Attorneys Seek Information In Order to Prove Conflict of Interest Impacted Claim Denial
Another case appeared recently before the United States District Court, Northern District of Indiana, Hammond Division. It sheds light on motions to compel. We will look at the background behind the motion before looking at how the Court evaluated the need for discovery into a disability insurance company’s claims decision process. This case is another example of how a disability insurance company will fight with great effort to hide their potentially unreasonable claims handling activities.
BP Corporation of North America employed Clifford Hall for 27 years as a process operator. On December 1, 2007 he was involved in the motor vehicle accident that caused serious neck and back injuries and a traumatic brain injury as well. He worked his last day at BP the next day.
He was no longer able to fulfill the duties of his medium level job. His responsibilities had included carrying various tools and equipment, using a computer, connecting and disconnecting tank cars, loading tank cars and other physical activities at the oil refinery. He had participated in the BP Welfare Plan Trust-III (BP Plan) as an employee benefit. Life Insurance Company of North America (LINA) provided the long-term disability insurance coverage to employees who participated in this plan.
Hall applied for disability benefits through LINA, providing objective medical proof that he was unable to work due to the medical conditions caused by his accident. He was approved for short-term disability, and benefits were paid for several weeks. Then LINA denied Hall’s claim for long-term disability benefits.
Disability insurance company provides only some of the information requested.
After seeking legal representation, Hall filed a disability lawsuit on June 22, 2009. In an effort to represent Hall effectively, his disability attorneys served Interrogatories and a Request for Production of Documents to Life Insurance Company of North America (LINA) also known as CIGNA on August 19, 2009. In their response of September 25, the disability insurance company provided Hall with some answers to the interrogatories and partial responses to the Request for Production. LINA objected to some of the information being requested.
Here were LINA’s arguments:
- The information the disability insurance attorney’s wanted was not reasonably calculated to lead to admissible evidence.
- The information they were asking for was private.
- The information the disability attorneys sought was confidential, proprietary, and trade secret information.
- The information the disability attorneys wanted went beyond the information that was submitted to LINA during the claims process.
The disability attorneys conferred with LINA’s attorneys and agreed to revise their discovery requests. LINA agreed that if this was done, they would respond to the remaining requests by October 20. Nothing was heard from the insurance company by that date. Finally on December 15, 2009, Hall’s disability insurance attorneys emailed LINA asking when a response could be expected. On December 18, LINA informed Hall’s attorneys that they were not going to provide the supplemental responses after all.
Meanwhile, Hall’s disability insurance attorneys were aware that LINA had asked Intracorp to assign a specialist in occupational medicine to review Hall’s medical records. Intracorp had assigned Dr. Ephraim Brenman. As both companies were wholly owned subsidiaries of CIGNA, the attorneys had reason to suspect a conflict of interest. They served Intracorp with a subpoena duces tecum, a written command that required Intracorp to produce documentary or other tangible evidence in their possession or control that was relevant to Hall’s lawsuit.
Because LINA refused to provide the additional information requested, Hall’s disability attorneys filed a Motion to Compel with the court on December 22, 2009. The day before LINA had filed a Motion to Quash the subpoena directed at Intracorp or sought, as an alternative, protective orders. LINA also filed a motion for extension of time on January 22, 2010. When the Court heard the arguments on February 25, the motions were fully briefed and ripe for ruling.
Disability insurance attorneys argue for right to discovery.
Hall’s disability insurance attorneys argued that as an ERISA benefits suit they had the right to seek discovery outside of the administrative record as this would permit the Court to evaluate the role conflict of interest played in LINA’s decision to deny benefits. Because LINA was both the plan administrator and payer of benefits, conflict of interest was a possibility. His attorneys contended that LINA’s claim review was biased because it has emphasized medical reports that favored denying the benefits and deemphasized reports that demonstrated Hall’s total disability.
LINA argued that the scope of discovery Hall’s attorneys were requesting exceeded that permissible when the standard of review under ERISA is the arbitrary and capricious standard. The insurance company claimed that Hall had to do more than suggest there might be a conflict of interest. His disability attorneys also had to show that there was reason to believe that the discovery would reveal a procedural defect in LINA’s benefits determination.
The Court began to consider the case law applying to discovery. In Glenn v. Metlife, the Supreme Court reaffirmed that a deferential standard of review was appropriate when a plan administrator operated under a structural conflict of interest – when an insurance company determines who is eligible for the benefits and then pays for those benefits out of its own pocket. This ruling encourages courts to consider whether a disability insurance provider has a history of biased claims administration and to review the active steps an insurance company has put into place to reduce potential bias and to promote accuracy in their claims processing methods.
