Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-azd-2_06-cv-02779/USCOURTS-azd-2_06-cv-02779-1/pdf.json

Nature of Suit Code: 110
Nature of Suit: Insurance
Cause of Action: 28:1441 Petition for Removal- Insurance Contract

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WO

IN THE UNITED STATES DISTRICT COURT

FOR THE DISTRICT OF ARIZONA

Lisa Divito Weber, )

Individually, as Personal )

Representative of the Estate ) No. CIV 06-02779 PHX RCB

of Norman Scott Weber, )

Deceased, and next-friend of ) O R D E R

Brittany M. Weber and Wittney )

Nicole Weber, minor children, )

of Decedent, )

)

Plaintiff, )

 )

 vs. )

 ) 

Hartford Life and Accident )

Insurance company, a ) 

Connecticut corporation, )

)

 Defendant. )

______________________________)

Background

In this action brought pursuant to the Employee Retirement

Income Security Act of 1974, the fundamental issue is whether the

death of Norman Scott Weber was an accident, as plaintiff contends,

or a suicide, as defendant contends. Primarily because “the

parties have a fundamental disagreement” as to how this case should

proceed, doc. 64 at 1:22, they have submitted separate supplemental 

Case 2:06-cv-02779-RCB Document 69 Filed 12/19/08 Page 1 of 6
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status reports and proposed scheduling orders for the court’s

consideration (docs. 64 and 65). Although they agree that any

trial herein will be a bench trial subject to de novo review, the

parties disagree as to the scope of the record for such trial. 

They also disagree as to the necessity for additional discovery. 

Defendant assumes that no further discovery is necessary, but

plaintiff contemplates additional discovery. Indeed, her proposed

supplemental pretrial scheduling order includes deadlines for the

taking of expert depositions and a discovery cut-off date, to be

determined. 

The December 15, 2008, deadline for a settlement conference

has passed. The court assumes by the parties’ silence that this

matter has not been resolved. Consequently, it is necessary to

consider the issues which the parties’ respective status reports

raise, including the proposed deadlines contained therein. 

Discussion

I. Scope of Review

Defendants are taking the position that the court should

review only the administrative record at trial, whereas plaintiff

is seeking to have the court also consider “such additional

evidence or testimony [as] the [court] may allow or require to

resolve the question of decedent’s cause of death[.]” Pl. Supp.

Status Report (doc. 65) at 3, ¶ 8:18-20. As defendant suggests,

“[i]n most cases only the evidence that was before the plan

administrator should be considered[]” by a reviewing court. See

Kearney v. Standard Ins. Co., 175 F.3d 1084, 1091 (9th Cir. 1999)

(internal quotation marks and citation omitted). Or, as the

Kearney Court put it, “the record that was before the administrator

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furnishes the primary basis for review.” Id. at 1090 (emphasis

added). 

Reviewing only the administrative record is not a hard and

fast rule, however. In Mongeluzo v. Baxter Travenol Long Term 

Disability Benefit Plan, 46 F.3d 938 (9th Cir. 1995), the Ninth

Circuit “recognized that the administrative record need not serve

as the exclusive basis for review.” Dishman v. Unum Life Ins. Co.,

269 F.3d 974, 985 (9th Cir. 2001). Rather, “[a] district court

may, in its discretion, allow evidence that was not before the plan

administrator when circumstances clearly establish that additional

evidence is necessary to conduct an adequate de novo review of the

benefit decision.” Id. (internal quotation marks, footnote and

citation omitted). “The Mongeluzo court juxtaposed necessity to

situations in which someone at a later time comes up with new

evidence that was not presented to the plan administrator.” Id. at

985, n.46 (internal quotation marks and citation omitted). 

So, for example, in Kearney the Ninth Circuit held that the

district court did not abuse its discretion when it limited its

review to the evidence before the plan administrator. There was no

abuse of discretion, the Ninth Circuit found, for two reasons. 

