Virgil Harris v. The Lincoln National Life Insurance Company, et al, No. 21-13186 (11th Cir. 2022)
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Under the Employment Retirement Income Security Act, 29 U.S.C. Section 1132(a)(1)(B), a plan administrator’s benefits decision is subject to plenary review in federal court unless the administrator is given discretion to determine eligibility or construe the terms of the plan. If the administrator has discretion, a court determines whether its benefits decision was arbitrary and capricious (i.e., whether it lacked a reasonable basis).
In this ERISA case, all parties agree that Lincoln’s denial of long-term disability benefits to Plaintiff triggered de novo review because the plan did not give Lincoln discretion. The district court, acknowledging that its review of the denial was plenary, ruled that Plaintiff could not submit evidence that had not been presented to Lincoln before it denied benefits.
The Eleventh Circuit reversed holding that the district court’s evidentiary ruling constituted error under Eleventh Circuit precedent. The court explained that Lincoln also argues that even under Moon and Kirwan an ERISA plaintiff does not have the unfettered right to introduce new evidence when challenging the denial of benefits under plenary review. However, the court explained it has never mentioned, a showing of good cause to present new evidence in ERISA benefit cases governed by the de novo standard. Further, although Lincoln that under plenary review the administrative record supports the denial of long-term disability benefits to Plaintiff, the court cannot, however, affirm on this basis. Accordingly, the district court erred by not considering Plaintiff's post-denial evidence, and Lincoln does not assert that this error was harmless.
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