Price v. Hartford Life & accid.Ins.Co.

Price v. Hartford Life & Accid.Ins.Co., 2010 U.S.Dist.LEXIS 108691 (E.D.Mich. October 12, 2010)(Issue: Discovery). After acknowledging the split in the Sixth Circuit as to whether a plaintiff need first satisfy a condition before receiving permission to take discovery, the court determined:

[E]xisting rules of procedure govern discovery in ERISA cases, just as other civil actions in the district courts. Under those rules, before a plaintiff may obtain discovery in an ERISA benefits action, the matters under inquiry must be relevant (within the meaning of Federal Rule of Civil Procedure 26(b)(1)) to the dispute raised in good faith by the suit papers (as required by Federal Rule of Civil Procedure 11(b)). The scope of such discovery is always subject to the Court's authority to limit inquiry under Rule 26(b)(2)(C). See Fed. R. Civ. P. 26(b)(1).

The plaintiff, who had qualified to receive Social Security disability benefits, was nonetheless denied benefits by Hartford. After exhausting pre-suit appeals, Price filed suit and sought documentation relating to the potential bias from the relationship between Hartford and the organization through which a physician was hired to review the claim (MCMC), among several related topics.

After reviewing the cases issued within the Sixth Circuit following,em> MetLife v. Glenn, 554 U.S. 105 (2008), the court ruled that district courts are equipped to evaluate discovery requests, but still preserved the "interests of economy, efficiency, accuracy, and fairness." *12-13. Further, consistent with Glenn's admonition that no special rules should apply, the court determined that the limitations imposed by Rule 26 and the court's power to control pretrial proceedings afforded by Rule 16 are sufficient to determine what discovery is appropriate and what limits should be placed on discovery.

The court discussed the plaintiff's statement of procedural challenge as a trigger to discovery, which included the following theories of bias:

(1) the defendant plan administrator both evaluates claims and makes decisions concerning the payment of benefits, and thus "has a direct financial stake in the outcome of this case," Mot. to Compel at 3; (2) the defendant relied solely on the reviewer's conclusions from the October 1, 2008 functional capacity evaluation and failed to consider other details and observations that the plaintiff experienced high pain levels throughout the short testing period, including during the seated portions, as well as evidence from her doctors and the Social Security Administration in reaching its conclusion that the plaintiff could perform sedentary work; (3) the defendant failed to produce records from SIU, which suggests that the plaintiff did not receive a full and fair review; (4) the defendant had the plaintiff's records reviewed by MCMC, an organization that provides over 50,000 independent medical reviews for the insurance industry annually, and paid MCMC $1950 for this review; (5) the defendant and MCMC have a particularly close working relationship, as evidenced by the special referral form created specifically for this organization, and MCMC would have an incentive to provide favorable reviews for the defendant; and (6) the defendant terminated the plaintiff's benefits even though there had not been a substantial change in circumstances, her doctors continued to conclude that she was disabled, and she had been approved for Social Security disability benefits (following the defendant's recommendation that she seek out these benefits). In support of these allegations, the plaintiff has provided a California Market Conduct Examination, which the plaintiff describes as "an examination of this Insurer's claims handling practices [which] has been strongly criticized during a market conduct examination." Id. at 5 & Ex. E, California Market Conduct Examination. *16-18.

(It is unclear which market conduct examination was cited, but the most recent one available on the California Department of Insurance website is from 2007 - http://www20.insurance.ca.gov/epubacc/REPORT/95830.htm)

The court then quoted the discovery requests verbatim:

Interrogatory No. 1: For each doctor, file reviewer, or surveillance company used for file review in this claim, please state the following:

a. The name of each physician, reviewer, surveillance company or vendor involved in this claim;

b. Whether the relationship of each individual or entity identified above is subject to a contract;

c. The fees paid to each physician, reviewer or contractor (including any entity through which they are utilized) in this matter;

d. The fees paid to each physician, reviewer or contractor (including any entity through which they are utilized) for each of the past three years;

e. The number of times Defendant has utilized each physician, [*19] reviewer or contractor;

f. The number of times the physician, reviewer or contractor opinion has supported a decision to deny benefits;

g. A complete list of documents provided to each individual or entity identified above.

Interrogatory No. 2: Please state the total number of claims made under the subject disability plan for the last ten (10) years with respect to those, please state the following:

a. number of claims approved;

b. total amounts paid for LTD benefits under the plan;

c. the number of claims denied under the plan; and

d. the amount expended by Defendant on the individuals and entities identified above for each claim that was denied.

Interrogatory No.3: Please state the names of all persons who performed any administrative review of the Plaintiffs claim. With respect to those persons listed, please state the following:

a. whether the person is employed by Defendant and

b. credentials the person has with regard to said review.

The court found the discovery was appropriate based on a "good-faith and articulate assertion of a potential conflict of interest in its statement of procedural challenge, certified under Rule 11(b)." The court thus approved interrogatories 1 and 3; and pointed out that "information concerning how frequently a consultant has been used and the compensation paid should be readily available, since much of that data is required to be reported to tax authorities." As to question 1(f), although the court acknowledged it might be "somewhat difficult" to assemble a response, the court deemed the information "highly relevant to the plan administrator's exercise of discretion." Question 2 was rejected, though; the court deemed the burden of assembling the information outweighed its potential benefit.

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