Supplemental Evidence – Long Term Disability ERISA

A reviewing court has discretion to consider supplemental evidence presented by the parties in the context of an ERISA LTD claim.  Viera v. Life Ins. Co. of North American, 642 F.3d 407, 418 (3rd Cir. 2011).  In particular, a party may supplement the record with evidence concerning a plan’s funding mechanism to show a conflict of interest.  Kosiba v. Merck & Co., 384 F.3d 58 (3rd Cir. 2004).   Interestingly, in the context of a conflict of interest, Court’s have noted “structural conflicts of interest”; but held that disposition of the matter turns on “whether a reasonable basis existed for the administrator’s benefits decision.”  Blankenship v. Metropolitan Life Ins. Co., 644 F.3d 1350 (11th Cir. 2011).   In other words, some Courts find that although the conflict of interest must be considered, it does not alter the basic analysis of an ERISA LTD claim.  Id.  In my opinion, the fact of a conflict of interest should be important, especially on “borderline” claims.  

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Conflict of Interest

According to a recent district court decision,

Raising the spectre of a conflict of interest is insufficient for the Court to find the administrator’s decision to be arbitrary and capricious. Absent evidence that the administrator’s decision was motivated by its dual role, the Court will give only slight weight to the conflict of interest when reviewing the administrator’s decision. Curry v. Eaton Corp., 400 F. App’x 51, 58-59 (6th Cir. 2010)(applying “ordinary” arbitrary and capricious review where no evidence was provided that the administrator’s decision was motivated by its alleged conflict of interest); Hayden v. Martin Marietta Materials, Inc. Flexible Benefits Program, 2012 U.S. Dist. LEXIS 106497, 2012 WL 3109496 (W.D. Ky. July 31, 2012) (giving only slight weight to a structural conflict of interest where neither party had presented evidence).

Maynard v. The Prudential Ins. Co. of America, 2013 U.S.Dist. Lexis 159648 (N.D. Ohio, 11/7/2013)