United States District Court, D. Connecticut
ORDER ON MOTION TO REMAND
MICHAEL P. SHEA, U.S.D.J.
S.B., a minor at all times relevant to this action, brought
this suit against Defendant Oxford Health Insurance, Inc.
(“Oxford”) under 29 U.S.C. §§ 1132(a),
(e), (f) and (g) of the Employee Retirement Income Security
Act of 1974 (“ERISA”) for denial of health care
benefits due under a qualifying employee welfare benefit
plan. (See generally ECF No. 18.) S.B. moves to
remand her claim to Oxford for further administrative review.
(ECF No. 41.) Specifically, S.B. argues that Oxford failed to
conduct a full and fair review by failing to adequately
communicate to S.B. its August 6, 2015 decision denying her
second-level appeal, by repeatedly failing to send
correspondence to S.B.'s counsel, and because the
responses Oxford did send to S.B.'s counsel were
inadequate. (ECF No. 41 at 12.) In addition, S.B. argues that
Oxford did not sufficiently develop the administrative record
because it failed to consider additional treatment records
S.B.'s counsel submitted in March 2016 (i.e.,
after the August 6, 2015 decision denying S.B.'s
second-level appeal). (ECF No. 41 at 8, 13-14.) Oxford argues
in opposition that it considered all the documentation S.B.
submitted before issuing its August 6, 2015 decision, that no
legal basis exists for remanding the case to consider
later-submitted records, and that S.B.'s alleged
non-receipt of the August 6, 2015 decision neither violated
applicable regulations nor prejudiced S.B. (ECF No. 44 at
4-5.) S.B. submitted a reply brief along the same lines,
which the Court has also reviewed. (ECF No. 45.)
Court concludes that remanding the case would be premature,
because the Court may consider each of S.B.'s arguments
in deciding the parties' dispositive motions on the
merits, and no authority requires this Court to remand before
considering on dispositive motions whether the
administrator's decision was proper. As some of the cases
cited by S.B. show, courts may consider on summary judgment
whether a claimant was given “full and fair review,
” and may remand to the administrator if not. See
Buffonge v. Prudential Ins. Co. Of Am., 426 F.3d 20,
30-32 (1st Cir. 2005) (reversing grant of summary judgment
and remanding to administrator because administrator's
reliance on faulty evidence rendered the administrator's
decision arbitrary and affected the integrity of the
decision-making process); Hoffman v. Screen Actors
Guild-Producers Pension Plan, 571 Fed.Appx. 588, 590
(9th Cir. 2014) (reversing denial of summary judgment and
remanding to administrator because the failure to obtain
independent medical analysis constituted a “denial of a
full and fair review of [plaintiff's] claim [which]
prevented full development of the administrative
record”); see also Krauss v. Oxford Health Plans,
Inc., 517 F.3d 614, 630 (2d Cir. 2008) (affirming grant
of summary judgment where remanding claimant's denial of
“full and fair review” based on
“nondisclosure[s], misleading statements, and untimely
responses” would be futile). This Court also has
discretion to consider on dispositive motions additional
evidence outside of the record upon a showing of good cause,
including “if the plan's failure to comply with the
claims-procedure regulation [29 C.F.R. § 2560.503-1]
adversely affected the development of the administrative
record.” See Halo v. Yale Health Plan, Dir. of
Benefits & Records Yale Univ., 819 F.3d 42, 60 (2d
Cir. 2016). In other words, both of S.B.'s arguments may
be addressed at the summary judgment stage.
the Court's review of Second Circuit precedent indicates
only that remand is one available remedy if the court
concludes on the merits that the administrator's decision
was flawed, not that remand is preemptively required prior to
considering the full record. See Miles v. Principal Life
Ins. Co., 720 F.3d 472, 490 (2d Cir. 2013) (“Our
precedents make clear that even where we conclude a plan
administrator's finding was arbitrary and capricious, we
will typically not substitute our own judgment, but rather
will return the claim for reconsideration unless we conclude
that there is no possible evidence that could support a
denial of benefits.” (internal quotation marks and
citation omitted)). The in-Circuit district court cases S.B.
cites for this proposition are not to the contrary. (ECF No.
45 at 4.) See Benjamin v. Oxford Health Ins., Inc.,
No. 3:16-CV-00408 (CSH), 2018 WL 3489588, at *8-9 (D. Conn.
July 19, 2018) (concluding on cross-motions for summary
judgment that denial of benefits was arbitrary and capricious
and remanding to administrator for further consideration)
(citing Miles, 720 F.3d at 490); Easter v.
Cayuga Med. Ctr. at Ithaca Prepaid Health Plan, 217
F.Supp.3d 608, 633-34 (N.D.N.Y. 2016) (denying cross-motions
for summary judgment on improper denial of benefits claim for
insufficient information and remanding to claims
administrator for further development of the
S.B.'s motion to remand is DENIED without prejudice. (ECF
No. 41.) The Court will decide the parties' cross-motions
for summary judgment in due course.
 The other, out-of-district cases S.B.
cites that grant a motion to remand before dispositive
motions are not binding on this Court and the Court declines
to follow them ...