A prior ruling in the Seventh Circuit, Semien v. Life Ins. Co. of N. Am., had established a two-pronged requirement before limited discovery could be compelled by the Court. First, the specific conflict of interest or instance in which the conflict occurred had to be identified. Then, convincing arguments for how limited discovery into these allegations would reveal a procedural defect in the plan administrator’s determination had to be presented.
Insurance company and Disability Attorneys agree on conflict of interest.
Both LINA and Hall’s disability attorneys agreed that the conflict of interest described in Glenn applied to LINA. But they disagreed on whether Semien bore a connection to discovery in this case.
There has been considerable variation on how Glenn has been applied in District Courts across the country. Some courts within the Seventh Circuit had ruled that Glenn overruled Semien, while others considered Semien still applicable. Some rulings have found that allowing discovery into evidence relevant to the claim administrator’s alleged conflict of interest should be more accessible as under Glenn, but tempered by the relevancy required under Semien.
Court determines that discovery is necessary to prove whether disability insurance company had a conflict of interest.
The Court in this case sided with Glenn, determining that without information that revealed whether a relationship existed between LINA, Intracorp and Dr. Brenman, it would be impossible for the Court to determine if this relationship resulted in a biased claims review. LINA had already answered questions on the Interogatory that implied the disability insurance company’s acceptance that information about the structural conflict of interest was relevant, but the company wanted to be selective in their disclosure. (This is something the Court generally looks on with disfavor.)
The Court ruled that Hall’s disability attorneys had the right to conduct reasonable and limited discovery into the extent to which conflict of interest colored the long-term disability denial decision. But the Court was not going to give cart-blanche rights to discovery. Each request would be evaluated for the reasonable nature of the request.
Court supports disability attorney’s interrogatories.
The Court found every interrogatory to the point and ordered LINA to supply all the requested answers. The requests to produce information were also in most cases sufficiently limited in their scope. One request for information was too broad in that it asked for copies of the correspondence between all of LINA’s medical examiners during the time Hall’s claim was being reviewed. The Court found that this put highly personal information from many individuals who had no connection with Hall’s case at risk. LINA’s objections were sustained, with one exception. If there was any correspondence relating to Hall’s claim that was not in the administrative record, it was to be delivered as requested.
A second request for reports which reviewing physicians had provided to LINA during the past five years was likewise found to be too broad. Citing Hughs and Barker, the Court found that the potential relevance of these reports was too minor to justify the invasion of the privacy of so many claimants who were not connected with Hall’s claim.
Court considers subpoena to Intracorp.
Finally, the Court addressed the Motion to Quash the subpoena on Intracorp. LINA argued that a copy of the subpoena should have been submitted to them first, before it was sent to Intracorp, as required by Federal Rule of Civil Procedure 45(b). The Court found that because Intracorp had not supplied any of the requested documents and LINA had been able to use the Motion to Quash to raise their objections to the subpoena, there was nothing to quash.
The Court moved on to consider the objections to the subpoena. Was Hall’s disability attorney’s requests for the contracts, agreements or writings regarding Dr. Brenman’s reviews or consultations for Intracorp over the last three years reasonable? Was it reasonable to seek information on how much Intracorp had paid Dr. Brenman over the past three years for medical examinations, reviews and consultations? Did the disability insurance attorneys really need to know what contracts existed between Intracorp and LINA? The Court said yes, but ordered that all personal information other than Dr. Brenman’s first name be deleted from the documents produced.
Hall’s disability attorneys had also requested information revealing how many medical reviews and consultations Intracorp had preformed for LINA, and the number specifically performed by Dr. Brenman over the past three years. The Court found this request addressed the issue of bias. The request of information on how much LINA had paid Intracorp for the past three years was likewise validated with the stipulation that all personal information but Dr. Brenman’s name be blacked out.
Court issues protective order when Disability Attorneys requests information not connected to lawsuit directly.
The Court issued a protective order as requested by LINA for Hall’s request for “[a]ny and all documents, letters, records, or other writings which reflect how many medical records reviews were performed by Dr. Brenman (or Intracorp] for LINA over the past three years,” and Request No. 13, which asked for information as to Dr. Brenman’s and Intracorp’s billing rates for the past three years for medical records review. Only records that reflected the fact of Dr. Brenman’s or Intracorp’s work without containing the substance of the work, where personally identifiable information could be blacked out easily, needed to be produced.
LINA argued that some of the evidence requests were seeking duplication of information and placed an undue burden upon the disability insurance company. The Court disagreed and ordered LINA to produce them.
Two of the requests for information were too broad by the Court’s standards. Hall’s disability attorneys had asked for all the disability claims related reports generated by Intracorp for LINA, and Dr. Brenman in particular, over the past three years. The Court issued protective orders for these requests, instructing Intracorp to not respond to these requests.
The final result of these proceedings was favorable to Hall and his disability attorneys. Almost every item that they had asked the Court to compel LINA to respond to had been granted.