On July 26, 2013, Magistrate Judge Jeffrey Gilbert issued a ruling in Warner v. Unum Life Ins.Co. of America, No. 12 C 2782 Click Here (N.D.Ill.) granting plaintiff’s motion to compel discovery in an ERISA action governed by the arbitrary and capricious standard of review. DeBofsky, Sherman & Casciari attorney Martina Sherman successfully argued that limiting discovery to the so-called administrative record, or the claim record assembled by the insurance company during the course of the claim, was too restrictive. Instead, the court permitted exploration of Unum’s potential conflict of interest based on evidence suggesting that Unum may not have objectively assessed Debra Warner’s claim for disability benefits. In particular, the court questioned why the insurer disregarded testing performed by a physical therapist. Consequently, the court permitted Warner to obtain compensation information and performance appraisals of Unum personnel in order to determine whether financial incentives may have biased their assessment of the evidence. However, the court refused to permit discovery of statistical information regarding approval/denial rates or a sampling of prior reports because it deemed such evidence potentially misleading. The court also found that communications between Unum claims personnel and the insurer’s legal staff during the course of the claim appeal could not be withheld from production under an assertion of attorney-client privilege.

For more information, contact Martina Sherman [email protected]

Related Articles

Air Ambulance Ruling Severely Undermines No Surprises Act

Air Ambulance Ruling Severely Undermines No Surprises Act

Acting in response to consumer complaints about surprise medical bills, Congress enacted a law known as the No Surprises Act,[1] which went into effect on Jan. 1, 2022.[2] The law’s intent was to prevent surprise billing by requiring nonnetwork health providers to provide patients with an advanced explanation of benefits containing a good faith estimate of anticipated charges. […]

Understanding Government and Church Plan Exceptions to ERISA

Understanding Government and Church Plan Exceptions to ERISA

The Employee Retirement Income Security Act (ERISA) is a landmark piece of legislation enacted in 1974 to safeguard the interests of employees who participate in retirement and health benefit plans offered by their employers. ERISA sets standards for these plans, ensuring transparency, fiduciary responsibility, and fairness in their administration. […]