1 2 3 4 5 6 7 8 UNITED STATES DISTRICT COURT 9 SOUTHERN DISTRICT OF CALIFORNIA 10 11 STEVEN ROETTKER, Case No.: 24-cv-343-RSH-AHG

12 Plaintiff, ORDER DENYING PLAINTIFF’S 13 v. MOTION TO SUPPLEMENT ADMINISTRATIVE RECORD 14 UNUM LIFE INSURANCE COMPANY

OF AMERICA, 15 [ECF No. 24] Defendant. 16 17 18 19 Pending before the Court is plaintiff Steven Roettker’s motion to supplement the 20 administrative record. ECF No. 24. The motion has been fully briefed. ECF Nos. 25, 26. 21 For the reasons stated below, the Court denies the motion. 22 I. BACKGROUND 23 Plaintiff is a participant in an employee benefit plan, regulated by the Employee 24 Retirement Income Security Act of 1974 (“ERISA”), that was sponsored by his former 25 employer. ECF No. 1 ¶¶ 4, 5. The plan provided disability benefits through a group 26 insurance company issued by defendant Unum Life Insurance Company of America. Id. ¶ 27 7. Defendant is also the claims administrator under the plan. Id. ¶ 14. 28 Plaintiff brings this lawsuit for disability benefits, after Defendant terminated his 1 benefits and, on November 15, 2023, denied his administrative appeal. Id. ¶ 21. 2 On June 3, 2024, Defendant filed the administrative record. ECF No. 15. In 3 Plaintiff’s motion, he seeks to supplement that record with five additional exhibits, attached 4 the motion as Exhibits 1 through 5. The Parties have not yet filed their respective motions 5 for judgment. 6 II. LEGAL STANDARD 7 “Judicial review of an ERISA plan administrator’s decision on the merits is limited 8 to the administrative record.” Montour v. Hartford Life & Acc. Ins. Co.,

, 632 9 (9th Cir. 2009). “In the ERISA context, the ‘administrative record’ consists of ‘the papers 10 the insurer had when it denied the claim.’”

at 632 n.4 (quoting Kearney v. Standard Ins. 11 Co.,

(9th Cir. 1999)). 12 Extrinsic evidence, or evidence beyond what was before the administrator, can be 13 considered “only under certain limited circumstances,” namely, “only when circumstances 14 clearly establish that additional evidence is necessary to conduct an adequate de novo 15 review of the benefit decision.” Opeta v. Nw. Airlines Pension Plan for Cont. Emps., 484

(9th Cir. 2007) (citations and quotation marks omitted). The Ninth Circuit 17 has provided a “non-exhaustive list of exceptional circumstances where introduction of 18 evidence beyond the administrative record could be considered necessary.”

The list 19 includes: 20 claims that require consideration of complex medical questions or issues regarding the credibility of medical experts; the availability of 21 very limited administrative review procedures with little or no 22 evidentiary record; the necessity of evidence regarding interpretation of the terms of the plan rather than specific historical facts; instances 23 where the payor and the administrator are the same entity and the court 24 is concerned about impartiality; claims which would have been insurance contract claims prior to ERISA; and circumstances in which 25 there is additional evidence that the claimant could not have presented 26 in the administrative process.

27

at 1217 (quoting Quesinberry v. Life Ins. Co. of N. Am.,

, 1027 (4th Cir. 28 1 1993) (en banc)). “[A] district court should not take additional evidence merely because 2 someone at a later time comes up with new evidence that was not presented to the plan 3 administrator.” Mongeluzo v. Baxter Travenol Long Term Disability Ben. Plan,

938, 944 (9th Cir. 1995). 5 The party seeking to supplement the record bears the burden of establishing why the 6 district court should exercise its discretion to admit that particular evidence. See Steiner v. 7 Hartford Life and Acc. Ins., No. C 03-3160,

