JED S. RAKOFF, District Judge.
Plaintiff Ramona Joyner brings this suit challenging the denial of her long-term disability insurance benefits claim under the Employee Retirement Income Security Act of 1974 ("ERISA"), 88 Stat. 891. In connection with her claims, plaintiff seeks discovery beyond the scope of the administrative record of defendant Hartford Life Group Insurance Company ("Hartford"), successor-in-interest to named defendant Continental Casualty Co. ("Continental"). Defendant objects to any extra-record discovery. After the initial scheduling conference in this case, held on October 12, 2011, the Court directed the parties to submit letter briefing defending their respective positions on the standard of review and discovery outside the administrative record. Both parties submitted their briefs on October 19, 2011, and their responses to each other's brief one week later, on October 26, 2011.
Having carefully considered the parties' briefs, the Court determines that limited discovery on some of the issues plaintiff raises is warranted. In particular, the Court concludes that plaintiff can seek discovery on two issues. First, plaintiff may seek discovery of any further plan documents that show whether defendant Hartford was a proper "named fiduciary" identified in "the plan instrument" as required by ERISA. See 29 U.S.C. 1102(a)(2). Second, in accordance with the Supreme Court's direction in Met. Life Ins. Co. v. Glenn, 554 U.S. 105, 128 S.Ct. 2343, 171 L.Ed.2d 299 (2008), plaintiff may seek discovery on the issue of Hartford's alleged
"Point I" of plaintiff's submission seeks discovery to ascertain whether Hartford was properly delegated discretionary authority to determine plaintiff's eligibility for benefits and to interpret the terms and provisions of the policy, and whether Hartford is the proper "named fiduciary" with the right to review, evaluate and decide plaintiff's appeal of her denied disability claim. Letter Brief of Plaintiff Ramona Joyner dated Oct. 19, 2011 ("Pl. Br.") at 2. The Court must address three separate questions contained in plaintiff's "Point I": first, whether the Plan originally conferred discretionary authority on Continental Casualty; second, whether Continental transferred that authority to defendant Hartford, the successor-in-interest to Continental's group disability business, when Hartford purchased the disability plan at issue; and third, whether Hartford was a "named fiduciary" that could provide plaintiff with a "full and fair review" of her claim pursuant to 29 U.S.C. § 1133(2).
As to the question of whether the Plan conferred discretionary authority on Continental Casualty, no further discovery is necessary. The "Group Long Term Disability Certificate" clearly states that "When making a benefit determination under the policy, We have discretionary authority to determine Your eligibility for benefits and to interpret the terms and provisions of the policy." Hartford Letter Brief dated Oct. 19, 2011 ("Def. Br.") Ex. A, at 6. "We" in the Certificate is defined by the contract to mean the "Continental Casualty Company, Chicago, Illinois." Pl. Br., Ex. 1 at 17. This clear language shows the Plan vests discretionary authority in Continental. See Krauss v. Oxford Health Plans (N.Y.), Inc., 517 F.3d 614, 622-23 (2d Cir.2008) (holding that reservation of discretion must be "clear" but need not use the words "discretion" or "deference").
