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Wittmann v. Unum Life Insurance Company of America

United States District Court, E.D. Louisiana

October 31, 2018

ANNE WITTMANN
v.
UNUM LIFE INSURANCE COMPANY OF AMERICA

         SECTION “F”

          ORDER AND REASONS

          MARTIN L. C. FELDMAN UNITED STATES DISTRICT JUDGE.

         Before the Court are two motions: (1) the plaintiff's motion to strike from the administrative record all documents generated after September 22, 2017; and (2) the defendant's motion for partial summary judgment that the documents generated as a result of plaintiff's post-litigation administrative appeal are part of the administrative record, or in the alternative, motion for summary judgment dismissing plaintiff's suit for failure to exhaust administrative remedies. For the following reasons, the plaintiff's motion is GRANTED, and the defendant's motion is DENIED.

         Background

         This ERISA lawsuit challenges the denial of disability benefits under a group benefits plan.

         Anne Wittmann is a participant to a long-term disability insurance plan through her employment as an attorney with Baker, Donelson, Bearman, Caldwell, Berkowitz PC. Unum Life Insurance Company of America serves as the underwriter of the Plan and has been delegated the discretionary authority to make benefit determinations. Suffering from fibromyalgia, Wittmann ceased working as an attorney on December 31, 2013. She then filed a claim for long-term disability benefits under the Plan in April of 2014, which Unum denied by letter dated October 3, 2014.[1] That letter also advised Wittmann of her right to request an appeal, which she exercised on January 26, 2015. By letter dated May 29, 2015, Unum denied Wittmann's appeal and invited her to submit additional information in support of her claim.[2] Unum acknowledged receipt of Wittmann's request for a second appeal on June 23, 2015, and ultimately denied that appeal by letter dated July 20, 2015.[3]

         In that letter, Unum also advised:

Unum Life Insurance Company of America has completed our review of your appeal. No. further review is available and your appeal is now closed.
If you disagree with this decision, you have a right to bring a civil suit under section 502(a) of the Employee Retirement Income Security Act of 1974.

         Before filing suit, Wittmann submitted to Unum a disability determination by the Social Security Administration and invited Unum to reconsider its decision once again. By letter dated January 24, 2017, Unum granted Wittmann mental illness disability benefits from June 30, 2014 through June 30, 2016 and stated that it would investigate further to determine her entitlement to benefits beyond 24 months for a disability unrelated to mental illness.[4] In response, plaintiff's counsel provided Unum with updated medical records from Wittmann's treating psychiatrist, a letter from her massage therapist, and office notes from one of her physicians. By letter dated July 31, 2017, Unum notified plaintiff's counsel that Wittmann was not entitled to such additional benefits because there was no evidence of physical or organic medical problems that would preclude her from being able to perform her sedentary occupation as an attorney after June 30, 2016. The letter also advised that, pursuant to the Plan, Wittmann was required to file an administrative appeal within 180 days if she disagreed with the decision.

         On September 22, 2017, Wittmann sued Unum for the denial of her claim for physical disability benefits under her long-term disability plan, pursuant to Section 502(a)(1)(B) of the Employee Retirement Income Act of 1974. 29 U.S.C. § 1132(a)(1)(B). Four months later, by letter dated February 25, 2018, Wittmann's counsel requested an administrative appeal of Unum's July 2017 decision. Because the request was made within the requisite 180-day appeal period, Unum agreed to consider the appeal; it then filed a motion to dismiss this lawsuit for failure to exhaust administrative remedies, or in the alternative, to stay the proceedings pending the exhaustion of administrative remedies. Before the Court had the opportunity to consider that motion, Unum completed its administrative review, rendering the motion moot.[5]

         About a month later, Unum filed a motion to submit the “disputed administrative record” under seal, which this Court granted in its Order dated May 16, 2018. In that motion, Unum noted that Wittmann objects to the inclusion in the administrative record of any documents generated after her complaint was filed on September 22, 2017. Wittmann now moves to strike from the administrative record and this Court's record those post-litigation documents, and Unum moves for partial summary judgment that all documents associated with Wittmann's post-litigation administrative appeal are part of the administrative record, or in the alternative, for summary judgment dismissing Wittmann's suit for failure to exhaust administrative remedies.

         I.

         Federal Rule of Civil Procedure 56 instructs that summary judgment is proper if the record discloses no genuine dispute as to any material fact such that the moving party is entitled to judgment as a matter of law. No. genuine dispute of fact exists if the record taken as a whole could not lead a rational trier of fact to find for the non-moving party. See Matsushita Elec. Indus. Co. v. Zenith Radio Corp., 475 U.S. 574, 587 (1986). A genuine dispute of fact exists only “if the evidence is such that a reasonable jury could return a verdict for the non-moving party.” Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 248 (1986).

         The mere argued existence of a factual dispute does not defeat an otherwise properly supported motion. See id. In this regard, the non-moving party must do more than simply deny the allegations raised by the moving party. See Donaghey v. Ocean Drilling & Exploration Co., 974 F.2d 646, 649 (5th Cir. 1992). Rather, he must come forward with competent evidence, such as affidavits or depositions, to buttress his claims. Id. Hearsay evidence and unsworn documents that cannot be presented in a form that would be admissible in evidence at trial do not qualify as competent opposing evidence. Martin v. John W. Stone Oil Distrib., Inc., 819 F.2d 547, 549 (5th Cir. 1987); Fed.R.Civ.P. 56(c)(2).

         “[T]he nonmoving party cannot defeat summary judgment with conclusory allegations, unsubstantiated assertions, or only a scintilla of evidence.” Hathaway v. Bazany, 507 F.3d 312, 319 (5th Cir. 2007)(internal quotation marks and citation omitted). Ultimately, “[i]f the evidence is merely colorable . . . or is not significantly probative, ” summary judgment is appropriate. Anderson, 477 U.S. at 249 (citations omitted); King v. ...


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