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Discrediting Evidence Presented to an ERISA Plan Administrator

According to the Fifth Circuit’s recent opinion in Truitt v. Unum Life Ins. Co. of America, decided September 6, 2013, the plan administrator may consider evidence from any source without a duty to investigate the source, and it is up to the insured to discredit the source.  Truitt had practiced law as an attorney and her policy had an “own occupation” policy which allowed her to receive benefits if she could not perform the material duties of the specialty in which she practiced.  Truitt had practiced international arbitrations involving oil and gas issues. While it paid benefits Unum engaged in much surveillance of Truitt, which showed inconsistencies in her reported limitations and her actual functioning capabilities.  Unem then received an unsolicited communication from an acquaintance of Truiit, who provided 600 pages of e-mails which ostensibly showed Truiit engaged in International travel during the time she received benefits. The Court cited to 29 U.S.C. § 1133, which requires a plan administrator to identify “specific reasons” for denying benefits which then allows a claimant to attempt to discredit that evidence by, among other things, attacking its source. The Fifth Circuit found that Unum’s decision to consider the emails was not an abuse of discretion as Truitt did not introduce any evidence that the emails were forged or hacked.

Unum also sought $1 million in benefits it had paid Truiit and the District Court denied that claim applying Texas law, the state where Truitt had been employed.  The Fifth Circuit reversed that finding saying that federal common law should govern Unum’s claim for reimbursement citing Provident Life & Accident Ins. Co. v.Sharpless, 364 F.3d 634, 641 (5th Cir. 2004) (“Federal common law governs rights and obligations stemming from ERISA-regulated plans[.]”).  Accordingly, the Fifth Circuit vacated that part of the district court’s opinion and remanded for further proceedings.