This month’s Friday Five covers cases relating to an incarcerated individual’s entitlement to benefits, the relevance of post-decision evidence, hearsay objections to documents in the administrative record, the requirement of objective evidence to support subjective complaints of the claimant, the proof required to establish the threshold amount in controversy for diversity of citizenship jurisdiction, and recent DOL regulations regarding the impact of COVID-19 on certain ERISA deadlines.

1. Insurer Not Required to Provide LTD Benefits to Incarcerated Individual. In Deane, the insurer discovered that a claimant was incarcerated for most of a two-year timeframe following his application for LTD benefits. Upon this discovery, the insurer enforced the incarceration exclusion under the policy, which stated that a claimant lost eligibility for LTD benefits while incarcerated. The court agreed that the insurer properly relied upon the exclusion and further determined that the plaintiff failed to establish disability upon his release from prison and ongoing disability thereafter. As such, the court granted summary judgment for the insurer, holding that the insurer’s decision to terminate the plaintiff’s LTD benefits was not arbitrary and capricious. Deane v. Aetna Life Ins. Co., No. 17-1646, 2020 WL 2572756 (D. Conn. May 21, 2020).

2. Court Rejects Plaintiff’s Attempts to Include Post-LTD Decision Social Security Ruling and Exclude as Hearsay Physician Conversations. In Cofield, before addressing the parties’ competing summary judgment motions, the court addressed two initial motions brought by the plaintiff in an LTD dispute. First, the court rejected the plaintiff’s request for a remand to the insurer for consideration of a more recent decision approving Social Security Disability Benefits. The court reasoned that because the decision was not before the insurer when it made the decision to terminate LTD benefits, it was not relevant. Second, the court further rejected the plaintiff’s attempts to exclude as hearsay a summary of a conversation between the insurer’s independent medical review provider and the plaintiff’s treating physician. The court determined that the recap of this conversation was not hearsay because it was not offered for the truth of the matter asserted and, further, that it satisfied the business record exemption. Cofield v. The Hartford, No. 18-607, 2020 WL 2218935 (May 7, 2020 N.D. Ala.).

3. Insurer Permitted to Rely on Objective Evidence to Counter Plaintiff’s Subjective Complaints. In Catania, the plaintiff, an anesthesiologist, complained of back pain following two car accidents. The court reviewed the administrative record on a de novo standard, noting that subjective complaints by the claimant are “important factors to be considered in determining disability.” The court ultimately entered summary judgment in favor of the insurer, however, further concluding that it was “hardly unreasonable for the administrator to require an objective component” to establish disability, particularly where the policy required “proof” of such disability suggesting an objectivity requirement. The plaintiff’s failure to support his subjective complaints with objective medical evidence doomed his claim. Catania v. UNUM Life Ins. Co., No. 19-133, 2020 WL 2129374 (NDNY May 5, 2020).

4. Colorado District Court Provides In-Depth Overview of Removal Standards. In Carney, the district court provided an in-depth and helpful refresher on the standards for removal to federal court for diversity of citizenship jurisdiction. The court specifically reviewed how much and what type of evidence was required to meet the $75,000 amount in controversy threshold. In the case, the complaint was silent as to the amount at issue, but the court noted that allegations as to the amount in the notice of removal can carry the day, and that the plaintiff cannot avoid removal merely by remaining silent on damages. Once the defendant shows by a preponderance of the evidence that the jurisdictional threshold is satisfied, the burden shifts to the plaintiff to establish that it is “legally certain” that it cannot recover more than $75,000 (which, of course, might be a concession many plaintiffs are not willing to make, particularly at the outset of a litigation). Carney v. Anthem Life Ins. Co., No. 19-3075, 2020 WL 2188779 (D. Col. Apr. 22, 2020).

5. Department of Labor Issues Regulations Related to Certain Deadlines Impacted by COVID-19. The Department of Labor (DOL) recently issued regulations regarding the treatment of certain timeframes under ERISA due to the COVID-19 pandemic. In its regulations, the DOL explained that “the Agencies are extending certain timeframes otherwise applicable to group health plans, disability and other welfare plans, pension plans, and their participants and beneficiaries under ERISA . . . .” The DOL noted, for example, that plans should “disregard the period from March 1, 2020 until sixty (60) days after the announced end of the National Emergency or such other date announced by the Agencies in a future notification (the ‘Outbreak Period’)” for a claimant to “file an appeal of an adverse benefit determination under the plan’s claims procedures . . . .”