Edmond Menard v. Hartford Life & Accident Insur. , 260 F. App'x 205 ( 2007 )

[DO NOT PUBLISH]
IN THE UNITED STATES COURT OF APPEALS
FOR THE ELEVENTH CIRCUIT FILED
U.S. COURT OF APPEALS
ELEVENTH CIRCUIT
DECEMBER 21, 2007
No. 07-11405 THOMAS K. KAHN
CLERK
D. C. Docket No. 05-01145-CV-ORL-31-DAB
EDMOND MENARD,
Plaintiff-Appellee,
versus
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY,
Defendant-Appellant.
Appeal from the United States District Court
for the Middle District of Florida
(December 21, 2007)
Before DUBINA and KRAVITCH, Circuit Judges, and GOLDBERG,* Judge.
PER CURIAM:
* Honorable Richard W. Goldberg, Judge. United States Court of International Trade, sitting by
designation.
Appellant Hartford Life and Accident Insurance Company (“Hartford Life”)
appeals the district court’s judgment in favor of appellee’s, Edmond Menard
(“Menard”), continued benefits under the applicable ERISA-based group
insurance policy. Hartford Life argues that the district court erred in considering a
social security administration determination outside of the administrative record.
Specifically, Hartford Life requests that this Court reverse and remand the district
court’s decision for further proceedings without reference to this extra-record
evidence.
We review de novo a district court’s ruling on a motion for summary
judgment “applying the same standards that governed the district court’s
decision.” Williams v. BellSouth Telecomms., Inc., 373 F.3d 1132, 1133 (11th Cir.
2004). When, as in this case, an ERISA policy administrator has made a denial
decision with reasonable support in the record, but also has a conflict of interest,
heightened arbitrary and capricious review applies. Torres v. Pittston, 346 F.3d
1324, 1334 (11th Cir. 2003).
Under heightened arbitrary and capricious review, evidence outside of the
administrative record cannot be used to reverse an ERISA plan administrator’s
denial decision. Jett v. Blue Cross & Blue Shield of Ala., 890 F.2d 1137, 1139-40
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(11th Cir. 1989). In this case, Hartford Life issued its final denial decision on
June 29, 2005. The social security administration determination relied upon by the
district court was not issued until July 10, 2006, and was clearly outside of the
administrative record Hartford Life considered when it denied Menard continued
benefits. Accordingly, after reviewing the record, reading the parties’ briefs, and
having the benefit of oral argument, this Court reverses and remands this case to
the district court. On remand, the district court should confine its review to the
administrative record before Hartford Life at the time of its final denial decision.
Hartford Life also argues the district court committed further error in
awarding attorney fees. Because the district court did not provide any explanation
for awarding attorney’s fees, we cannot determine from the record whether the
district court properly exercised its discretionary authority. On remand, if the
district court still finds that Menard is entitled to policy benefits, we further
instruct the court to explain and set forth the basis of any award of attorney’s fees
consistent with Wright v. Hanna Steel Corp., 270 F.3d 1336 (11th Cir. 2001).
REVERSED and REMANDED.
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