Under the Employment Retirement Income Security Act (ERISA), a plan administrator's benefits decision undergoes plenary review unless the administrator is granted discretion in determining eligibility or interpreting plan terms. In the case of Virgil Harris against The Lincoln National Life Insurance Company, the court determined that Lincoln's denial of long-term disability benefits triggered de novo review since the plan did not grant discretion. The district court ruled that Harris could not present evidence not submitted to Lincoln prior to the benefits denial in August 2019. Consequently, the court excluded an affidavit and updated medical records from consideration when granting Lincoln judgment on the administrative record. This exclusion was identified as an error under Eleventh Circuit precedent, prompting a reversal and remand for further proceedings. The court emphasized that the de novo standard prohibits, requires, or allows consideration of new evidence, with different circuits adopting varying approaches. Some circuits restrict evidence to the administrative record, while others permit new evidence under certain conditions. Ultimately, the court concluded that only evidence presented to the plan administrator should be reviewed, except in instances where additional evidence is deemed necessary for resolving the claim.
The court may decide cases based on the administrative record but should allow parties to introduce relevant extra-record evidence and pursue discovery. Extra-record evidence should only be admitted for good cause to prevent district courts from acting as plan administrators. While some circuits advocate for a comprehensive review of all relevant evidence during de novo review, limiting evidence to that available to the administrator is seen as counterintuitive. De novo review entails an independent examination of the case, with no deference to the administrator's conclusions.
The ERISA remedies outlined in 29 U.S.C. 1132(a)(1)(B) are akin to common law breach of contract claims, allowing for the introduction of evidence not presented to the administrator. Specific cases, such as Moon v. Am. Home Assurance Co. and Kirwan v. Marriott Corp., affirm that a district court can consider post-denial evidence when conducting a de novo review. These precedents remain binding and have not been overturned by the Supreme Court or an en banc opinion. The district court's exclusion of Mr. Harris’ post-denial evidence was based on existing circuit precedents, which restrict the admissibility of such evidence.
The court's de novo review is restricted to the administrative record, contrasting with arbitrary and capricious review where such limitations apply due to the nature of the review standard. Under ERISA, the review standard influences what evidence is admissible. The cited cases indicate that when a plan grants discretion to the administrator, review may be limited differently, but in this case, Lincoln's plan does not confer such discretion, making relevant precedents inapplicable. While the arbitrary and capricious standard requires the court to evaluate the reasonableness of the administrator’s decision based solely on the facts known at the time, de novo review mandates that the court independently reassess the decision without such limitations.
The district court erroneously limited the evidence it could consider during de novo review, contrary to established precedent, which suggests that de novo review should allow for a more extensive evaluation of evidence. Lincoln's arguments for excluding post-denial evidence were deemed unpersuasive, as they conflicted with earlier rulings (Moon and Kirwan) that would govern in the event of an intra-circuit conflict. Although Lincoln contends that later cases create a multi-step approach that limits the introduction of new evidence, these cases do not directly address the scope of evidence permissible in de novo reviews, thereby not undermining earlier rulings. Ultimately, even under Moon and Kirwan, introducing new evidence in a plenary review context is not unrestricted for ERISA plaintiffs.
Other circuits have required a showing of good cause for the submission of new evidence to a district court, as seen in cases like Quesinberry and Jewell. However, the current circuit has not established such a requirement in ERISA benefit cases evaluated under the de novo standard. In this instance, the district court did not address or determine good cause but issued a broad ruling limiting review to the record available to the administrator at the time of benefits denial. This ruling was incorrect based on precedents set in Moon and Kirwan. Lincoln argued that the administrative record supported the denial of Mr. Harris's long-term disability benefits; however, under de novo review, parties are permitted to introduce evidence beyond the administrative record. The district court erred by not considering evidence presented by Mr. Harris after the denial, and Lincoln did not claim this error was harmless. While there is discretion to conduct a harmless error analysis, the court chose not to evaluate prejudice in this case without further briefing. Consequently, the judgment favoring Lincoln is reversed and remanded for further proceedings aligned with this opinion.
