Jane Doe v. Harvard Pilgrim Health Care, Inc., et al.

This case presents two acknowledged circuit conflicts regarding how district courts adjudicate benefits claims under the Employee Retirement Income Security Act, 29 U.S.C. 1132(a)(1)(B), when those claims are considered de novo under Firestone Tire & Rubber Co. v. Bruch, 489 U.S. 101 (1989). Here, despite recognizing that the expert medical evidence conflicted, the district court granted respondents summary judgment and denied petitioner’s request to examine the experts. The First Circuit affirmed. First, the court held that “[i]n the ERISA context, ‘the burdens and presumptions normally attendant to summary judgment practice do not apply,’” so the district court can resolve fact conflicts. That holding aligns with the Sixth Circuit, but ten other circuits apply Rule 56 the usual way: “If a paper record contains a material dispute, a trial is essential.” Krolnik v. Prudential Ins. Co. of Am., 570 F.3d 841, 844 (7th Cir. 2009) (Easterbrook, J.). Second, the court held that, absent a challenge to the plan’s administrative process, district courts are confined to the record before the administrator. That holding entrenches an eleven-circuit, four-way split about the scope of the record for de novo ERISA benefits claims. The questions presented are:

1. Whether, on de novo consideration of an ERISA benefits claim, summary judgment must be denied if there is a genuine dispute of material fact.

2. Whether, on de novo consideration of an ERISA benefits claim and absent a challenge to the plan’s procedures, a district court has discretion to consider evidence that was not part of the record before the plan administrator. (I) 276878.1