Taft v. Equitable Life Assurance Society

concurring in part and dissenting in part:

I agree that the district court should not have examined evidence outside the administrative record in this case, but I cannot conclude that its determinations that Equitable “should have known the report provided by Dr. Audell was not the report requested,” that Equitable “knew Dr. Ashby had not seen any prior reports or x-rays,” and that Equitable “had insufficient evidence to determine that [Taft] was able to obtain full-time employment based on his experience, education or training” are incorrect. Because Dr. Audell’s report indicates on its face that it was based on a non-pertinent injury and *1475 immaterial workers’ compensation criteria, and Dr. Ashby’s indicates that he hadn’t seen any x-rays, I would affirm for lack of substantial evidence.

The Equitable Life Assurance Society of the United States appeals the district court’s judgment in favor of Morris J. Taft. The district court held that Equitable abused its discretion in violation of the Employee Retirement Income Security Act of 1974 (ERISA), 29 U.S.C. §§ 1001-1461 , by terminating Taft’s disability benefits. Because we find that the district court erred at trial by examining evidence that was not part of Equitable’s administrative record, we reverse.

I.

The Equitable Life Assurance Society of the United States hired Morris J. Taft as an insurance agent in 1964 and issued a group insurance policy covering him. Under the policy, Equitable agreed to pay full disability benefits in the event Taft became “totally disabled.” The policy defined “total disability” in relevant part as being “unable to engage in any gainful occupation for which [Taft] is or may reasonably become qualified by education, training, or experience.”

In 1975, Taft’s chronic back problems worsened and he applied for disability benefits. After examining him, Equitable found Taft totally disabled under the policy and began paying benefits. Each year thereafter, Taft submitted to Equitable an…