California Court orders CIGNA to disclose amount paid to MES Solutions for medical reviews
CIGNA Insurance Company can run but they can’t hide. Recently, the US District Court for the Central District of California granted Plaintiff Bradley Wojno’s Motion to Compel Defendant CIGNA Insurance to reveal the extent of it financial relationship with MES Solutions. Mr. Wojno’s disability attorney sought information from CIGNA that could unveil potential conflicts and biases of CIGNA’s hired gun doctors relied upon to terminate Mr. Wojno’s disability benefits.
CIGNA argues the information sought by Plaintiff is “wholly irrelevant.”
CIGNA terminated Plaintiff’s disability benefits based largely on testing performed by Dr. Schoenberg who was supplied to CIGNA by MES Solutions (“MES”), a company that supplies medical professionals to insurance companies for claim determinations. In order to determine the potential biases of MES and Dr. Schoenberg, plaintiff sought information on the amount of money paid by CIGNA or its affiliates to MES in the years 2006 through 2010 for medical examinations and medical reviews of claimants. CIGNA argued that the information sought is “wholly irrelevant,” but nonetheless agreed to provide the information pursuant to a protective order limiting access to the information to attorneys only.
Court rules that information sought is relevant to the parties’ claims and defenses.
The court explained that potential conflicts and biases of Dr. Schoenberg, on whom CIGNA relied to terminate the Plaintiff’s disability benefits, are plainly relevant. Furthermore, denying Plaintiff’s requested discovery would deny Plaintiff information that may bear on potential biases of MES and Dr. Schoenberg.
If CIGNA has relied on MES physicians over the years, this fact may indicate that MES, in order to obtain more business from CIGNA, supplies CIGNA with physicians likely to provide claim determinations favorable to CIGNA.
Traditionally, there has been little or no discovery permitted in ERISA cases, as benefit determinations are based on the administrative record.
In reviewing benefits determinations, courts have traditionally allowed little or no discovery in ERISA cases. This is because open-ended discovery would “frustrate a primary goal of ERISA to resolve benefit disputes inexpensively and expeditiously.” However, courts have permitted consideration of evidence outside the administrative record in de novo standard of review-benefit denials. In Welch v. Metropolitan Life Ins. Co. the 9th Circuit Court of Appeals recognized that discovery aimed at demonstrating a conflict of interest was appropriate.
CIGNA contends that Plaintiff’s discovery is legally irrelevant because discovery typically is done to achieve a shift in the standard of review from abuse of discretion to de novo.
In reviewing ERISA cases, courts typically apply a de novo standard of review or an abuse of discretion standard. When the abuse of discretion standard is used, a court defers to the administrator’s findings and merely decides whether reasonable grounds supported the administrator’s decision. In a de novo review however, a court affords no deference to the administrator’s decision and reviews the claim as if it were for the first time.
CIGNA argued that Plaintiff’s discovery was legally irrelevant because it was not intended to achieve a shift in the standard of review given that CIGNA had already agreed that de novo review was applicable. However, CIGNA’s argument did not consider the Plaintiff’s purpose to determine the potential biases of MES and Dr. Schoenberg based on the amount of money received by MES and the incentive MES may have had in supplying medical professionals likely to be favorable to CIGNA. Furthermore, the court noted that CIGNA failed to cite any case that bars all discovery in de novo cases or to address the potential biases of MES and Dr. Schoenberg.
CIGNA failed to adequately demonstrate why a protective order was necessary.
Because the information sought by the Plaintiff was considered by CIGNA to be “commercially sensitive,” CIGNA pleaded for a protective order to safeguard such information. However, CIGNA failed to convince the court that protective measures were necessary and the court granted Plaintiff’s motion. The court therefore granted Plaintiff’s Motion to Compel without benefit of protective order. We look forward to seeing this information as we believe that CIGNA has paid MES a significant amount of money over the past years.