WOLFF v. UNUM PROVIDENT

M. ARMIJO, District Judge

THIS MATTER comes before the Court on Plaintiff's Motion to Supplement the Administrative Record [Doc. 18] filed on June 28, 2005, and Plaintiff's Second Motion to Supplement the Administrator Record Based on the Social Security Administration [Doc. 27] filed on August 5, 2005. Having considered the parties' submissions, the applicable law, and otherwise being fully advised in the premises, the Court finds that Plaintiff has shown good cause for supplementing the Administrative Record with the three pages of medical records from Dr. James Bowen dated October 19, 2001, that were inadvertently omitted therefrom; however, Plaintiff has not shown good cause for supplementing the Administrative Record with the National Academy of Sciences publication entitled Multiple Sclerosis: Current Status and Strategies for the Future (2001), or the decision from the Social Security Administration dated November 12, 2002. Accordingly, Plaintiff's second motion to supplement the Administrative Record is denied, and Plaintiff's first motion to supplement the Administrative Record is granted in part and denied in part.

The extent of this Court's discretion to allow supplementation of the Administrative Record when reviewing a denial of benefits under ERISA is determined, in part, by the applicable standard of review. "[A] denial of benefits challenged under § 1132(a)(1)(B) [ERISA] is to be reviewed under a de novo standard unless the benefit plan gives the administrator or fiduciary discretionary authority to determine eligibility for benefits or to construe the terms of the plan." Firestone Tire Rubber Co. v. Bruch, 489 U.S. 101, 115, 109 S.Ct. 948, 103 L.Ed.2d 80 (1989). But if the plan expressly gives the plan administrator or fiduciary the discretion to determine whether to deny a claimant insurance benefits under the plan, then the Court applies "an `arbitrary and capricious' standard to a plan administrator's actions."Charter Canyon Treatment Ctr. v. Pool Co., 153 F.3d 1132, 1135 (10th Cir. 1998).

In cases subject to the arbitrary and capricious standard of review, courts "`are limited to the `administrative record' — the materials compiled by the administrator in the course of making his decision." Hall v. Unum Life Ins. Co. of Am., 300 F.3d 1197, 1201 (10th Cir. 2002). In cases subject to the de novo standard of review, the general rule is that courts also are limited to the administrative record; however, the administrative record may be supplemented in such cases where "`circumstances clearly establish that additional evidence is necessary to conduct an adequate de novo review of the benefit decision.'"Id. (quoting Quesinberry v. Life Ins. Co. of N. Am., 987 F.2d 1017, 1025 (4th Cir. 1993) (en banc)). "The party seeking to supplement the record bears the burden of establishing why the district court should exercise its discretion to admit particular evidence by showing how that evidence is necessary to the district court's de novo review." Id. at 1203.

For example, a party may show exceptional circumstances with respect to:

"claims that require consideration of complex medical questions or issues regarding the credibility of medical experts; the availability of very limited administrative review procedures with little or no evidentiary record; the necessity of evidence regarding interpretation of the terms of the plan rather than specific historical facts; instances where the payor and the administrator are the same entity and the court is concerned about impartiality; claims which would have been insurance contract claims prior to ERISA; and circumstances in which there is additional evidence that the claimant could not have presented in the administrative process."

Id. (quoting Quesinberry, 987 F.2d at 1027). These examples, however, are not intended to serve as blanket exceptions to the general rule limiting judicial review to the Administrative Record, because "the district court must still make a particularized determination of whether and why specific evidence outside the administrative record should be admitted" in each case. Id. at 1206.

The parties dispute whether this case is governed by the "arbitrary and capricious" standard of review or the de novo standard of review. Even if the de novo standard applies, I conclude that Plaintiff has not demonstrated exceptional circumstances which would warrant the inclusion of the National Academy of Science publication on multiple sclerosis or the decision of the Social Security Administration.

The National Academy of Sciences publication appears to be a learned treatise with generic descriptions of the symptoms of multiple sclerosis, along with recommendations for further research. While Plaintiff's efforts to educate the Court about the meaning of the medical terminology used in the Administrative Record are appreciated, the publication in question does not appear to have the type of clinical or practical focus that would make it directly relevant and necessary to the Court's analysis of Defendant's decision-making in this case.

To the extent that the parties' reference to learned treatises or medical dictionaries is intended solely to educate the Court by defining the accepted meaning of medical terminology used in the Administrative Record, the Court may take judicial notice of such references to the extent permissible under Fed.R.Evid. 201 without supplementing the Administrative Record. See generally 1 Jack B. Weinstein Margaret A. Berger, Weinstein's Federal Evidence § 201.12[7] (2d ed. 2005) (collecting cases taking judicial notice of scientific and medical facts that are "not subject to reasonable dispute" under Fed.R.Evid. 201); Annotation, Judicial Notice of Diseases or Similar Conditions Adversely Affecting Human Beings, 72 A.L.R. 2d 554 (1960) (similar); see, e.g., Dunn v. White, 880 F.2d 1188, 1195 (10th Cir. 1989) (taking judicial notice of seriousness of AIDS epidemic and potential for AIDS transmission among prisoners).

The decision of the Social Security Administration may have more direct relevance to this case insofar as it concerns the actual application of medical principles to Plaintiff's condition; however, the legal principles and procedures which an Administrative Law Judge must employ in determining a person's disability for purposes of Social Security benefits are distinguishable from those applicable in ERISA cases. See Black Decker Disability Plan v. Nord, 533 U.S. 822, 833-34 (2003); Wagner-Harding v. Farmland Indus. Inc. Employee Retirement Plan, No. 01-3085, 26 Fed. Appx. 811, 817 (10th Cir. 2001) (unpublished disposition). Therefore, the conclusions drawn by the Administrative Law Judge regarding Plaintiff's application to the Social Security Administration do not necessarily require Defendant to draw the same conclusions with respect to her claim for benefits under ERISA, and comparisons between the two maybe more misleading than helpful. For these reasons, I find that the particular circumstances of this case are not exceptional enough to warrant adding the decision from the Social Security Administration to the Administrative Record.

Finally, the Court notes that the Administrative Record lodged by Defendant on June 10, 2005, consists of a stack of documents with no staples or dividers showing how each page is to be grouped and no index showing at which page number the beginning of each document may be found. [Doc. 17.] Production of the Administrative Record in this inchoate form does not facilitate the Court's review, especially given the peculiar way the pages therein are numbered. Accordingly, the Court will order Defendant to file an index to the Administrative Record that identifies each separate document or grouping of papers therein and shows the page number at which the beginning of each such document or grouping may be found as well as the range of page numbers that correspond with each separate document or grouping of papers.

Such an index will allow the Court to undertake its review of the Administrative Record in accordance with the relevant Tenth Circuit precedents. The Court will announce the results of this review at a later date.

IT IS THEREFORE ORDERED that Plaintiff's Motion to Supplement the Administrative Record [Doc. 18] is GRANTED IN PART with respect to the three pages of medical records from Dr. James Bowen dated October 19, 2001, and DENIED IN PART with respect to the National Academy of Sciences publication entitledMultiple Sclerosis: Current Status and Strategies for the Future (2001).

IT IS FURTHER ORDERED that Plaintiff's Second Motion to Supplement the Administrator Record Based on the Social Security Administration [Doc. 27] is DENIED. IT IS FURTHER ORDERED that Defendant shall file an index to the Administrative Record by no later than January 31, 2006, that identifies each separate document or grouping of papers therein and shows the page number at which the beginning of each document or grouping may be found as well as the range of page numbers that correspond to each separate document or grouping.

SO ORDERED.