Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-azd-2_05-cv-00718/USCOURTS-azd-2_05-cv-00718-3/pdf.json

Nature of Suit Code: 791
Nature of Suit: Employee Retirement Income Security Act (ERISA)
Cause of Action: 29:1001 E.R.I.S.A.: Employee Retirement

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WO

IN THE UNITED STATES DISTRICT COURT

FOR THE DISTRICT OF ARIZONA

Raymond Vaught, 

Plaintiff, 

vs.

Scottsdale Healthcare Corporation

Health Plan, 

Defendant. 

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No. CV-05-718-PHX-DGC

ORDER

Raymond Vaught is a participant in the Scottsdale Healthcare Corporation Health Plan

(“Plan”), an ERISA-governed medical plan. Vaught sought reimbursement of accidentrelated medical costs from the Plan. The claim was denied, and Vaught filed a complaint

alleging that the Plan had violated ERISA and the terms of the Plan. Dkt. #1. The Court

issued orders finding that de novo review applies and that Plaintiff was entitled to conduct

limited discovery and present certain extrinsic evidence in support of his claim. Dkt. ##50,

54. The parties have filed a joint report regarding the method and schedule for the

disposition of the case. Dkt. #57.

The parties agree that the Court may enter judgment on the merits following briefing

in the form of motions for judgment. Dkt. #57 at 2, ¶ I(A). Defendant proposes a schedule

that includes two supplementations of the administrative record: simultaneous initial and

rebuttal supplementations. Id. at 3. Plaintiff argues that Defendant – as the plan

administrator – should not be allowed to supplement the record and essentially “tack on” a

Case 2:05-cv-00718-DGC Document 59 Filed 06/01/09 Page 1 of 3
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new reason for the administrative decision denying the claim. Id. at 3-4.

As the Court explained in its April 6, 2009 order, because the Court is reviewing the

administrative decision de novo, it may, under certain limited circumstances, consider

evidence outside the administrative record where the evidence is necessary to conduct an

adequate review. See Dkt. #54 at 2 (citing Abatie v. Alta Health & Life Ins. Co., 458 F.3d

955, 969-70 (9th Cir. 2006) (en banc); Mongeluzo v. Baxter Travenol LTD Benefit Plan, 46

F.3d 938, 943-44 (9th Cir. 1995)). The Court concluded that Plaintiff should be allowed to

present extrinsic because the administrative decision was based on a sparse evidentiary

record and consideration of the proposed extrinsic evidence is necessary to conduct an

adequate de novo review. Id. (citing Opeta v. Nw. Airlines Pension Plan for Contract

Employers, 484 F.3d 1211, 1217 (9th Cir. 2007)).

Defendant has not identified the extrinsic evidence it may seek to present, nor has it

shown that the evidence is necessary for an adequate de novo review. The Court cannot, on

the record before it, determine whether Defendant should be permitted to present extrinsic

evidence in support of the denial of Plaintiff’s claim. The Court will require Plaintiff to

present all of his extrinsic evidence in his motion for judgment. Defendant may present

rebuttal extrinsic evidence in its response to Plaintiff’s motion, but must explain why that

evidence is necessary to an adequate de novo review.

IT IS ORDERED:

1. The parties shall file motions for judgment, not to exceed 10 pages, by

August 14, 2009. Plaintiff shall present all of his extrinsic evidence in his

motion for judgment.

2. Responses, not to exceed 7 pages, shall be filed by August 28, 2009.

Defendant may present rebuttal extrinsic evidence in its response to Plaintiff’s

motion, but must explain why that evidence is necessary to an adequate de

novo review.

3. Replies, not to exceed 7 pages, shall be filed by September 11, 2009..

4. After briefing is complete, the Court will determine whether oral argument, a

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bench trial, or other evidentiary hearing is required.

DATED this 1st day of June, 2009.

Case 2:05-cv-00718-DGC Document 59 Filed 06/01/09 Page 3 of 3