Plaintiff, however, argues that because this Certificate is admittedly not the "Policy," Def. Br. Ex. A at 6, "it is not a governing plan document and of no force or effect." Pl. Br. at 4-5; see CIGNA Corp. v. Amara, ___ U.S. ___, 131 S.Ct. 1866, 1878, 179 L.Ed.2d 843 (2011) (holding "summary documents" do not constitute the terms of the plan for purposes of § 502(a)(1)(B)). But CIGNA is inapplicable to this case. In CIGNA, the Supreme Court held that the insurer's Summary Plan Description, a document required by 29 U.S.C. § 1022(a), did not constitute the terms of the plan for purposes of ERISA § 502(a)(1)(B). Id. Here, however, the Certificate is not designated a Summary Plan Description, nor does it comport with the SPD requirements outlined in 29 U.S.C. § 1022. Further, the integration clause in the Group Policy states "The policy, the Employer's application, Your certificate of coverage, and Your application, if any, and any other attached papers, form the entire contract between the parties." Pl. Br. Ex. 1, at 15. Thus, unlike a Summary Plan Description, this Certificate, according to the plain language of the Policy, is part of the plan's terms and is
Turning to whether Continental transferred its discretionary authority to Hartford when Hartford purchased Continental's group disability business, Hartford has provided this Court and Joyner with the asset purchase documents for that transaction, filed under seal. See Protective Order dated Oct. 31, 2011. Those documents show that the CNA Group Life Assurance Company ("CNA"), the reinsurer of Continental's group health insurance businesses, was purchased by Hartford Life, Inc. and Hartford Life and Accident Insurance Company ("Hartford Inc.") and that CNA would administer the insurance plans sold to Hartford Inc., including the instant plan. See Declaration of Leslie T. Soler ("Soler Decl.") Ex. A at JOYNER 002623-24, 002628, 002647 CONFIDENTIAL.
Soler Decl. Ex. B § 4.02(c), (i) (emphasis supplied). Given that CNA was to administer the plans in accordance with the terms of the Policies and any Certificates issued under the Policies, and given that the instant Certificate stated that Continental had "discretionary authority" to interpret provisions of the Plan, that discretionary authority was vested in CNA, and thus transferred to Hartford.
Other courts that have examined whether Hartford held discretionary authority after purchasing the Continental plans have concluded similarly. In Schnur v. CTC Comms. Corp. Group Disability Plan, No. 05-CV-3297(RJS), 2010 WL 1253481 (S.D.N.Y. Mar. 29, 2010), aff'd 413 Fed.Appx. 377 (2d Cir.2011), the Court held that Hartford acquired discretionary authority through the transfer agreements
Separately, plaintiff argues that she requires discovery to determine whether Hartford is an "appropriate named fiduciary" that can provide plaintiff with the requisite opportunity for a "full and fair review." Pl. Br. at 5 (quoting 29 U.S.C. § 1133(2)). The Court concludes that plaintiff is entitled to discovery on this issue, as it is not clear from the documents provided to the Court that Hartford is a "named fiduciary" for purposes of ERISA. See 29 U.S.C. § 1102. Plaintiff intimates that because the Plan documents do not state explicitly that Hartford is a "named fiduciary," it cannot be a named fiduciary. See Pl. Br. at 6-7 ("[T]he purported contract does not contain the word `fiduciary' at all."). This is an incorrect interpretation of the phrase "named fiduciary" in ERISA. ERISA does not require that the plan documents name Hartford as a fiduciary. Rather, all that is required is that Hartford is a fiduciary who is named in the plan documents. See 29 U.S.C. § 1102(a)(2) ("[T]he term `named fiduciary' means a fiduciary who is named in the plan instrument ...." (emphasis supplied)). Here, the Administrative Services Agreement assigns Hartford (formerly CNA) the responsibility of evaluating and reviewing benefits claims, see Soler Decl. Ex. B § 4, making Hartford a fiduciary for ERISA purposes. See Schnur, 2010 WL 1253481, at *10 (holding defendant "became a fiduciary pursuant to its responsibilities under the administrative services agreement"); Winkler v. Met. Life Ins. Co., No. 03 Civ. 9656(SAS), 2004 WL 1687202, at *2 (S.D.N.Y. July 27, 2004) ("The SPD invests MetLife with authority to evaluate claims and to review participants' appeals. MetLife is thus charged with an important discretionary role in implementing the Plan, and is a fiduciary for ERISA purposes.").
But, even though Hartford is a fiduciary for ERISA purposes, the Court cannot yet determine that Hartford is "named in the plan instrument" as ERISA requires, 29 U.S.C. § 1102(a)(2). Defendant argues that the policy Endorsement provided to the Court names Hartford as the claim fiduciary under the Plan, following completion of Hartford's purchase of Continental's long-term disability policies. See Letter Brief of Defendant Hartford Life Group Insurance Company dated Oct.
