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Healy v. Fortis Benefits Insurance Co.

United States District Court, Northern District of California

November 5, 2014

LIZABETH HEALY, Plaintiff,
v.
FORTIS BENEFITS INSURANCE COMPANY, et al., Defendants

For Lizabeth Healy, Plaintiff: Lauren Curtis, Rebecca Grey, The Grey Law Firm PC, San Francisco, CA.

For Fortis Benefits Insurance Company, Union Security Insurance Company, Assurant Employee Benefits, Lighthouse Capital Partners Inc. Long Term Disability Plan, Defendants: Horace W. Green, LEAD ATTORNEY, Buchman Provine Brothers Smith LLP, Walnut Creek, CA.

DISCOVERY ORDER Re: Dkt. Nos. 36, 38

MARIA-ELENA JAMES, United States Magistrate Judge.

I. INTRODUCTION

Pending before the Court are two joint discovery letters regarding Plaintiff Lizabeth Healy's (" Plaintiff") Request for Production of Documents and Notice of Deposition served on Defendant Union Security Insurance Company (" Union") (formerly known as Fortis Benefits Insurance Company). Dkt. Nos. 36, 28. The issue presented concerns the limits of discovery in an Employee Retirement Income Security Act (" ERISA") action, 29 U.S.C. § 1001 et seq., where the Court's standard of review is de novo.[1] Having considered the parties' positions, relevant legal authority, and the record in this case, the Court issues the following order.

II. BACKGROUND

The parties provided the following joint factual summary. Dkt. No. 26. at 1-2. Plaintiff was employed by Lighthouse Capital Partners, Inc. (" Lighthouse") from 1995 through 2011. Effective August 1, 2004, Union issued a group disability insurance policy to Lighthouse which insured Defendant Lighthouse Capital Partners, Inc. Long Term Disability Plan. Union also served as the claims review fiduciary for the Plan. Lighthouse is the Plan Administrator.

Plaintiff submitted a claim for disability benefits under the Plan in September 2010, based on wrist, neck, back pain, post-operative shoulder pain, thoracic outlet syndrome, ulnar numbness, and limited spine motion caused by cervical degenerative disc disease and chronic cervical strain. Union granted the claim and paid benefits through November 19, 2010. Plaintiff appealed Union's 2010 termination, and Union overturned its decision and paid benefits to Plaintiff through October 26, 2012, at which point it terminated her benefits for a second time. Plaintiff again appealed Union's termination, and Union upheld its decision on two levels of appeal, after which Plaintiff had exhausted her administrative remedies. Plaintiff filed the present ERISA complaint on February 25, 2014.

On July 25, 2014, Plaintiff served Union with a Notice of Deposition for medical reviewers involved in Plaintiff's claim for benefits and a request for documents. Dkt. No. 36, Ex. 1; Dkt. No. 38, Ex. 1. Defendants objected to Plaintiff's requests, and the parties were unable to resolve their disputes.

III. LEGAL STANDARD

In conducting a de novo review of an ERISA plan's denial of benefits, " [t]he court simply proceeds to evaluate whether the plan administrator correctly or incorrectly denied benefits." Abatie v. Alta Health & Life Ins. Co., 458 F.3d 955, 963 (9th Cir. 2006) (en banc). Under this standard, a district court should determine whether the plaintiff is entitled to benefits based on the evidence in the administrative record, and evidence outside the administrative record may only be considered in " certain limited circumstances." Opeta v. Nw. Airlines Pension Plan, 484 F.3d 1211, 1217 (9th Cir. 2007). " [A] district court should exercise its discretion to consider evidence outside of the administrative record only when circumstances clearly establish that additional evidence is necessary to conduct an adequate de novo review of the benefit decision." Id. (emphasis in original; internal citation and quotations omitted).

In Opeta, the Ninth Circuit cited a non-exhaustive list of circumstances in which looking outside the administrative record may be necessary on de novo review:

claims that require consideration of complex medical questions or issues regarding the credibility of medical experts; the availability of very limited administrative review procedures with little or no evidentiary record; the necessity of evidence regarding interpretation of the terms of the plan rather than specific historical facts; instances where the payor and the administrator are the same entity and the court is concerned about impartiality; claims which would have been insurance contract claims prior to ERISA; and circumstances in which there is additional evidence that the claimant could not have presented in the administrative process.

Id. (quoting Quesinberry v. Life Ins. Co. of N. Am., 987 F.2d 1017, 1027 (4th Cir. 1993)). In adopting Quesinberry, the Ninth Circuit has warned " that 'a district court should not take additional evidence merely because someone at a later time comes up with new evidence' and that '[i]n most cases' only the evidence that was before the plan administrator at the time of determination should be considered." Id. (quoting Mongeluzo v. Baxter Travenol Long Term Disability Benefit Plan, 46 F.3d 938, 944 (9th Cir. 1995)). Thus, judges in this District have determined that a bare showing of relevance adequate under Federal Rule of Civil Procedure 26 is not sufficient in an ERISA claims decision. Gonda v. Permanente Med. Grp., Inc., 300 F.R.D. 609, 613 (N.D. Cal. ...


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