of interest caused it to breach its fiduciary obligations. Therefore, de novo review is not appropriate in this case.

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Even if Plaintiff somehow makes the required showing to justify de novo review, however, the Court still should not admit evidence outside the administrative record. The Mongeluzo court explained that: The district court should exercise its discretion [to admit evidence outside the administrative record], however, only when circumstances clearly establish that additional evidence is necessary to conduct an adequate de novo review of the benefit decision. In most cases, where additional evidence is not necessary for adequate review of the benefits decision, the district court should only look at the evidence that was before the plan administrator . . . at the time of the determination. 46 F.3d at 944. In Mongeluzo, the court held such evidence was necessary for adequate de novo review because the plan administrator in that case had made its determination under a misconception of the law (the meaning of "mental illness" or "functional nervous disorder"). Having corrected that misconception, the district court then needed new evidence in order to fully review the administrator's determination. In the present case, there is no evidence that MetLife was operating under any similar misconception. "Consequently, absent unusual circumstances such as the misconception of law in Mongeluzo, district courts should only consider the administrative record in conducting de novo review." Thomas v. Continental Cas. Co., 7 F.Supp.2d 1048, 1056 (C.D. Cal. 1998). There are no such unusual circumstances justifying consideration of evidence beyond the administrative record in the present case. In fact, the circumstances of this case support rejecting additional evidence because Plaintiff was represented by counsel when she submitted her original appeal in 2003, and again by different counsel when the appeal was re-considered in 2005. Thus, there is no reason why any evidence outside the administrative record could not have been presented during the administrative process. See Quesinberry v. Life Ins. Co. of N. Am., 987 F.2d 1017,

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1026-1027 (4th Cir. 1993).4 Plaintiff Has No Claims Against MetLife Under the FMLA It is not clear what claims Plaintiff is making against MetLife based on the FMLA. The FMLA generally provides for 12 weeks of medical leave if an employee has a serious health condition that makes the employee unable to perform the functions of the position of such employee. See 29 U.S.C. § 2612(a)(1)(D). MetLife, as the administrator of American Express's FMLA program, approved Plaintiff's leave, for the twelve week period between November 7, 2002 through January 30, 2003. Consequently, MetLife could not have violated the FMLA by failing to approve requested leave. Plaintiff's portion of the joint case management plan dated November 25, 2003, claimed that "Defendants retaliated against and terminated her in violation of the [FMLA]."5 MetLife, however, was only the administrator of the American Express FMLA program. Any termination of Plaintiff would have been performed by American Express, as her employer. Since Plaintiff has settled with American Express, it does not appear that there is a viable FMLA claim remaining against MetLife.6 As a result, the purported FMLA claim would not justify admission of evidence outside the administrative record. Conclusion For these reasons, MetLife requests that this Court not admit any evidence that it outside the administrative record considered by MetLife in deciding Plaintiff's appeal. This will result in basically a bench trial based solely on the documentary record. Kearney v. Standard Ins. Co., 175 F.3d 1084, 1094-95 (9th Cir. 1999). It such a case,
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The Ninth Circuit favorably cited this portion of Quesinberry in adopting its position in Mogeluzo. 46 F.3d at 943. 5 November 25, 2003 Joint Case Management Plan at pg. 11, lines 22-25. 6 This issue was first raised in MetLife's October 18, 2005 Status Report. The "Motion to Represent Plaintiff and Response to Defendants' Status Report and Suggested Deadlines" filed by Plaintiff's husband on November 1, 2005, did not dispute that Plaintiff has no viable FMLA claims against MetLife.
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the district court sits basically as an appellate tribunal, evaluating the reasonableness of an administrative determination in light of the docume ntary record compiled before the plan fiduciary. Leahy v. Raytheon Co., 315 F.3d 11, 18 (1st Cir. 2002). DATED: December 5, 2005 MOHR, HACKETT, PEDERSON, BLAKLEY & RANDOLPH, P.C. By /s/ Daniel P. Beeks Robert C. Hackett Daniel P. Beeks Suite 1100 2800 North Central Avenue Phoenix, Arizona 85004-1043 Attorneys for Defendant Metropolitan Life Insurance Company COPIES of the foregoing mailed December 5, 2005 to: The Honorable Susan R. Bolton United States District Court of Arizona 401 West Washington, SPC 50 Phoenix, AZ 85003-0001 Sybol Terrell-Sims P.O. Box 93428 Phoenix, Arizona 85070 Plaintiff

/s/ Daniel P. Beeks

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