The Failure to Disclose Information to the Participant Justified an Increased Level of Scrutiny and the Court’s Review of “New” Evidence Not Offered During The Claim

Both the Plan Administrator and Participant moved for summary judgment on a cause of action challenging the denial of long-term disability benefits under ERISA. Noting that the Plan contained discretionary language and citing Abatie, the District Court rejected the Participant’s contention that the claim decision should be reviewed de novo. However, the court stated that a “moderate level” of scrutiny of the Defendants’ claim decision was justified due to the structural conflict of interest and because, during the claim review process, the Plan Administrator failed to disclose information regarding the Participant’s activities it obtained from the Internet. Additionally, the Court ruled that because of the administrator’s failure to disclose the information, the Participant was denied the opportunity to present counter evidence that might further support her claim for benefits, and, thus, the Court allowed Torres to submit information responding to the new “internet information” Nevertheless, even in light of the increased scrutiny and the new evidence submitted by Torres, the court found that the medical documentation provided a reasonable basis for the conclusion that Plaintiff was not totally disabled within the meaning of that term as defined by the Plan, and therefore Defendants did not abuse their discretion.