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Sallivanti v. UNUM Life Insurance Company of America

United States District Court, M.D. Pennsylvania

August 23, 2013

KAREN A. SALLIVANTI, Plaintiff,
v.
UNUM LIFE INSURANCE COMPANY, OF AMERICA, Defendant

For Karen A. Sallavanti, Plaintiff: Alan H. Casper, Philadelphia, PA.

For UNUM Life Insurance Company of America, Defendant: Elizabeth A. Venditta, White and Williams, Philadelphia, PA.

OPINION

Robert D. Mariani, United States District Judge.

Page 665

MEMORANDUM OPINION

I. Introduction

Presently before the Court are cross-motions for summary judgment filed by Plaintiff Karen Sallivanti (Doc. 42) and by Defendant Unum Life Insurance Company (Doc. 33). Plaintiff filed this action under Section 1132(a)(1)(B) of the Employee Retirement Income Security Act (ERISA), 29 U.S.C. § § 1001, et seq., to recover benefits that she alleges that Unum Life Insurance owes her following a car accident that allegedly prevented her from performing the material duties of her occupation. (Pl.'s Compl., Doc. 1, at ¶ ¶ 1, 98-100.) For the reasons set forth below, the Court will deny the cross-motions, because there are many genuine issues of material fact which must be resolved at trial.

II. Scope and Standard of Review

The parties have stipulated that the proper standard of review of Unum's decision to deny Sallivanti benefits is de novo. ( See Doc. 18.) In an Order dated July 25, 2012, the Court approved that stipulation. ( See Doc. 19 at 7.)

At the outset, there are two issues raised in the parties' motions that the Court must address. First, the Defendant argues that, when a court rules on a summary judgment motion based on an administrative record under de novo review, the court is not required to view the evidence in the light most favorable to the non-moving party, but rather must make its own independent resolution of material facts. ( See Brief in Supp. of Def.'s Mot. for Summ. J., Doc. 35, at 13.) Defendant's support for this claim comes from a footnote in a recent case from the Eastern District of Pennsylvania. See White v. Prudential Ins. Co., 908 F.Supp.2d 618, 625 n.9 (E.D. Pa. 2012) (citing MacFarlan v. Ivy Hill SNF, LLC, 675 F.3d 266, 271 (3d Cir. 2012)). However, while the White court does indeed support the Defendant's statement, the Third Circuit case that White itself cited for the same proposition states exactly the opposite. In relevant part, the Third Circuit stated that when ruling on a summary judgment motion based on an administrative record, " [w]e must also view the evidence in the light most favorable to Macfarlan (the nonmovant) and draw all reasonable inferences in his favor." MacFarlan, 675 F.3d at 271. This Court is aware of no case law supporting the proposition that a district court may make its own resolutions of factual disputes at the summary judgment stage when conducting de novo review of an administrative record, and so Defendant's position appears meritless.

Equally meritless is the Defendant's second claim that the " Court is generally limited to the ERISA administrative record on de novo review if the record is sufficiently developed." ( See Brief in Supp. of Def.'s Mot. for Summ. J. at 14.)

Page 666

Once again, the cases cited do not substantiate this proposition. The seminal Third Circuit case on review of ERISA claims states in unequivocal terms:

We hold that a district court exercising de novo review over an ERISA determination between beneficiary claimants is not limited to the evidence before the Fund's Administrator. Accordingly, the district court did not err by considering documents not before the Fund's Administrator.

Luby v. Teamsters Health, Welfare, and Pension Trust Funds, 944 F.2d 1176, 1184-85 (3d Cir. 1991). It adds,

If the record on review is sufficiently developed, the district court may, in its discretion, merely conduct a de novo review of the record of the administrator's decision, making its own independent benefit determination. See McMahan v. New England Mut. Life Ins. Co., 888 F.2d 426, 431 (6th Cir.1989) (where the record was insufficiently developed for review of a fact based benefit denial, the court remanded for the district court to " supplement the record" and then make a de novo benefit determination).

Id. at 1184. As the quoted text makes clear, such limitations are purely discretionary. Nowhere does the court in Luby say that a district court must, or even should, limit its review to what is contained in a fully developed record.

Neither side has presented any case law supporting the proposition that the Court should treat a challenge to, or defense of, an ERISA denial of benefits based on an administrative review any differently at the summary judgment stage than it would any other cause of ...


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