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Goble v. Liberty Life Assurance Company of Boston

United States District Court, Third Circuit

October 11, 2013

WILLIAM GOBLE, Plaintiff,
v.
LIBERTY LIFE ASSURANCE COMPANY OF BOSTON, d/b/a, LIBERTY MUTUAL, and BNP PARIBAS, COMPREHENSIVE WELFARE, BENEFITS PLAN, Defendant.

MEMORANDUM OPINION

TONIANNE J. BONGIOVANNI, Magistrate Judge.

This matter has been opened to the Court upon Motion [Docket Entry No. 12] by Plaintiff William Goble ("Plaintiff") seeking an Order compelling discovery from Defendants Liberty Life Assurance Company of Boston and BNP Paribas Comprehensive Welfare Plan (collectively, "Defendants"). Defendants oppose Plaintiff's motion [Docket Entry No. 13]. The Court has fully reviewed the submissions of the parties and considers same without oral argument pursuant to Fed.R.Civ.P. 78. For the following reasons, Plaintiff's Motion to Compel is DENIED.

I. Background and Procedural History

Plaintiff, William Goble, was employed by BNP Paribas as an Information Technology Auditor from April 2005 to January 2010, when he experienced symptoms related to peripheral neuropathy and neuropathic pain. Plaintiff's Brief in Support at *2. Plaintiff was paid short-term disability ("STD") benefits from January 2010 until July 2010, when he received long-term disability ("LTD") benefits until termination of those benefits in November 2011. The underlying case relates to Plaintiff's appeal of his eligibility for disability insurance on the policy held with Defendants.

In June 2011, Plaintiff underwent an Independent Medical Evaluation ("IME") with Gary Yen, M.D., who determined that Plaintiff's eligibility was no longer medically supported. Defendants subsequently terminated Plaintiff's disability benefits in November 2011.

In May 2012, Plaintiff submitted an administrative appeal of Defendants' determination, claiming that he remained unable to work due to symptoms of peripheral neuropathy and neuropathic pain. In support, Plaintiff submitted medical records and reports of his treating neurologist, Dr. Spellman, and podiatrist, Dr. Regulski, as well as a vocational analysis by John Sargent, regarding Plaintiff's occupational requirements at BNP Paribas. Plaintiff also provided a Functional Capacity Evaluation Report by Ellen Rader Smith. Defendants upheld their determination and denied Plaintiff's appeal via letter dated July 20, 2012. Plaintiff then brought this action in federal court on September 25, 2012 [Docket Entry No. 1] alleging violation of the Employee Retirement Income Security Act of 1974 ("ERISA").

A. Plaintiff's Argument

Plaintiff contends that he is entitled to additional discovery for the reasons stated below. Plaintiff wishes to conduct expanded discovery concerning (1) relevant data compiled by Defendants in constructing the administrative record and (2) Defendants' internal policies and procedures relevant to the handling of the claim. As part of his argument, Plaintiff claims that the evidence in the administrative record shows that discovery is warranted.

1. Administrative Record

Plaintiff states that he "is entitled to discover those documents properly belonging in the administrative record, which Defendants have admittedly withheld..." Plaintiff's Brief in Support at *8. Plaintiff seeks to include items from the First Notice to Produce, Items 4 and 5, and Interrogatory 17 in the administrative record. Id. Plaintiff asserts that because these documents belong in the administrative record pursuant to ERISA regulation 29 C.F.R. § 2560.503-1(m)(8), his discovery request is warranted. To support this position, Plaintiff cites to Crosby v. Louisiana Health Serv. & Indem. Co., 647 F.3d 258 (5th Cir. 2011), which held that a discovery request is permitted when it is "reasonably calculated to lead to the discovery of some admissible evidence" relating to the administrative record. Id. at 263-264. Plaintiff thus contends that under ERISA, Defendants must produce any and all information belonging in the administrative record.

2. Defendants' Policies and Procedures

Plaintiff states that he "is entitled to discover the specific written rules, guidelines, policies, procedures or like written materials pertaining [to] his LTD claim..." Plaintiff's Brief in Support at *10. Plaintiff's discovery request includes items from the First Notice to Produce, Interrogatory 13, 14, and 23, and the Second Notice to Produce. Id. at *10-11. Plaintiff contends that under ERISA regulations 29 C.F.R. § 2560.503-1(m)(8)(iii) and (iv), Defendants must produce any documentation relevant to their determination of his claim, which includes the policies and procedures relating to "surveillance, the provision of surveillance footage to IME examiners, and the consideration of a favorable Social Security determination in administering a beneficiary's claim." Id. at 11. To support this position, Plaintiff cites to Ganem v. Liberty Life Assur. Co. of Boston, 12 U.S. Dist. LEXIS 161072 (D. Me. Sep. 13, 2012), which found that the "Plaintiff [there] has a right to access and utilize in her merits presentation any written rule, guideline, protocol, policy, procedure or like written materials that bear on her claim for disability benefits." Id. at 10, citing 29 C.F.R. § 2560.503-1(g)(1)(v)(A).

Plaintiff also cites to ERISA regulation 29 C.F.R. § 2560.503-1(g)(1)(v)(A), which indicates that in the case of an adverse benefit determination, the plan administrator must provide to the claimant:

an internal rule, guideline, protocol, or other similar criterion was relied upon in making the adverse determination, either the specific rule, guideline, protocol, or other similar criterion; or a statement that such a rule, guideline, protocol, or other similar criterion was relied upon in making the adverse determination and that a copy of such rule, guideline, protocol, or other criterion will be provided free of charge to the claimant upon request.

Plaintiff argues that the ERISA regulation requires Defendants to produce discovery "to the extent that Liberty consulted same in the process of rendering a decision on Plaintiff's LTD claim." Plaintiff's Brief in Support at *14.

3. Relevant Documentation

Plaintiff argues that Defendants concede in Answers to Interrogatories and Responses to Notice to Produce that the administrative record is incomplete and that additional documents do exist. Plaintiff's Reply Brief at *1. Plaintiff states that ERISA regulation, 29 CFR § 2560.503-1(m)(8)(ii), requires "production of all documentation that was submitted, considered, or generated in the course of making the benefits determination without regard to whether it was physically attached and made a part of the claim filed by the administrator." Id. (internal quotation marks omitted). Plaintiff thus contends that "all of the information in [his] discovery requests must necessarily have been submitted, considered, or generated in the process of administering Plaintiff's claim." Id. (internal quotation marks omitted).

4. Interpretation of the ERISA regulations

A. 29 CFR § 2560.503-1(m)(8)(iv)

Plaintiff contends that based on a plain reading of ERISA regulation 29 CFR § 2560.503-1(m)(8)(iv), he is entitled to Defendants' Policies, Procedures and Exceptions ("PPE") "concerning the denied treatment option or benefit for the claimant's diagnosis..." Id. at *2, citing 29 CFR § 2560.503-1(m)(8)(iv). ERISA regulation 29 CFR § 2560.503-1(m)(8)(iv) provides:

in the case of a group health plan or a plan providing disability benefits, constitutes a statement of policy or guidance with respect to the plan concerning the denied treatment option or benefit for the claimant's diagnosis, without regard to whether such advice or statement was relied upon in making the benefit determination.

Plaintiff states that "the placement of the word "benefit" as a subject in this sentence indicates that the discoverable policies or guidance' in this subsection are those pertaining to a denied treatment option in the case of a health insurance claim, and a denied benefit in the case of a disability claim." Id. at *3. Plaintiff thus argues that the regulation requires ...


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