Opinion ID: 170023
Heading Depth: 3
Heading Rank: 2

Heading: Inability to Present Evidence During Administrative Process

Text: Second, the party attempting to bring evidence before the district court which it did not offer to the plan administrator must demonstrate that [the evidence] could not have been submitted . . . at the time the challenged decision was made. Hall, 300 F.3d at 1203. [4] During the claims administration process a claimant must come forward with all evidence which he knows or should know. See Davidson v. Prudential Ins. Co. of Am., 953 F.2d 1093, 1095 (8th Cir.1992). By evidence, we of course mean not just the particular document or testimony that a claimant might offer to the district court, but its substance. In this case, then, it is not enough for Mr. Jewell to demonstrate that he could not have offered to LINA the particular letters in question. The letters were written some thirteen months after this litigation was commenced in state court, so meeting that requirement would be trivial. Rather, he must show that the information contained in those letters was not of a substance known to him, or which should have been known to him, during the administrative process. We agree with the Eighth Circuit that where additional evidence, now believed by the claimant to be necessary to the benefit determination, is created after litigation had begun, [but] was known or should have been known to [the claimant] during the administrative proceedings, the claimant's subsequent proffer of that evidence amounts to nothing more than a last-gasp attempt to quarrel with the administrator's benefit determination, and should not be permitted. Id. (emphasis added). In the first disputed letter, dated February 7, 2005, Dr. Peters states that he had conducted three examinations of Mr. Jewell: on December 9, 1999, November 11, 2002, and January 13, 2003. (Dr. Peters' notes from those examinations were already in the administrative record compiled by LINA.) Mr. Jewell has offered no reason why he could not have solicited this explanatory letter promptly, instead of waiting two years after the last examination to do so. Nor do the contents of the letter seem to be outside the scope of information that was known or should have been known to Mr. Jewell during the administrative process. The only new matter of real substance in the letter is the claim that Mr. Jewell could be diagnosed with complex partial seizure disorder, apparently an organic defect, on the basis of his clinical history alone, and that any type of seizure is never diagnosed on the basis of [an] electroencephalogram. App. 734. But in the same letter Dr. Peters states that this clinical-history method of diagnosing seizures is well-known and even axiomatic in the neurologic community. App. 734. If so, it is information Mr. Jewell should have known, and could have presented to the plan administrator, long before 2005. Dr. Peters' letter, therefore, fails under this prong of the Hall admissibility test. See also Davidson, 953 F.2d at 1095. The second disputed letter, that of Dr. Caster dated February 9, 2005, begins by reprinting verbatim the six paragraphs of a 2002 letter from Dr. Caster which was already in the administrative record. The next paragraph contains information relating to the period up to June 2003, which could have been presented to LINA during Mr. Jewell's administrative appeals. The final paragraph, however, contains a statement that Mr. Jewell had suffered grand mal seizures in March 2003 and July 2004, names the medicines Mr. Jewell was subsequently prescribed specifically to treat seizure activity and other manifestations of his organic mental disorder, and opines that Mr. Jewell's condition continued to be completely disabling up to the time the letter was written. App. 743. The first seizure was reported by Dr. Caster elsewhere in the record in an April 18, 2003 note. The rest, however, was new information concerning events that had not occurred by the time the administrative record was closed; the second seizure and subsequent treatment history could not have been presented to LINA during the claim administration. These portions of Dr. Caster's letter accordingly would survive the second prong of the Hall test.