First, plaintiff “easily” could have submitted his additional

evidence, “pages of an ‘Occupational Outlook Handbook’ published by

the U.S. Department of Labor,” to the plan administrator, but he

did not. Kearney, 175 F.3d at 1091. Second, the Ninth Circuit

found that the additional evidence was not needed for the district

court to “conduct an adequate de novo review[,]” of the denial of

benefits decision. As an “experienced trial judge[,]” the district

court was aware of “what trial lawyers do[;]” and hence did not

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need the “assistance of a secondary source[]” -- the DOL Handbook 

-- to inform him on that issue, the Ninth Circuit reasoned. See

id.

In contrast, where “[n]o administrative review preceded [an

insurer’s] decision to suspend [plaintiff’s] benefits[,]” the Ninth

Circuit in Dishman, held that the district court did not abuse its

discretion in allowing evidence outside the administrative record. 

Dishman, 269 F.3d at 985. The Ninth Circuit explained that because

the insurer told plaintiff that “no appeals process applied to

him,” plaintiff could “hardly” be “fault[ed]” for not submitting 

materials to the insurer, which he later sought to present to the

district court. Id. Similarly, in Friedrich v. Intel Corp., 181

F.3d 1105 (9th Cir. 1999), the Ninth Circuit held that the district

court properly allowed additional medical evidence where the plan

administrator had “limited [plaintiff] to an administrative record

that included only some of [his] medical records and those records

were illegible and disorganized.” Id. at 1111. That additional

evidence was necessary so that the district court could “conduct an

independent de novo review of the benefit claim denial[.]” Id. 

Another exception to the general rule limiting review to the

administrative record is “when a plan administrator operates under

a conflict of interest.” Harris v. Standard Ins. Co., 2008 WL

917119, at *12 (D.Or. March 26, 2008). In that situation, “[t]he

district court may, in its discretion, consider evidence outside

the administrative record to decide the nature, extent, and effect

on the decision-making process of any conflict of interest[.]”

Abatie v. Alta Health & Life Ins. Co., 458 F.3d 955, 970 (9th Cir.

2006). Procedural irregularities by plan administrators also

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provide a basis for consideration of “evidence outside the

administrative record to supplement gaps in the record caused by

th[os]e procedural defalcations.” Harris, 2008 WL 917119, at *13

(citing Abatie, 458 F.3d at 972-973). 

As should be evident by now, the court cannot make a

determination as to the need to supplement the administrative

record in a vacuum. Therefore, before issuing a Supplemental Pretrial Scheduling Order, the court will require the parties to file

and serve a memorandum of law, and any accompanying documentation

they deem relevant, setting forth the legal and factual bases for

their respective positions on whether to allow supplementation of

the administrative record. 

II. Discovery

Likewise, the need for additional discovery cannot be resolved

in a factual vacuum. In part because the court has not been

apprised of the extent of the administrative record, the need for

additional discovery along the lines which plaintiff suggests is

not readily apparent. Therefore, the court further requires the

parties to file and serve a memorandum of law and any accompanying

documentation they deem relevant, setting forth the legal and

factual bases for their respective positions as to the necessity

for further discovery. If further discovery is desired, proposed

discovery deadlines shall be included therewith. 

As set forth above, the court hereby ORDERS:

(1) the parties to file and serve a memorandum of law, and any

accompanying documentation they deem relevant, setting forth the

legal and factual bases for their respective positions on whether

to allow supplementation of the administrative record by no later

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than ten (10) days from the date of entry of this order;

the court further ORDERS:

(2) the parties to file and serve, no later than ten (10) days

from the date of entry of this order, a memorandum of law and any

accompanying documentation they deem relevant, setting forth the

legal and factual bases for their respective positions as to the

necessity for further discovery. If further discovery is desired,

proposed discovery deadlines shall be included therewith. 

DATED this 18th day of December, 2008.

Copies to counsel of record

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