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Mellian v. Hartford Life and Accident Insurance Co.

United States District Court, E.D. Michigan, Southern Division

December 24, 2014

TERI LYNN MELLIAN, Plaintiff,
v.
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY, Defendant.

OPINION AND ORDER REGARDING PLAINTIFF'S MOTION FOR LIMITED DISCOVERY AND DEFENDANT'S CROSS-MOTION FOR PROTECTIVE ORDER

GERALD E. ROSEN, Chief District Judge.

I. INTRODUCTION

Plaintiff Teri Lynn Mellian is a former employee of Unistrut International Corporation ("Unistrut"), a division of Atkore International, Inc. Defendant Hartford Life and Accident Insurance Company is the insurer of a policy known as the "Group Long Term Disability Plan for Employees of Atkore International, Inc." (the "Plan"), an employee benefit plan that is subject to the terms of the federal Employee Retirement Income Security Act of 1974 ("ERISA"), 29 U.S.C. § 1001 et seq. Through the present suit commenced on February 24, 2014, Plaintiff has asserted a claim under § 501(a)(1)(B) of ERISA, 29 U.S.C. § 1132(a)(1)(B), requesting that the Court reverse a decision by the Defendant insurer to deny Plaintiff's claim for long term disability benefits under the Plan.

In Wilkins v. Baptist Healthcare System, Inc., 150 F.3d 609, 619 (6th Cir. 1998), the Sixth Circuit adopted a set of guidelines for conducting judicial review of a plan administrator's decision to deny benefits under an ERISA plan. As pertinent here, Wilkins holds that a district court's review of such a decision ordinarily should be "based solely upon the administrative record, " and that a district court may stray beyond the four corners of this administrative record only to consider evidence "offered in support of a procedural challenge to the administrator's decision, such as an alleged lack of due process afforded by the administrator or alleged bias on its part." Wilkins, 150 F.3d at 619. As a corollary to this rule, the Sixth Circuit has held that discovery typically is not available in an ERISA action contesting a denial of benefits, unless it is deemed necessary to support a procedural challenge to the administrator's decision. Wilkins, 150 F.3d at 619; see also Calvert v. Firstar Finance, Inc., 409 F.3d 286, 293 n.2 (6th Cir. 2005).

In a motion filed on April 24, 2014, Plaintiff seeks leave of the Court to conduct the limited discovery permitted under Wilkins and its progeny, arguing that this discovery is needed to pursue Plaintiff's allegations of procedural irregularities, bias, and conflict of interest on the part of the Defendant claims administrator. Defendant filed a response in opposition to Plaintiff's motion on May 8, 2014, as well as a cross-motion for a protective order prohibiting any discovery in this suit. Having reviewed the parties' briefs in support of and in opposition to these cross-motions, [1] as well as their accompanying exhibits and the remainder of the record, the Court finds that the relevant allegations, facts, and legal issues are sufficiently presented in these written submissions, and that oral argument would not aid the decisional process. Accordingly, the Court will decide the parties' cross-motions "on the briefs." See Local Rule 7.1(f)(2), U.S. District Court, Eastern District of Michigan. This opinion and order sets forth the Court's rulings on these motions.

II. FACTUAL AND PROCEDURAL BACKGROUND

Plaintiff commenced her employment with Unistrut on November 20, 2000, initially working as an administrative assistant to the plant manager at Unistrut's manufacturing facility in Wayne, Michigan, and later holding a position in the accounting department. As a Unistrut employee, Plaintiff was eligible for coverage under the Plan issued by the Defendant insurer to Unistrut's parent corporation, Atkore International.

On June 7, 2012, Plaintiff was placed on disability leave as a result of surgery on her right foot, and she was granted short term disability benefits. During this disability leave, Plaintiff had additional surgery on her right foot in November of 2012, and she also continued to experience pain from a back injury she had suffered in a motor vehicle accident several years earlier. Accordingly, Plaintiff applied for long term disability benefits under the Plan, and Defendant approved this request for the period from December 6, 2012 through February 28, 2013. On March 12, 2013, however, Defendant denied Plaintiff's request for continuation of her long term disability benefits, determining that as of March 1, 2013, Plaintiff could perform the essential duties of her occupation on a full time basis.[2]

On June 25, 2013, Plaintiff sought reconsideration of this adverse decision. In support of this administrative appeal, Plaintiff produced additional office notes from her treating foot and back specialists, both of whom opined that Plaintiff was unable to perform the duties of her job. Defendant, in turn, referred Plaintiff's claim for review by a medical consulting firm, MCMC, [3] which designated two physicians to examine Plaintiff's medical records, contact Plaintiff's physicians, and provide opinions as to Plaintiff's "physical restrictions and limitations" and her "ability to perform primarily sedentary level work activities." ( See Defendant's Response, Ex. E, Lobel Report at 2; Ex. F, Rubinfeld Report at 1.) After each of the two physicians retained by MCMC opined that Plaintiff had the "ability to perform primarily sedentary level work activities, " ( see Lobel Report at 3; Rubinfeld Report at 2), Defendant denied Plaintiff's administrative appeal on August 28, 2013. Having exhausted her administrative remedies, Plaintiff commenced this action on February 24, 2014, challenging Defendant's denial of her claim for long term disability benefits under the Plan.

