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Monday, November 15, 2004

Outside the record. The Second Circuit affirmed the decision of the District Court in which the Court, after a three-day bench trial, determined that the plaintiff was entitled to disablity benefits. The defendant insurance company had argued that the District Court had erred in considering material outside the administrative record in reaching its decision. The administrator in this case was the very insurance company that had denied the claim.

The Second Circuit held that such a conflict, in and of itself, did not per se constitute good cause to consider evidence outside of the administrative record. Such a rule would allow a plaintiff to add evidence to the record in almost every case because the administrator of the benefits plan is always linked to the insurer. However, in this case, there were no written procedures for claims review, and the Court held that the lack of such procedures exacerbated the conflict, rendering it proper for the District Court to have considered the new evidence.

The Court then looked to the evidence and held that it was sufficient to justify the District Court's finding. The Court also upheld the District Court's award of attorneys' fees.

The decision in Locher v. Unum Life Insurance Co. can be found here.

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