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Defendant's Attorney: Amy Elizabeth Jensen, Hannah Styron Symonds, Scott Pomeroy

Description: Atlanta, Georgia insurance law lawyer represented Plaintiff, who sued Defendants on E.R.I.S.A. law theories.

Under the Employment Retirement Income Security Act, 29
U.S.C. § 1132(a)(1)(B), a plan administrator’s benefits decision is
subject to plenary review in federal court unless the administrator
is given discretion to determine eligibility or construe the terms of
the plan.
See Aetna Health, Inc. v. Davila, 542 U.S. 200, 210 (2004);
Gilley v. Monsanto Co., Inc., 490 F.3d 848, 856 (11th Cir. 2007). If
the administrator has discretion, a court determines whether its
benefits decision was arbitrary and capricious (i.e., whether it
lacked a reasonable basis).
See, e.g., Glazer v. Reliance Standard
Life Ins. Co., 524 F.3d 1241, 1246 (11th Cir. 2008).

In this ERISA case, everyone agrees that Lincoln’s denial of
long-term disability benefits to Virgil Harris triggered de novo re-
view because the plan did not give Lincoln discretion. The district
court, acknowledging that its review of the denial was plenary,
ruled that Mr. Harris could not submit evidence that had not been
presented to Lincoln before it denied benefits in August of 2019.
As a result, when the court granted Lincoln’s motion for judgment
on the administrative record, it did not consider an affidavit and
updated medical records which post-dated the denial of benefits.

* * *

See: https://media.ca11.uscourts.gov/opinions/pub/files/202113186.pdf

Outcome: The district court’s evidentiary ruling constituted error un-
der Eleventh Circuit precedent. We therefore reverse and remand
for further proceedings.

Plaintiff's Experts:

Defendant's Experts:

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