The opinion
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8 UNITED STATES DISTRICT COURT
9 SOUTHERN DISTRICT OF CALIFORNIA
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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.
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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., 588 F.3d 623, 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.’” Id. at 632 n.4 (quoting Kearney v. Standard Ins.
11 Co., 175 F.3d 1084, 1086 (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
16 F.3d 1211, 1217 (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.” Id. The list
19 includes:
20 claims that require consideration of complex medical questions or
issues regarding the credibility of medical experts; the availability of
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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
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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
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there is additional evidence that the claimant could not have presented
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Id. at 1217 (quoting Quesinberry v. Life Ins. Co. of N. Am., 987 F.2d 1017, 1027 (4th Cir.
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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, 46 F.3d
4 938, 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, 2004 WL 2271599, 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.” Id. at 4-5. 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
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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
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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
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| ||}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, 2015 WL 6459689, 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
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