What happens when the Social Security Administration issues a disability finding after the ERISA administrator has issued the decision denying disability benefits?

Is the ERISA administrator obligated to reevaluate the record based on this new finding? No.

Should the Court consider this as “evidence” in a subsequent lawsuit?  No.

This new case highlights the point. Ortiz v The Hartford, 2019 WL 5697784 (D. New Mexico November 4, 2019)(“[W]hen Social Security decisions arise after the close of the ERISA record, there is nothing for the administrator to assess, and the administrator needn’t reevaluate the ERISA claim.”)(attached).

FACTS: Plaintiff received disability benefits due to fibromyalgia and degenerative joint disease from February 2014 to September 6, 2016.  At that time Hartford determined, based on three medical reviewers, that she could perform jobs under the “any occupation” standard. Plaintiff later received a favorable decision for Social Security disability benefits. The plan conferred discretionary authority to Hartford.

ISSUE: Whether the Court should consider a Social Security Administration disability determination rendered after the close of the record for the administrative decision?

DISTRICT COURT HELD: NO

  1. “Hartford fairly and thoroughly evaluated Ortiz’s medical history at the end of the two-year period under the any occupation standard.”  Op. at 3
  2. Hartford produced an “Employability Analysis Report” based on information from Ortiz’s physician and found based on those physical restrictions she could perform three positions, including case aide, referral clerk and gate guard.  Op. at 3.
  3. Plaintiff argued that her treating physician’s opinions “should carry additional weight.” But the Court determined that the three independent doctors considered the treating physician’s opinions.  Besides that,  the Tenth Circuit has held that the conflicting opinion of the primary doctor is “not in and of itself a basis for reversal.”  Op. at 3.
  4. The Court concluded that it did not need to consider the later Social Security decision. Hartford’s decision came one year before the Social Security judgment.  When the administrator’s decision occurs prior to the Social Security disability decision, it cannot take the latter information into account. Op. at 3
  5. “[W]hen Social Security decisions arise after the close of the ERISA record, there is nothing for the administrator to assess, and the administrator needn’t reevaluate the ERISA claim.”  Op. at 4.