, at *4 (N.D. Cal. June 4, 8 2004). 9 III. ANALYSIS 10 A. The Administrative Record 11 As an initial matter, the Parties dispute whether two of the five exhibits at issue were 12 in fact before the plan administrator when it denied Plaintiff’s claim. Plaintiff contends that 13 these two exhibits were documents submitted to or relied upon by the plan administrator 14 and therefore should have been included by Defendant in the administrative record it filed 15 with the court, rather than being treated as extrinsic evidence. 16 Exhibit 2 is a one-page exhibit styled as “Addendum 1” to the “Functional Capacity 17 Evaluation Report” and dated July 27, 2023. ECF No. 24-3. Plaintiff asserts he that 18 provided this page to Defendant along with the Functional Capacity Report with his 19 administrative appeal, and assumes that the omission of this page from the administrative 20 record filed by Defendant is “a clerical error on UNUM’s part.” ECF No. 24 at 2. 21 Exhibit 3 consists of four pages on letterhead of the Economic Research Institute 22 describing occupational classifications for the job of systems engineer. ECF No. 24-4. 23 Plaintiff asserts that these are “records relied upon by UNUM in defining Plaintiff’s ‘usual 24 occupation.’” ECF No. 24 at 2, 3. 25 Defendant appears to dispute Plaintiff’s factual assertions about these documents, 26 and describes those assertions as unsupported. ECF No. 25 at 4-5. Indeed, Plaintiff has not 27 supported the factual assertions above with a declaration or other evidence that allows the 28 Court to conclude that Exhibit 2 was in fact submitted by Plaintiff to Defendant in the 1 course of Plaintiff’s administrative appeal, or that Exhibit 3 was in fact relied upon by the 2 plan administrator in denying that appeal. The Court therefore declines to treat either 3 document as having been part of the administrative record. 4 B. Extrinsic Evidence 5 The other documents at issue are: Exhibit 1, a letter and attachment from Plaintiff’s 6 counsel dated February 8, 2024; Exhibit 4, a single page from Defendant’s Claims Manual; 7 and Exhibit 5, a settlement agreement between the California Department of Insurance and 8 Defendant from 2005.1 Plaintiff does not appear to dispute that, for each of these 9 documents, he could have submitted the relevant information during the administrative 10 appeals process, but did not do so. Plaintiff does not explain why he did not provide the 11 relevant information at that stage.2 12 Plaintiff argues that his request falls within several of the “exceptional 13 circumstances” in which extrinsic evidence should be considered: “First, this claim would 14 have been an insurance contract claim prior to ERISA. Second, this claim involves complex 15 medical questions. Finally, the payor and the administrator are the same entity and there 16 are serious concerns about UNUM’s impartiality.” ECF No. 24 at 4. Plaintiff elaborates on 17 Defendant’s impartiality by alleging that the plan administrator relied on records of the 18 Economic Research Institute that Defendant “withh[e]ld … during the administrative 19 process.”

. However, as discussed above, Plaintiff has not established that 20 Defendant relied on the records in Exhibit 3. Nor has he established that they were 21

22 23 1 None of the five documents is authenticated, beyond an attorney declaration stating in cursory terms that they are “true and accurate copies” of: (1) “Plaintiff’s counsel’s letter 24 dated February 8, 2024, and the attachment statement of Plaintiff,” (2) “Matheson 25 Functional Pain Scale,” (3) “eDot records produced in discovery,” (4) “UNUM’s Claims Manual,” and (5) “The California Settlement Agreement.” ECF No. 24-1 at 1-2. 26 2 Exhibit 1, the letter from Plaintiff’s counsel, is dated after Plaintiff’s administrative 27 appeal was denied, but Plaintiff does not argue that he could not have provided the information contained in or attached to the letter in connection with his administrative 28 | ||}improperly withheld or produced in an untimely manner. 2 The Court does not believe that the fact that Plaintiff's claim would have been an 3 ||insurance contract claim prior to ERISA, or that the payor and the administrator are the 4 ||same entity, rise to the level of establishing “exceptional circumstances” here. They are not 5 exceptional. See Nguyen v. Sun Life Assur. Co., No. 3:14-cv-5295,

, at 6 || *6 (N.D. Cal. Oct. 27, 2015) (“Defendants in ERISA cases have often served as both plan 7 administrator and plan funder. The situation appears to be common. That a defendant acted 8 both administrator and payer thus cannot qualify, on its own, as an ‘exceptional 9 circumstance’ under Opeta’s ‘restrictive’ rule.”). The Court concludes, instead, that 10 ||Plaintiff's request to supplement is his effort, after reflecting upon the denial of his 11 |}administrative appeal, to produce “new evidence that was not presented to the plan 12 |}administrator.” See Mongeluzo, 46 F.3d at 944. Plaintiff has not established “exceptional 13 || circumstances” warranting introduction of evidence beyond the administrative record. 14 CONCLUSION 15 For the foregoing reasons, Plaintiff's motion is DENIED. 16 IT IS SO ORDERED. Dated: December 5, 2024 fekut C Lows

United States District Judge 20 21 22 23 24 25 26 27 28