United States District Court, N.D. Ohio
LINDA M. HINES, Plaintiff,
UNUM LIFE INSURANCE COMPANY OF AMERICA, Defendant.
OPINION & ORDER [RESOLVING DOC. 16]
S. GWIN UNITED STATES DISTRICT JUDGE.
ERISA case, Plaintiff Linda M. Hines claims that Defendant
UNUM Life Insurance Company of America (“UNUM”)
wrongfully denied her long-term disability
benefits. On June 7, 2018, Defendant UNUM filed
under seal the administrative record it used in its
argues that the administrative record is missing documents
and information that Plaintiff's healthcare providers
gave to UNUM. Plaintiff therefore moves the Court for
limited discovery about these omissions. Defendant UNUM
general matter, an ERISA claimant cannot seek discovery of
evidence outside of the administrative record. In reviewing a
benefits claim denial, district courts are usually
“confined to the record that was before the Plan
Administrator.” The exception to this rule is for evidence
concerning a “procedural challenge to the
administrator's decision, such as an alleged lack of due
process afforded by the administrator or alleged bias on its
Hines argues that her medical records from Dr. Marc F.G.
Estafanous, Dr. Gregory Louis, and Dr. Patricia Grace are
relevant to her disability claim and were provided to UNUM,
but are not included in the filed administrative
record. Plaintiff argues that discovery about
these absences is relevant to showing that UNUM
“deliberately utilized an incomplete record” to
deny Plaintiff benefits.
however, argues that such evidence is inappropriate because
Plaintiff fails to make any colorable procedural challenge to
warrant discovery. Defendant UNUM argues that Plaintiff
presents no evidence that the record is incomplete or that
UNUM deliberately excluded the relevant
records. Defendant UNUM argues that Plaintiff
cannot now supplement the record when she failed to do so
during the administrative process.
Court finds that Plaintiff sufficiently makes a procedural
challenge to the Administrator's decision based on an
arguably incomplete administrative record. Further discovery
on whether Plaintiff or her healthcare providers forwarded
medical records to UNUM that are not included in the
administrative record is relevant to her procedural
discovery can help determine whether there are administrative
record gaps that impair the Court's ability to consider
all evidence with respect to Defendant UNUM when it made the
benefits denial. Should that be the case, remand back to
Defendant UNUM would be the appropriate remedy. This is
because Defendant UNUM must be allowed to “conduct a
review in the first instance, considering the relevant
material it originally excluded.”
the Court GRANTS Plaintiff's request to seek discovery
specifically on whether Plaintiff Hines or Plaintiff's
healthcare providers forwarded relevant medical evidence to
UNUM that is not included in the filed administrative record.
 Doc. 1-1.
 Doc. 14. Defendant UNUM certifies that
the administrative record file constitutes “a true and
accurate copy.” ...