Opinion ID: 585282
Heading Depth: 1
Heading Rank: 4

Heading: A Full and Fair Review

Text: 25 ERISA provides that a plan must follow certain procedural steps when denying or terminating benefits to a plan participant. First, the plan must provide the participant with written notice of the denial which sets forth the specific reasons underlying the decision. 29 U.S.C. § 1133(1). Second, the plan must afford a reasonable opportunity ... for a full and fair review by the appropriate named fiduciary of the decision denying the claim. Id. § 1133(2). Labor regulations specify that the review procedure must permit the claimant to (i) [r]equest a review upon written application to the plan; (ii) [r]eview pertinent documents; and (iii) [s]ubmit issues and comments in writing. 29 C.F.R. § 2560.503-1(g)(1). 26 Sandoval argues that he failed to receive a full and fair review of the decision to terminate his benefits, pursuant to 29 U.S.C. § 1133(2). We have previously held that receiving a full and fair review requires  'knowing what evidence the decision-maker relied upon, having an opportunity to address the accuracy and reliability of the evidence, and having the decision-maker consider the evidence presented by both parties prior to reaching and rendering his decision.'  Sage v. Automation, Inc. Pension Plan & Trust, 845 F.2d 885, 893-94 (10th Cir.1988) (quoting Grossmuller v. International Union, United Auto. Aerospace & Agric. Implement Workers, Local 813, 715 F.2d 853, 858 n. 5 (3d Cir.1983)). 27 Sandoval was represented by counsel throughout the review process. Sandoval was told of Dr. Walsky's medical diagnosis. Furthermore, the Review Committee invited Sandoval to submit additional evidence. Sandoval's counsel knew that the initial review by a Jacobs employee had resulted in a determination to reject total disability. Sandoval had the opportunity to submit additional evidence of physical or other disability to the Review Committee but declined to do so. The Review Committee noted explicitly the conflicting medical opinions and found Dr. Walsky's to be more detailed, less conclusory, and more convincing. The Review Committee had no affirmative duty to rule out a claim not before it. In short, Jacobs complied with the statutory requirements of section 1133. 28 Given that Jacobs complied with the statutory and regulatory requirements, Sandoval cannot complain that the procedures followed were unfair. Congress intended these review procedures to help reduce the number of frivolous lawsuits under ERISA; to promote the consistent treatment of claims for benefits; to provide a nonadversarial method of claims settlement; and to minimize the costs of claims settlement for all concerned. Amato v. Bernard, 618 F.2d 559, 567 (9th Cir.1980). Absent such safeguards, mounting costs of administering a plan might discourage employers from establishing such plans. Cf. Pilot Life Ins. Co. v. Dedeaux, 481 U.S. 41, 54, 107 S.Ct. 1549, 1556, 95 L.Ed.2d 39 (1987) (civil enforcement scheme of 29 U.S.C. § 1132 represents a careful balancing of the need for prompt and fair claims settlement procedure against the public interest in encouraging the formation of employee benefit plans.). Based upon our review of the record, Sandoval received a full and fair review.