III. ANALYSIS

Through her present motion, Plaintiff seeks leave to conduct discovery so that she may explore her allegations that Defendant's denial of her claim for long term disability benefits was tainted by impermissible bias and a conflict of interest. In support of her claim of bias, Plaintiff characterizes the outside medical consulting firm chosen by Defendant, MCMC, as a "hired gun" that "maintains its customers' by rubberstamping the opinions of the Plan Administrator." (Plaintiff's Motion at ¶ 5.) As for her claim that Defendant operated with a conflict of interest, Plaintiff points to Defendant's dual role in paying benefits under the Plan and in deciding which claims to pay. Accordingly, Plaintiff requests that she be permitted to propound discovery to Defendant that would shed light on "Defendant's relationship with MCMC, its history of referring claims to that entity, and MCMC's history of affirming[] or contradicting Defendant's decisions concerning whether a claimant is disabled, " as well as any guidelines or protocols that govern MCMC's reviews. ( Id. )

As observed earlier, the Sixth Circuit has held that discovery is available in an ERISA action contesting a denial of benefits only if it is shown to be necessary to support a procedural challenge to the plan administrator's decision. See Wilkins, 150 F.3d at 619; see also Calvert, 409 F.3d at 293 n.2. Plaintiff, of course, seeks to pursue such a procedural challenge here, citing allegations of bias and conflict of interest. Nonetheless, the Sixth Circuit has emphasized in a number of cases that mere allegations of bias or some other procedural irregularity are "not sufficient to permit discovery under Wilkins ' exception." Putney v. Medical Mutual of Ohio, No. 02-3901, 111 F.Appx. 803, 807 (6th Cir. Sept. 10, 2004); see also Huffaker v. Metropolitan Life Insurance Co., No. 07-5410, 271 F.Appx. 493, 504 (6th Cir. Mar. 25, 2008) ("A claimant cannot obtain discovery beyond the administrative record - even if limited to a procedural challenge - merely by alleging a procedural violation."); Likas v. Life Insurance Co. of North America, No. 06-5124, 222 F.Appx. 481, 486 (6th Cir. Mar. 12, 2007). Rather, "a claimant must make a predicate showing with respect to an alleged procedural violation to be granted further discovery." Huffaker, 271 F.Appx. at 504.

To be sure, the law of this Circuit is not altogether clear as to precisely what sort of showing or evidence a claimant must put forward in order to pursue discovery in aid of a procedural challenge. In Johnson v. Connecticut General Life Insurance Co., No. 08-3347, 324 F.Appx. 459, 466 (6th Cir. Apr. 7, 2009), for example, the court viewed the Supreme Court's then-recent decision in Metropolitan Life Insurance Co. v. Glenn, 554 U.S. 105, 128 S.Ct. 2343 (2008), as "counsel[ing] against" a hard-and-fast rule that a claimant must make "a threshold evidentiary showing of bias as a prerequisite to discovery under Wilkins. " Yet, while the court in Johnson affirmed the district court's decision to allow limited discovery as to the defendant plan administrator's conflict of interest, it cautioned that discovery is not "automatically... available any time the defendant is both the administrator and the payor under an ERISA plan, " and the court further explained that the plaintiff in that case had "offered more than a mere allegation of bias." Johnson, 324 F.Appx. at 467.

Upon thoroughly surveying the Sixth Circuit decisions addressing the availability of discovery in ERISA actions, as well as rulings on this subject by district courts within this Circuit, Magistrate Judge Scheer of this District aptly observed that "[t]he role of discovery in the process of weighing a conflict [of interest or claim of bias] remains somewhat obscure." Geer v. Hartford Life & Accident Insurance Co., No. 08-12837, 2009 WL 1620402, at *2 (E.D. Mich. June 9, 2009); see also Price v. Hartford Life & Accident Insurance Co., 746 F.Supp.2d 860, 865 (E.D. Mich. Oct. 12, 2010) (likewise stating that this question "remains unsettled" among the district courts in this Circuit). Against this admittedly uncertain backdrop, Magistrate Judge Scheer rejected "the proposition that an inherent decision maker/payor conflict automatically entitles a benefits claimant to discovery, " reasoning that "[a]cceptance of that view would effectively eliminate the general rule against discovery in ERISA suits in a substantial portion of such cases." Geer, 2009 WL 1620402, at *4. Instead, the court in Geer concluded that "discovery should be allowed where a plaintiff has provided sufficient initial facts suggesting a likelihood that probative evidence of bias or procedural deprivation would be developed." 2009 WL 1620402, at *5. Magistrate Judge Scheer acknowledged the apparent anomaly that "a claimant must have some evidence of bias before being allowed to seek such evidence in discovery, " but reiterated that "an unconditional right to discovery, in the absence of some predicate showing that it is likely to be productive, would completely eviscerate the general rule against discovery in ERISA benefits review cases and undermine the well recognized legislative intent that the statute provide parties with a prompt a economical means of resolving disputes." 2009 WL 1620402, at *5; see also Kennard v. Means ...


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