Soenksen v. Takeda Pharmaceuticals North America, Inc.

Filing 58

MEMORANDUM Opinion and Order. Plaintiff, Mary Soenksen ("Soenksen") has sought discovery in her action challenging the denial by Takeda Pharmaceuticals North America, Inc. Welfare Plan ("the Plan") and Aetna Life Insurance Compa ny ("Aetna") of Soenksen's claim for Plan benefits, and that request has triggered a full set (indeed, a good deal more than the usual full set) of memoranda dealing with the legal issues involved in that respect. Because the Plan-Ae tna position reflects a bizarre notion of the meaning of "de novo" -- the standard that both sides agree is applicable to this Court's consideration of Soenksen's claim -- the motion is granted. Status hearing set for 8/28/2014 at 9:00 AM. Signed by the Honorable Milton I. Shadur on 7/8/2014. Mailed notice(tlp, )

IN THE UNITED STATES DISTRICT COURT
FOR THE NORTHERN DISTRICT OF ILLINOIS
EASTERN DIVISION

MARY SOENKSEN,
Plaintiff,
v.
TAKEDA PHARMACEUTICALS NORTH
AMERICA, INC. WELFARE PLAN, an
Illinois corporation, et al.,
Defendants.

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Case No. 12 C 2437

MEMORANDUM OPINION AND ORDER
Plaintiff, Mary Soenksen ("Soenksen") has sought discovery in her action challenging the
denial by Takeda Pharmaceuticals North America, Inc. Welfare Plan ("the Plan") and Aetna Life
Insurance Company ("Aetna") of Soenksen's claim for Plan benefits, and that request has
triggered a full set (indeed, a good deal more than the usual full set) of memoranda dealing with
the legal issues involved in that respect. Because the Plan-Aetna position reflects a bizarre
notion of the meaning of "de novo" -- the standard that both sides agree is applicable to this
Court's consideration of Soenksen's claim -- the motion is granted.
Ever since Firestone Tire & Rubber Co. v. Bruch, 489 U.S. 101 (1989) ("Bruch") was
decided, the conventional wisdom in ERISA benefits cases has been that appropriate plan
language can limit the judicial consideration of administrative decisions on benefits to the
question whether those decisions are arbitrary and capricious. But in Diaz v. Prudential Ins. Co.
of Am., 424 F.3d 635, 637 (7th Cir. 2005) our Court of Appeals explained that in some situations
Bruch teaches the application of de novo review instead, and the court therefore remanded the

case for reconsideration in those terms. And when the District Court also got it wrong the
second time around, Diaz II, 499 F.3d 640, 643 (7th Cir. 2007) reinforced Diaz I's earlier
teaching.
Because the confusion that the two Diaz opinions sought to clear up appears to be
contagious (or at least has reappeared in the Plan-Aetna submissions here), it is worth repeating
the explanation in Diaz II. Here it is (499 F.3d at 643):
The district court's task in engaging in de novo consideration of the decision of
the plan administrator is not the same as its job in reviewing administrative
determinations on the basis of the record the agency compiled under the
substantial evidence rule, as it might do in a Social Security benefits case. See
Ramsey v. Hercules Inc., 77 F.3d 199, 205 (7th Cir. 1996). Some of the confusion
in this area may be attributable to the common phrase " de novo review" used in
connection with ERISA cases. In fact, in these cases the district courts are not
reviewing anything; they are making an independent decision about the
employee's entitlement to benefits. In the administrative arena, the court normally
will be required to defer to the agency's findings of fact; when de novo
consideration is appropriate in an ERISA case, in contrast, the court can and must
come to an independent decision on both the legal and factual issues that form the
basis of the claim. What happened before the Plan administrator or ERISA
fiduciary is irrelevant. See Patton v. MFS/Sun Life Financial Distributors, Inc.,
480 F.3d 478, 485-86 (7th Cir. 2007). That means that the question before the
district court was not whether Prudential gave Diaz a full and fair hearing or
undertook a selective review of the evidence; rather, it was the ultimate question
whether Diaz was entitled to the benefits he sought under the plan. See Wilczynski
v. Kemper Nat. Ins. Companies, 178 F.3d 933, 934-35 (7th Cir. 1999).
Given that explanation, the proposed conclusion reached in the last sentence of the
following excerpt from page 2 of the Plan-Aetna submission filed June 13, 2014 1 seems almost
oxymoronic:

1

As an indication of the memorandum overload with which this Court has been favored,
here is the caption of that most recent submission: Defendants' Response To Plaintiff's Second
Supplemental Memorandum in Response To Defendants' Objection To Plaintiff's Request for
Discovery [D/E 52].
-2-

In Diaz v. Prudential Ins. Co. of America, 499 F.3d 640, 643(7th Cir. 2007), the
Seventh Circuit stated that when de novo review is appropriate what happened
before the plan administrator is irrelevant. The courts have made it clear that in a
de novo review, the evidence concerning the administrative process is of no
weight. See Kuznowicz v. Wrigley Sales Co., LLC, 2013 WL 4052381, at *13
(N.D. Ill. August 12, 2013) (the court stated what happened before the plan
administrator is irrelevant in a de novo review). Thus consistent with the case law
of this circuit, it is Defendants' position that discovery in this case is unnecessary.
In this instance, however, the administrative treatment (or lack of treatment) of the views of
Soenksen's treating physician Dr. Peter Allegretti particularly calls for fleshing out through
further discovery, 2 and further medical information that bears on whether Soenksen was or was
not disabled when she applied for benefits also has potential to be useful. As stated at the outset,
Soenksen's motion is granted, and this action is set for a next status hearing at 9 a.m. on
August 28, 2014. 3

__________________________________________
Milton I. Shadur
Senior United States District Judge
Date: July 8, 2014

2

In that respect, for example, two documents emanating from Dr. Allegretti and
contained in the administrative record are puzzling in nature and require further elaboration or
explanation or both.
3

If the parties run into further problems in connection with the scope of discovery, it
may be appropriate to refer those to a Magistrate Judge to be decided by lot (the originally
assigned Magistrate Judge, Honorable Martin Ashman, has passed away), for this Court is not in
a position to engage in continuous monitoring. That however remains to be seem.
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