Virgil Harris v. The Lincoln National Life Insurance Company, et al.

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.



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

The district court’s evidentiary ruling constituted error un-

der Eleventh Circuit precedent. We therefore reverse and remand

for further proceedings.