Next, in Point II of plaintiff's submission, plaintiff seeks discovery "to ascertain the extent to which defendant's financial conflict of interest influenced its decision to terminate plaintiff's claim." Pl. Br. at 9. When the standard of review is the arbitrary and capricious standard, the Court is generally limited to reviewing the administrative record of the plan administrator. Miller v. United Welfare Fund, 72 F.3d 1066, 1071 (2d Cir.1995).
That being said, "the standard for permitting discovery to supplement the administrative record in an ERISA case is far less stringent than the standard for actually considering that outside evidence." Baird v. Prudential Ins. Co. of Am., No.
Here, plaintiff seeks conflict of interest discovery on:
Pl. Br. at 11.
If the standard is the ordinary discovery standard of allowing plaintiff to obtain any "relevant" evidence that "appears reasonably calculated to lead to the discovery of admissible evidence," then plaintiff's discovery requests are proper. Fed.R.Civ.P. 26(b)(1); Hogan-Cross, 568 F.Supp.2d at 414. If, on the other hand, the standard is evidence that has a "reasonable chance" of satisfying the "good cause" requirement, the question becomes a closer call. The only argument plaintiff makes suggesting this evidence has a reasonable chance of showing "specific allegations" of a financial conflict rising to the level of "good cause" such that the Court can go outside the administrative record is the purported bias of Dr. Dennis Payne who performed the medical peer review that formed the basis of the claim denial. Letter Brief of Plaintiff Ramona Joyner dated Oct. 26, 2011 ("Pl. Opp. Br.") at 9-10. At this albeit preliminary stage, this purported peer review bias appears unlikely to be sufficient to show "good cause" for Hartford's conflict of interest. According to defendant, Dr. Payne's review is only one piece of evidence in the record, plaintiff has not identified any medically unsound parts of the opinion, and, according to defendant, on administrative appeal after a blind referral to Dr. Paul F. Howard, M.D., Dr. Howard reached similar conclusions as Dr. Payne, and the Hartford claims specialists ultimately made their own independent conclusions. See Def. Opp. Br. at 16-18. Absent evidence of a flawed medical opinion,
In Glenn, the Supreme Court stated that district courts "should consider" a financial conflict of interest as a "factor" in determining whether a plan administrator abused its discretion. 554 U.S. at 115-19, 128 S.Ct. 2343. In so holding, the Court noted that it did not "believe it necessary or desirable for courts to create special burden-of-proof rules, or other special procedural or evidentiary rules, focused narrowly upon the evaluator/payor conflict." Id. at 116, 128 S.Ct. 2343. The Court did not address specifically the standard of discovery, and noted it was not providing "a detailed set of instructions." Id. at 119, 128 S.Ct. 2343; id. at 121, 128 S.Ct. 2343 (Roberts, C.J., concurring in part and concurring in the judgment) (criticizing majority for being "so imprecise about how the existence of a conflict should be treated in a reviewing court's analysis"). Courts around the country have adopted a wide range of standards — some permitting open discovery, others limited discovery on conflicts, and others no discovery at all. See, e.g., Winterbauer v. Life Ins. Co. of N. Am., No. 4:07 CV 1026 DDN, 2008 WL 4643942, at *4-6 (E.D.Mo. Oct. 20, 2008) (collecting cases).
Given Glenn's command that district courts "should consider" evidence of a financial conflict of interest, 554 U.S. at 108, 128 S.Ct. 2343 (emphasis supplied), it appears reasonable to allow plaintiff the opportunity to discover evidence the Court may find gives it good cause to go outside the administrative record. And since Glenn warned against erecting procedural hurdles to showing a financial conflict, 554 U.S. at 116-17, 128 S.Ct. 2343, the Court concludes that it is unwarranted to impose a standard such as a "reasonable chance" that discovery will lead to "good cause" at the discovery stage of litigation. See Baird, 2010 WL 3743839, at *8.
