UNITED STATES CO URT OF APPEALS FOR THE TENTH CIRCUIT

PATRICK GARRETT, Plaintiff-Appellee,

v. PRINCIPAL LIFE INSURANCE COMPANY, Defendant-Appellant. No. 13-6087 (D.C. No. 5:09-CV-01378-M) (W.D. Okla.)

ORDER AND JUDGMENT *

Before LUCERO and BALDOCK , Circuit Judges, and BRORBY , Senior Circuit Judge.
This is an appeal by de fendant Principal Life Insu rance Company (Principal) from the district court’s orders that reve rsed Principal’s decision to deny plaintiff Patrick Garrett’s claim for medical benefi ts and awarded Mr. Garrett the full amount of his claim. We have jurisdiction under 28 U.S.C. § 12 91 and affirm.

* After examining the briefs and appella te record, this pa nel has determined unanimously to grant the parties’ request for a decision on the briefs without oral argument. See Fed. R. App. P. 34(f); 10th Cir. R. 34.1(G). The case is therefore ordered submitted without oral argument. This order and judgment is not binding precedent, except under the doctr ines of law of the case, res judicata, and collateral estoppel. It may be cite d, however, for its persuasi ve value consistent with Fed. R. App. P. 32.1 and 10th Cir. R. 32.1. FILED United States Court of Appeals Tenth Circuit 

### February 18, 2014
Elisabeth A. Shumaker Clerk of Court- 2 - Background Mr. Garrett has been insured since 1998 through a group medical benefits policy issued to hi s employer as part of an em ployee benefits plan under the Employee Retirement In come Security Act of 1974 (ERISA), 29 U.S.C. §§ 1001-1461. A group policy issued by Principal in February 2007 provided coverage for inpatient hosp ital alcohol abuse treatment. In conjunction with its issuance of the policy, Pr incipal supplied “Policyholder Certificates,” whose purpose were described in the policy its elf as: “The Certificates wi ll be evidence of insurance and will describe the basic fe atures of the coverage. Th ey will not be considered a part of this Group Policy.” Aplt. App. Vol. 4 at 740. In June 2008, Principal se nt the employer a new “Gr oup Booklet-Certificate.” Id . Vol. 1 at 39. The booklet-certificate pur ported to exclude inpatient coverage for alcohol abuse treatment, but stated: “ Member rights and benefits are determined by the provisions of the Group Policy. This booklet briefly describes those rights and benefits. It outlines what you mu st do to be insured. It e xplains how to file claims. It is your certificate while you are insured.” Id . at 41 (emphasis added). As explained below, Principal did not i ssue a “new” group policy until October 2009 – more than six months afte r Mr. Garrett filed his clai m for medical benefits. Mr. Garrett went to Cliffside Malibu (Cliffside) in March 2009 for inpatient alcohol abuse treatment. When the fa cility inquired about medical coverage, Principal told Cliffside that it did not meet the definition of a hospital and declined to- 3 - approve the costs. Nonethele ss, at the conclusion of Mr. Ga rrett’s treatment in April, Cliffside submitted a claim to Principal for $65,000. On ce again, Principal denied the claim on the grounds that Cli ffside was not a covered facility. Mr. Garrett’s lawyer wrot e to Principal in Septem ber 2009 asserting that Cliffside met the definition of a hospital. He also quest ioned Principal’s failure to promptly, fully, and honestly respond to Mr . Garrett’s claim. Later that month, Principal admitted that Cliffside was a c overed facility, but again denied coverage, this time on the ground that the “new” po licy excluded coverage for inpatient alcohol abuse treatment. Because Mr. Garrett had never received a copy of the “new” policy, his lawyer asked Principal to send him a copy. This request set off a chain of conflicting explanations within the company as to how to respond. One employee acknowledged that the most recent policy th at was actually issued and sent to the employer was in February 2007. When a further review disclosed that a new “Group BookletCertificate” had been sent to the employer in 2008, a different employee asked whether Principal issues booklets without i ssuing an updated polic y. In response, another employee told her th at the policy was amended in 2008 to “add employees . . . [but] [t]here would have been no change to the Policy so that is why a Policy was not ordered. Booklets were ordered, I beli eve, for the new employ ees. . . . Just make sure the group knows that there was no ch ange in the benefits for the group.” Id

