Opinion ID: 420755
Heading Depth: 1
Heading Rank: 3

Heading: Instatement in the LTD Plan

Text: 28 The district court overturned Prudential's decision because Prudential arbitrarily and capriciously failed to develop any evidence on the relationship between the plaintiff's medical history and his poor job performance. Wolfe v. J.C. Penney Co., No. EV 79-33-C at 20 n. 6 (S.D.Ind. Sept. 1, 1982). In particular, the district court determined that Prudential should have exercised its authority to have Wolfe examined by a physician during the claim's pendency in light of the mass of uncontroverted medical information submitted and Prudential's recognition of the critical nature of the circumstances surrounding the plaintiff's determination.... Id. at 18-20. See generally, Central States, Southeast and Southwest Areas Pension Fund v. Central Transport, Inc., 698 F.2d 802, 811 (6th Cir.1983) (a trustee has a limited duty to investigate and a concomitant duty not to undertake unreasonable investigations to determine coverage). As a remedy for this procedural defect, the district court instated Wolfe in the LTD Plan because given the unliklihood [sic] that an examination of the plaintiff's health at the present time would shed any light upon his ability to perform his job in 1976, the court [was] of the opinion that an award without remand [was] appropriate. Id. Regardless of whether Prudential based its decision on substantial evidence, we must reverse the district court's directive to instate Wolfe into the LTD Plan. 29 In reviewing a fiduciary's decision, [a] federal court is to focus on the evidence before the truste[e] at the time of [his] final decision and is not to hold a de novo factual hearing on the question of applicant's eligibility. Wardle v. Central States, Southeast and Southwest Areas Pension Fund, 627 F.2d 820, 824 (7th Cir.1980), cert. denied, 449 U.S. 1112, 101 S.Ct. 922, 66 L.Ed.2d 841 (1981). See also Miles v. New York State Teamsters Conference, 698 F.2d 593, 599 (2d Cir.1983). Policy considerations favor allowing the fiduciary to decide an employee's benefit eligibility. Taylor v. Bakery & Confectionary Union, 455 F.Supp. 816, 820 (E.D.N.C.1978) (discussing importance of exhaustion). When additional evidence on the merits of the claim for benefits is presented for the first time to the district court, the court should remand to the fiduciary to make the initial assessment of whether such facts establish an applicant's eligibility. Wardle, 627 F.2d at 828. This is necessary to insure that the fiduciary retains the primary responsibility for claim processing that Congress intended. Challenger v. Local Union No. 1, 619 F.2d 645, 649 (7th Cir.1980). No remand is necessary, however, where it would be a 'useless formality.'  Id. (quoting Ruth v. Lewis, 166 F.Supp. 346, 349 (D.D.C.1958). In Wardle, we considered remand unnecessary where the unsuccessful applicant presented additional evidence which strengthened his position only minimally. Wardle, 627 F.2d at 828. Thus, we upheld the fiduciaries' decision and did not overturn it based on the additional evidence. 30 In contrast to Wardle, the additional evidence introduced at trial by Wolfe and the defendants-appellants is significant and led the district court to overturn the denial. Although a present examination of Wolfe is not apt to reveal whether he was disabled on October 6, 1976, Prudential must be permitted to evaluate the additional evidence produced at trial and determine Wolfe's eligibility. If Wolfe prevails at the hearing before the fiduciary, Wolfe would then be entitled to retroactive benefits. We do not, however, intend to indicate a view as to a final decision on the merits, only that the plaintiff is entitled to reconsideration of his claim by the fiduciary, the Board of Governors. 31 Reversed and remanded to the district court with direction to remand to the fiduciary.