The Eleventh Circuit Court of Appeals has confirmed that under a de novo standard of review, parties can introduce new evidence. Whether the de novo standard applies can depend on policy language or whether the insurance company failed to comply with ERISA deadlines.
How is the standard of review determined?
In all ERISA governed disability lawsuits, the court will review the claim under a “de novo” standard of review unless the Plan documents give the administrator (usually the insurance company) discretionary authority to determine eligibility for benefits or to construe the terms of the plans. If discretion is granted, the court will review whether the administrator’s benefit decision was “arbitrary and capricious,” i.e. whether it lacked a reasonable basis.
We frequently see plans with discretionary language than without which means we are up against the more stringent standard of review: arbitrary and capricious.
The standard of review the court uses will determine the evidence that may be introduced in the lawsuit.
Under an arbitrary and capricious standard, the court is limited to the claim file (i.e. the facts known to the administrator at the time the decision was made).
Under a de novo standard of review, the court is not limited to the claim file.
The Eleventh Circuit expands on what evidence can be introduced in a recent court ruling, Harris v. Lincoln National Life Insurance Company.
Virgil Harris brought suit against Lincoln for the denial of his disability benefits. Both parties agreed that the Plan documents did not grant discretionary authority to Lincoln and therefore, the court would review the case under the de novo standard of review.
However, the lower court wrongly ruled that Mr. Harris could not submit new evidence not presented to Lincoln before his benefits were denied.
Mr. Harris appealed to the Eleventh Circuit and the Eleventh Circuit ruled that the district court erred in their evidentiary ruling.
The Eleventh Circuit reaffirmed their prior decisions under Moon v. American Home Assurance Company (“American Home’s contention that a court conducting a de novo review must examine only such facts as were available to the plan administrator at the time of the benefits denial is contrary to the concept of a de novo review.”) and Kirwan v. Marriott Corp. (“In this circuit, a district court conducting a de novo review of an [a]dministrator’s benefits determination is not limited to the facts available to the Administrator at the time of the determination.”).
The Eleventh Circuit ruled, that based on their prior decisions in Moon and Kirwan, the parties can introduce evidence outside of the claim file.
For plaintiff litigating long term disability disputes in federal court, this means they have an opportunity to bring in new evidence that is not found in the claim file.
The experienced attorneys at Dabdoub Law firm have successfully argued for a de novo standard of review and then introduced new evidence during litigation. Understanding how and when claimants can do this may strengthen your case and level the playing field against insurance companies.
Help from a Lawyer with Expertise in Disability Insurance
Disability insurance law is complex. Hiring an experienced disability attorney is important. Because all disability lawyers at this law firm focus on disability insurance claims, we have expertise in disability insurance law.
That means we have:
- Experience with every major disability insurance company;
- A proven track record of success by winning major disability lawsuits;
- Recovered millions of dollars in disability benefits for clients;
And, we never charge fees or costs unless our clients get paid.
The firm can help at any stage of your disability insurance claim, including:
- Submitting a disability insurance claim;
- Appealing a long-term disability denial;
- Negotiating a lump-sum settlement; or
- Filing a lawsuit against your disability insurance company.
Because federal law applies to most disability insurance claims, our lawyers are able to represent clients across the country.
Contact Dabdoub Law Firm today at (800) 969-0488 for a free consultation with a disability attorney.