. Vol. 3 at 672.- 4 - The following day, a different employ ee decided that Principal should apply the limitation in the “new” policy to Mr. Garrett’s claim, but realized the potential problem in relying on the terms of a policy th at had never been issued. To that end, she suggested that the company “craft a letter . . . to expl ain where this limitation is in the policy itself, or we may need to prov ide [a] rationale as to why it isn’t [in the policy] but in [the] booklet only.” Id . at 676. Yet another employee acknowledged the need to find out “why the ‘official doc ument’ does not include the limitation.” Id . at 675. On October 27, 2009, Principal wrote to Mr . Garrett’s lawyer that its failure to issue a new policy in conjunction with the booklet “was an oversight.” Id . Vol. 4 at 848. “Once we identified this oversight, we issued the Group Policy and sent it to the Group Policyholder . . . on October 16, 2009.” Id . Principal explained that it had “inadvertently used the wrong denial re ason when denying c overage,” and was upholding its denial for treatment at Clif fside on the ground that Mr. Garrett had or should have received a copy of the 2008 bo oklet that contained the limitation on inpatient alcohol treatment. Id . at 849. Mr. Garrett filed an action challenging Principal’s denial of benefits under ERISA. See 29 U.S.C. § 1132(a)(1)(B). After Pr incipal submitted the administrative record to the district cour t, the parties submitted brie fing regarding their respective positions on the benefit determination. Th e court entered an order in which it found that Mr. Garrett was en titled to benefits under the 200 7 policy. The court directed- 5 - the parties to try to reach an agreement as to the amount owed and reserved the issue of attorney fees and prejudgment interest. 1 The parties could not agree on an amount, and following additional briefing, the court entered an order that Mr. Garrett was entitled to $65,000 in medical benefi ts. Principal app eals both orders. Analysis We address first Principal’s decision to deny benefits. See Holcomb v. Unum Life Ins. Co. of Am. , 578 F.3d 1187, 1192 (10th Cir. 2009) (“We review a plan administrator’s decision to de ny benefits to a claimant, as opposed to reviewing the district court’s ruling”). In conducting our review, we are “limited to the administrative record – the materials compiled by the administrator in the course of making his decision.” Id . (internal quotation marks omitted) . In the district court the parties agreed that Principa l’s decision to deny benefits should be reviewed de novo, and on appeal they do not argue for a different standard of review. Principal argues that the 2008 booklet-cer tificate should contro l what is and is not a covered medical benefit. Whether we view Princi pal’s argument as advocating that the 2007 policy was amended by the book let or that the booklet controls, the result is the same – we concl ude that the 2007 policy governs. First, a summary plan description should not be enforced over the terms of a plan. CIGNA Corp. v. Amara , ____ U.S. ____, 131 S. Ct. 1866, 1878 (2011); see

