GWYNNE E. BIRZER, Magistrate Judge.
This matter comes before the Court on Plaintiff's request to engage in discovery outside the administrative record ("Memorandum of Law Regarding Discovery," ECF No. 21) and Defendant's Memorandum concerning the same topic (ECF No. 20). Having reviewed the parties' briefing, and portions of the administrative record (ECF Nos. 13-19, sealed), the Court is now prepared to rule. For the reasons set forth below, Plaintiff's request (
Plaintiff Karen A. Baty initially filed this case in the Sedgwick County District Court
After her termination, Plaintiff applied for long-term disability ("LTD") benefits, and Defendant denied her claim. She claims Defendant's decision to deny her benefits was arbitrary, capricious, and not supported by substantial evidence. Defendant hired two physicians to review her case, and Plaintiff alleges those physicians used inaccurate and unreasonable review procedures, and based their decision on erroneous facts. Plaintiff brought this case to recover LTD benefits under the employee benefit plan pursuant to the Employee Retirement Income Security Act of 1974 ("ERISA"), 29 U.S.C. § 1132(a)(1)(B).
Defendant MetLife removed the case to this federal court on August 11, 2017. During the Scheduling Conference held on September 22, 2017, the parties announced they had reached an impasse regarding the appropriateness of discovery outside the administrative record reviewed by MetLife when determining Plaintiff's eligibility for LTD benefits. (See Order, ECF No. 12). In light of the discussions during the scheduling conference, the Court ordered the parties to brief the issue of the scope of discovery. Having had the opportunity to review the parties' written arguments, the Court is now prepared to rule.
When deciding whether discovery is appropriate in an ERISA denial of benefits case, the Court must acknowledge the standard by which it reviews the claims administrator's decision. The Supreme Court determined "a denial of benefits challenged under §1132(a)(1)(B) is to be reviewed under a de novo standard unless the benefit plan gives the administrator or fiduciary discretionary authority to determine eligibility for benefits or to construe the terms of the plan."
When utilizing the arbitrary and capricious standard to review the administrator's decision, "the district court generally may consider only the arguments and evidence before the administrator at the time it made that decision."
An inherent conflict of interest arises when a claims administrator acts in a dual role as both administrator/evaluator and insurer/payor of a claim.
Courts in this District and the Tenth Circuit apply the scope of discovery standard of Fed. R. Civ. P. 26(b) to requests for extra-record discovery related to a dual-role conflict of interest.
The parties agree that Defendant acted in a dual role regarding the LTD Plan: first, as the insurer (the entity that would pay out benefits); and second, as the administrator (the evaluator making the decision whether benefits are payable). Plaintiff contends discovery outside the administrative record is appropriate because "there are red flags within the administrative record that suggest the dual role conflict infected" Defendant's decision (ECF No. 21, at 6). Plaintiff lists examples of these red flags, such as that the reports prepared by Defendant's two Independent Physician Consultants ("IPCs") utilized the same formats. Additionally, the IPCs contacted Plaintiff's treating doctors with "cold calls" rather than scheduling interviews, which caught the physicians unprepared. Plaintiff's most troubling allegation is that both IPC reports contained factual inaccuracies about their interviews with the treating physicians in ways that favored Defendant. Plaintiff seeks discovery into Defendant's use of, and relationship with, its IPCs to determine whether it inappropriately coaches them in their review of claims.
Defendant disagrees that these examples support discovery outside the administrative record. It contends the administrative record already demonstrates what information and instruction the IPCs were given regarding their investigation of Plaintiff's claim, and no additional discovery is warranted. Additionally, Defendant points out that both Plaintiff's counsel and the treating physicians responded to the IPCs' initial reports with their concerns regarding the factual errors and procedural issues they found in the IPCs' initial reports. As a result of those notifications, the IPCs addressed and considered those concerns, and determined the issues did not change their evaluation of Plaintiff's claim. All of the correspondence surrounding Plaintiff's concerns are contained in the administrative record, and therefore Defendant concludes those alleged inaccuracies are not indicative of any bias on the part of the IPCs.
But this Court is not so certain. Defendant argues the administrative record demonstrates its referral process and selection of their IPCs (ML00379-ML00383, ECF No. 14, sealed). The Court has reviewed those portions of the record, and the forms do show that Defendant requested consulting physicians which specialize in neuropsychology and oncology, specifically directed the IPCs to contact Plaintiff's medical providers, and directed the IPCs to ask targeted questions of Plaintiff's treating physicians. But this information does not demonstrate, in a more empirical sense, how Defendant selects, trains, or otherwise directs its consultants—and, therefore, how it avoids bias and promotes accuracy in its claims reviews. The short statements showing a request for specific consultants tells nothing about how, or if, the IPCs' methodologies or opinions are reviewed; whether any unique training is provided to consulting physicians; how the consulting physicians are paid; or other information indicative of the relationship between Defendant and its IPCs. Such policies and procedures utilized by Defendant could later assist the court in its analysis of Defendant's dual-role conflict.
Defendant relies, in part, on Rutherford v. Reliance Standard,
In a more recent decision in this District, Parker v. Sun Life Assurance Company of Canada,
Likewise, when weighing the seriousness of the dual-role conflict in this case, the court may ultimately examine whether Defendant, as administrator of the Plan, took "active steps to reduce potential bias and to promote accuracy."
In many of the previous cases discussed here, those courts were tasked with reviewing specific extra-record discovery requests for appropriateness under Fed. R. Civ. P. 26(b).
At this juncture, however, Plaintiff has met her burden to show the propriety and relevance of some limited extra-record discovery. Plaintiff's request for discovery does not appear to be an attempt to supplement the record with substantive evidence of her disability or an attempt to muster better evidence than she provided for the initial claim review.