McCluer v. Sun Life Assurance Company of Canada et al

Filing 14

ORDER Granting Plaintiff's 12 Motion for Discovery. Signed by Magistrate Judge William V. Gallo on 4/1/21. (dlg)

Case 3:21-cv-00008-GPC-WVG Document 14 Filed 04/01/21 PageID.211 Page 1 of 4

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UNITED STATES DISTRICT COURT

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SOUTHERN DISTRICT OF CALIFORNIA

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MICHELE MCCLUER,

Case No.: 21-CV-8-GPC(WVG)
Plaintiff,

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v.

ORDER GRANTING PLAINTIFF’S
MOTION FOR DISCOVERY

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SUN LIFE ASSURANCE COMPANY
OF CANADA et al.,

[Doc. No. 12.]

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Defendants.

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In this ERISA action, Plaintiff seeks additional life insurance payments under a

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policy’s accidental death provision. She now moves for leave to conduct limited discovery.

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Because Plaintiff has met her burden to establish that the proposed discovery is appropriate,

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the motion is GRANTED.

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I.

LEGAL STANDARD

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The decisions made by administrators of ERISA plans are generally subject to de

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novo review. Firestone Tire & Rubber Co. v. Bruch, 489 U.S. 101 (1989). When the district

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court conducts a de novo review of an ERISA plan’s denial of benefits, its task is “to

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evaluate whether the plan administrator correctly or incorrectly denied benefits.” Abatie v.

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Alta Health & Life Ins. Co., 458 F.3d 955, 963 (9th Cir. 2006) (en banc). The court must
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act without deference to the administrator’s decision. Atwood v. Newmont Gold Co., Inc.,

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45 F.3d 1317, 1323 (9th Cir. 1995).

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Ninth Circuit jurisprudence has established that ERISA cases generally limit

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discovery to the administrative record that existed before the claim administrator when the

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claim determination was made, unless exceptional circumstances exist. See Kearney v.

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Standard Ins. Co., 175 F.3d 1084, 1090 (9th Cir. 1999). The district court has discretion to

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allow additional evidence “only when circumstances clearly establish that additional

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evidence is necessary to conduct an adequate de novo review.” Mongeluzo v. Baxter

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Travenol Disability Benefit Plan, 46 F.3d 938, 944 (9th Cir. 1995) (quoting Quesinberry

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v. Life Ins. Co., 987 F.2d 1017, 1025 (4th Cir. 1993) (en banc) (internal quotation marks

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omitted)).

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The party seeking to introduce extrinsic evidence must make more than “[a] bare

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showing of relevancy.” Blaj v. Unum Life Ins. Co. of Am., No. 13CV4075-MMC(KAW),

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2014 U.S. Dist. LEXIS 82539, 2014 WL 2735182, at *4 (N.D. Cal. June 16, 2014). A

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district court has discretion to consider evidence outside of the administrative record,

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though it “must be narrowly tailored and cannot be a fishing expedition.” Groom v.

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Standard Ins. Co., 492 F. Supp. 2d 1202, 1205 (C.D. Cal. 2007).

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II.

DISCUSSION

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The discovery Plaintiff seeks here is narrowly limited to the plan documents that the

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decedent received from either his employer or Defendant. (Doc. No. 12 at 6 (seeking

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“documents [that] were provided to him as part of the benefit plan . . . .”).) These include

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any summary of benefits he may have been provided. Plaintiff contends she does not have

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the ability to otherwise obtain these documents because her husband, the covered insured,

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is deceased. Plaintiff simply seeks to obtain whatever documents—whether they be the

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entire policy or a summary of benefits—were provided the decedent. As an initial matter,

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the Court finds this request is very narrowly tailored, would not be burdensome on either

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Defendant or the decedent’s employer, and would not constitute a “fishing expedition.”

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The Court thus turns to the necessity of these documents in this case.
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Citing Weis v. Accidental Death & Dismemberment Ben. Plan of Kaiser Found.

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Health Plan Inc., 442 F. Supp. 2d 850, 853 (N.D. Cal. 2006), Plaintiff states that that “court

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held that where a summary of benefits is distributed to insureds instead of the policy itself,

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then that summary of benefits should be considered in determining whether the Brooks

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proximate cause standard should be applied.”1 (Doc. No. 12 at 6.) Although Plaintiff does

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not flesh this argument out, the Court agrees that a summary of benefits may be relevant

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and necessary upon Judge Curiel’s consideration of the correct definition of the policy’s

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“Accidental Bodily Injury” provision—a definition that is hotly contested by the parties.

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Plaintiff further contends that if the “Court agrees with Plaintiff [that Defendant applied

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too narrow of a definition and rather the definition in Brooks applies] . . . , the Court must

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either remand the case back to Sun Life for a reevalution of the claim, or reevaluate the

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claim itself considering additional evidence outside of the administrative record presented

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by the parties.” (Id. at 5; see generally Stokes v. Police & Firemen’s Ins. Asso., 243 P.2d

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144, 147-48 (1952) (“It is our opinion that it is now the settled law of this state since the

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Brooks decision that a recovery may be had under the provisions of a policy providing for

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payment where ‘death is caused by external, violent and accidental means, independent of

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all other causes’ and ‘excluding payment where death is caused wholly or in part by

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disease’ if the accident is the proximate cause and sets in motion a chain of events leading

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directly to death, notwithstanding the fact that a preexisting disease contributed to the

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death.”).)

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Defendant counters that whatever documentation the decedent may have received is

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wholly irrelevant because only the terms of the master policy control. (Doc. No. 13 at 5.)

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However, this is not accurate. As the court in Weis explained, a provision in a summary of

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benefits that conflicts with the master policy may weigh in the insured’s favor under the

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“doctrine of reasonable expectations.” Weis, 442 F. Supp 2d at 853. Under this doctrine, a

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Defendant does not address Weis in its opposition.
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conflicting summary of benefits or policy provided to an insured may become relevant

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because, “[i]n general, courts will protect the reasonable expectations of applicants,

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insureds, and intended beneficiaries regarding the coverage afforded by insurance carriers

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even though a careful examination of the policy provisions indicates that such expectations

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are contrary to the expressed intention of the insurer.” Saltarelli v. Bob Baker Group

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Medical Trust, 35 F.3d 382, 386 (9th Cir. 1994) (quoting Robert E. Keeton & Alan I.

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Widiss, Insurance Law: A Guide to Fundamental Principles, Legal Doctrines, and

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Commercial Practices § 6.3 (West 1988)).

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Further, the master policy is not the only controlling document; a summary of

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benefits can also be relevant because it “is part of the ERISA plan.” Bergt v. Ret. Plan for

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Pilots Employed by Mark Air, Inc., 293 F.3d 1139, 1143 (9th Cir. 2002). Moreover, when

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a master policy and summary conflict, the document that is more favorable to the insured

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governs. Id. at 1145. Thus, while Defendant wishes to rely solely upon the language of the

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master policy, a conflicting summary of benefits—if one even exists—may impact Judge

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Curiel’s deliberations in the future. That may or may not ever happen in the end, but this

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Court is not prepared to foreclose such a possibility from the start. And given the limited

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scope of the discovery request, the Court finds good cause to grant it.

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III.

CONCLUSION

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For the reasons set forth above, Plaintiff is granted leave to conduct limited

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discovery in the form of a document request to Defendant for any plan documents and a

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document subpoena to the decedent’s employer for the same. The parties shall file a joint

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status report every 21 days starting from the date of this Order explaining where in the

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process the parties are and how long before the process completes.

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IT IS SO ORDERED.
DATED: April 1, 2021

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