This does not afford plaintiff free reign over discovery on any issue in this case, however, and the Court disagrees that Glenn has completely abrogated the "limitations on discovery unique to ERISA cases." Hogan-Cross, 568 F.Supp.2d at 415. But that issue is not presently before the Court. Plaintiff's proposed discovery topics on Point II all relate to an alleged financial conflict of interest, and plaintiff presents at least some allegations suggesting discovery on this issue will not be a mere fishing expedition. Indeed, all six topics plaintiff identifies for the scope of her inquiry relate to topics the Supreme Court identified as relevant to the financial conflict of interest inquiry in Glenn, including: 1) a history of biased claims administration; 2) whether the administrator has taken active steps to reduce potential bias and to promote accuracy; 3) encouraging
Turning next to Point III of plaintiff's submission, plaintiff seeks discovery "to determine the integrity of the claim file and to determine ambiguous or unclear terms therein." Pl. Br. at 13. Plaintiff states, however, that she has not yet received the claim file from Defendant. Defendant responds that "Hartford's records demonstrate that Joyner's counsel has had a copy of the claim file containing the initial claim review since on or about April 21, 2010." Def. Opp. Br. at 8 n. 3. Either way, this issue is not yet ripe for consideration. Accordingly, the Court hereby denies plaintiff's request, without prejudice to later requesting discovery once plaintiff has reviewed the claim file.
In Point IV of plaintiff's submission, she requests discovery "to identify the specific and segregated funds that have been set aside to pay her claim." Id. at 14. Plaintiff argues that she needs to determine whether defendant has identified specific funds to satisfy her equitable claim under ERISA § 502(a)(3), and that if those funds do not exist, "her claim will proceed at law under § 502(a)(1)(B)." Id. This argument relies on an incorrect interpretation of ERISA. To begin with, plaintiff has the order of her claims wrong; the Court will first determine whether she is entitled to relief under § 502(a)(1)(B) for an improper denial of benefits, and turn to § 502(a)(3) only if § 502(a)(1)(B) would not adequately address her claims. Biomed Pharms., Inc. v. Oxford Health Plans (N.Y.), Inc., 775 F.Supp.2d 730, 738 (S.D.N.Y.2011); see Devlin v. Empire Blue Cross & Blue Shield, 274 F.3d 76, 89 (2d Cir.2001) (holding equitable relief under § 502(a)(3) not "normally" appropriate (quoting Varity Corp. v. Howe, 516 U.S. 489, 515, 116 S.Ct. 1065, 134 L.Ed.2d 130 (1996))). Furthermore, plaintiff's reliance on Great-West Life & Annuity Ins. Co. v. Knudson, 534 U.S. 204, 122 S.Ct. 708, 151 L.Ed.2d 635 (2002), is inapposite. Great-West addressed an insurance company's claim for reimbursement of a tort settlement amount based on medical benefits provided to defendants, which the Court held to be a contract claim, a legal claim not entitled to equitable relief under § 502(a)(3). Id. at 207-10, 122 S.Ct. 708; see also Sereboff v. Mid Atl. Med. Servs., Inc., 547 U.S. 356, 362-63, 126 S.Ct. 1869, 164 L.Ed.2d 612 (2006) (distinguishing Great-West and allowing insurer's tort settlement reimbursement claim to proceed under § 502(a)(3) where insured's funds were "specifically identifiable" as they were set aside in insured's investment accounts). It did not address the type of claim presented in this case: a claim for improper denial of benefits brought by the beneficiary under § 502(a)(1)(B). Second, a claim under § 502(a)(1)(B) is a claim in equity, not law. Sullivan v. LTV Aerospace & Def. Co., 82 F.3d 1251, 1258-59 (2d Cir.1996). Finally, plaintiff provides no adequate legal basis that would justify discovery on identifying specific funds the
Thus, plaintiff's discovery at this time is limited to plan documents relating to whether defendant Hartford is a "named fiduciary" for ERISA purposes, and documents and one 30(b)(6) deposition of a Hartford representative for plaintiff's discovery requests regarding Hartford's alleged financial conflict. Assuming arguendo that this plan is valid, see supra at 10 n. 2, the Court will apply an arbitrary and capricious standard of review to Hartford's benefits determinations.
SO ORDERED.