Meaningful Dialogue, No Re Do: District Court Confirms ERISA Record Closes at Final Determination

In Nelson v. Reliance Standard Life Insurance, No. 6:24-CV-01307, 2025 WL 2811123 (W.D. La. Sept. 30, 2025), Judge Robert R. Summerhays granted Reliance’s motion for summary judgment on the threshold question of what belongs in the ERISA administrative record and denied Plaintiff’s motion in limine and cross‑motion for summary judgment. The Court held the record is limited to what was before Reliance when it issued the final appeal decision on June 30, 2023.

Background

Nelson, a Technical Services Sales Representative for Brill, Inc., received Reliance long‑term disability (“LTD”) benefits beginning April 6, 2021. Under the plan, the definition of “Total Disability” tightened after two years from an “own occupation” to an “any occupation” standard (effective April 6, 2023). Ahead of that change, Reliance asked Nelson to submit an authorization and updated medical/vocational information. When Nelson did not timely provide the materials, Reliance terminated benefits on November 6, 2022, with notice of appeal rights.

Nelson appealed on March 15, 2023. Reliance sought specific updated records, granted extensions, received the materials in early May, and obtained an independent neurologist’s review (Dr. Anthony Geraci), who opined Nelson was not “totally disabled” under the plan. Reliance invited further response; none came. It denied the appeal on June 30, 2023 (notified July 11, 2023). Months later, new counsel sent hundreds of pages of additional records and a sworn statement and asked Reliance to reconsider; Reliance declined to reopen. Nelson then sued.

The issue

Could the court supplement the ERISA record with roughly 582 pages of additional materials submitted nine months after Reliance’s final appeal decision but before suit, on the theory Reliance had a “fair opportunity” to consider them under the Fifth Circuit’s decision in Vega v. Nat’l Life Ins. Servs., Inc., 188 F.3d 287 (5th Cir. 1999) (en banc)?

The Court’s decision

No. The Court limited the record to what Reliance had when it decided the appeal. It relied on Fifth Circuit authority that a reviewing court focuses on the evidence before the administrator when the final benefit determination was made (citing Denton v. First Nat’l Bank of Waco), and read Vega in light of later Fifth Circuit cases (Shedrick v. Marriott Int’l, Inc., Killen v. Reliance Standard Life Ins. Co., and Dix v. Blue Cross and Blue Shield Ass’n) that reject adding materials provided after the administrative review has been exhausted so long as the plan substantially complied with ERISA’s “full and fair review” procedures.

The Court found Reliance substantially complied with 29 U.S.C. § 1133 and 29 C.F.R. § 2560.503‑1: it warned of the changing standard; requested forms and proof; accepted and reviewed late‑submitted materials; obtained an independent physician review; disclosed the adverse conclusion; and gave Nelson a chance to respond before deciding the appeal. Nelson did not identify any procedural defect. The Court emphasized that ERISA requires both the beneficiary and the fiduciary to make use of the administrative process.

As for the “new” materials: nearly half were physical therapy records from July–November 2023—months after the final appeal decision and outside the appeal timeline; the rest largely duplicated records Reliance already had. On this record, the nine‑month delay did not give Reliance a “reasonable opportunity” to consider the materials within the strict 45–90-day appeal window prescribed by the regulations. Lack of counsel during the appeal did not change the analysis.

The Court granted Reliance’s motion for summary judgment and denied Plaintiff’s motion in limine and cross‑motion. The Court also ruled that the administrative record is confined to the file Reliance lodged at ECF No. 7.

Key takeaways (for claimants and practitioners)

• The record closes at the final administrative decision. In the Fifth Circuit, courts generally will not add post‑appeal submissions to the record where the administrator substantially complied with ERISA’s claims‑procedure rules.
• Deadlines matter. The disability‑appeal decision must issue within 45 days (subject to limited extension); evidence that surfaces months later typically won’t be considered part of the record for judicial review.
• Respond to “any‑occupation” reviews. When the definition of disability tightens at the two‑year mark, promptly return forms and updated proof; failure to do so can lead to termination that may be hard to unwind later.
• Independent reviews carry weight. If an outside specialist’s report is adverse, take the administrator’s invitation to rebut it before the appeal closes.
• Being pro se isn’t a procedural defect. The Court did not allow supplementation merely because the claimant lacked counsel during the internal process.