1 The district court later entered an order for attorney fees and prejudgment interest. in May 2013. Princi pal’s appeal from that order is addressed separately in our order and judgment in Appeal No. 13-6142.- 6 - also Eugene S. v. Horizon Blue Cross Blue Shield of N.J. , 663 F.3d 1124, 1131 (10th Cir. 2011) (interpreting Amara as standing for the propositi on that “the terms of [a summary plan description] are not enfor ceable when they conflict with governing plan documents”). Second, there is no evidence that the 2007 policy was amended. The policy provided that it could be amended or change d as follows: (1) to co mply with laws or regulations; (2) to provide fo r consistent application of the policy’s provisions; or (3) by written agreement between Principal a nd the employer. Aplt. App. Vol. 4 at 737. As to the only arguably relevant re ason, there is no evidence of any agreement to amend. Principal nonetheless argue s that the employer consented to an amendment by continuing to pay its prem iums after it r eceived the “Group Booklet-Certificate” in June 2008. However, Principal cites no authority establishing that the policy could be amended by any mean s other than those st ated in the policy itself. Next, citing Curtiss-Wright Corp. v. Schoonejongen , 514 U.S. 73 (1995), Principal argues that “ERISA generally permit [s] employers or other plan sponsors to freely adopt, modify, or terminate welfar e plans.” Aplt. Opening Br. at 14. CurtissWright , however, is not relevant because it concerned an employee’s purported ERISA claim against an employer who ha d unilateral authority to amend the employee benefit plan and who intended to do so. 514 U.S. at 75, 79.- 7 - We turn now to the district court’s or der that granted Mr . Garrett the entire amount he claimed as benefits. In its dist rict court briefing on this issue, Principal argued for the first time th at it was entitled to a signi ficant reduction in the amount owed because: (1) Cliffside wa s not a preferred provider; (2) Mr. Garrett had not met his deductible; and (3) Mr. Garrett’s hospita lization should have been limited to ten days. In conjunction with its new rationa le, Principal attempted to supplement the administrative record with a pricing affida vit and a third-party pricing analysis. The court concluded that because Principal “bases its calculation of benefits owed to [Mr. Garrett] on rationales not relie d on by the claims administ rator below and has failed to show special circumstan ces warranting the supplementa tion of the administrative record, the [c]ourt will not rely on [Principal’s] calculation of benefits owed to [Mr. Garrett].” Id . at 169. We conclude that the dist rict court properly declined to consider Principal’s new arguments. “[W]hen reviewing a plan ad ministrator’s decision to deny benefits, we consider only the rationale asserted by th e plan administrator in the administrative record.” Spradley v. Owens-Ill. Hourly Emps . Welfare Benefit Plan , 686 F.3d 1135, 1140 (10th Cir. 2012) (internal quotation marks omitted). Th is rule furthers the goal of ERISA to allow plan administrators and beneficiaries to “hav[e] a full and meaningful dialogue regarding the denial of benefits . . . [and to prevent the plan administrator from] treat[ing] the administrative process as a trial run and offer[ing] a- 8 - post hoc rationale in district court.” Id . at 1140-41 (internal quotation marks omitted). As to the district court’s refusal to consider Princi pal’s request to supplement the record, we have recognized that “the best way to implement ERISA’ purposes . . . is ordinarily to restrict de novo review to the admini strative record.” Hall v. Unum Life Ins. Co. of Am. , 300 F.3d 1197, 1202 (10th Ci r. 2002). Thus, “it is the unusual case in which the di strict court should allow suppl ementation of the record.” Id . at 1203. “A party seeking to introduce evidence from outside the administrative record bears a significant burden in establishing that he may do so.” Jewell v. Life Ins. Co. of N. Am. , 508 F.3d 1303, 1309 (10th Cir. 2007). Among other things, “the evidence must be necessa ry to the district court’s de novo review . . . [and] the party offering the extra-record ev idence must demonstrate that it could not have been submitted to the plan admini strator at the time the cha llenged decision was made.” Id . (internal quotation marks omitted). We review the district court’s dete rmination whether to supplement the administrative record for an abuse of discretion. Id . “In making a discretionary decision, a court must present an explana tion for its choice sufficient to enable a reviewing court to determine that it did not act thoughtle ssly, but instead considered the factors relevant to it s decision and in fact ex ercised its discretion.” Id . at 1310 (internal quotation marks omitted). Here, th e court accurately re cited the relevant- 9 - Hall factors and explained why the admi nistrative record should not be supplemented. We see no abuse of discretion. The judgment of the distri ct court is affirmed.

Entered for the Court
Wade Brorby Senior Circuit Judge