ERISA practitioners are very familiar with what some have dubbed the “administrative record” rule, the dictates of which provide, in essence, that a reviewing district court may only consider the evidence that was presented to the claim administrator; “new” evidence will be disregarded. Still, there are recognized exceptions to the rule, as explored in Melech v. Life Ins. Co. of N. Am., 739 F.3d 663 (11th Cir. 2014), discussed in our blogpost of January 28, 2014.
More recently, the Fourth Circuit took up the subject in the context of a benefit denial issued to a claimant who had maintained that she suffered from post-traumatic stress disorder, and had provided contact information for her treating psychiatrist, but had not submitted medical records bearing out the diagnosis. Disagreeing with the district court decision in favor of the plan, the Fourth Circuit held that “[w]hile the primary responsibility for providing medical proof of disability undoubtedly rests with the claimant, a plan administrator cannot be willfully blind to medical information that may confirm the beneficiary’s theory of disability where there is no evidence in the record to refute that theory.”
Harrison v. Wells Fargo Bank, N.A., 773 F.3d 15 (4th Cir. 2014)