French et al v. Dade Behring Life Insurance Plan

Filing 62

RULING AND ORDER: IT IS ORDERED that the Motion for Leave to Conduct Discovery on Administrative Record is DENIED and the Motion For Extension of Time (R. Doc. 53) filed by plaintiffs, Linda French and Ann French Gonsalves, is hereby GRANTED and plai ntiffs are granted an additional thirty (30) days from date of this Order. IT IS FURTHER ORDERED that the Motion to Strike and [for] Leave to File Sur-Reply (R. Doc. 58) filed by defendant, the Dade Behring Life Insurance Plan, is GRANTED IN PART, in that the Plan is granted leave to file its sur-reply memorandum, and DENIED IN PART, in that no portion of plaintiffs reply memorandum shall be struck from the record. Signed by Magistrate Judge Christine Noland on 11/18/2010. (NLT)

Download PDF
UNITED STATES DISTRICT COURT MIDDLE DISTRICT OF LOUISIANA LINDA FRENCH AND ANN FRENCH GONSALVES VERSUS DADE BEHRING LIFE INSURANCE PLAN RULING & ORDER This matter is before the Court on the Motion for Leave to Conduct Discovery on Administrative Record and For Extension of Time (R. Doc. 53) filed by plaintiffs, Linda French and Ann French Gonsalves (collectively "plaintiffs"). Defendant, Dade Behring Life Insurance Plan ("the Plan"), has filed an opposition (R. Doc. 56) to plaintiffs' motion, in response to which plaintiffs have filed a reply memorandum (R. Doc. 61). Also at issue in this ruling is the Plan's Motion to Strike and [for] Leave to File Sur-Reply to Plaintiff's Reply Memorandum (R. Doc. 58), to which plaintiffs have filed an opposition (R. Doc. 59). FACTS & PROCEDURAL BACKGROUND The plaintiffs in this matter are two (2) sisters who are the named beneficiaries of an optional life insurance policy provided to their brother, Martin French ("Mr. French"), through an ERISA plan sponsored by his former employer, Dade Behring, Inc. ("Dade Behring").1 The plaintiffs brought the present action to obtain additional benefits from the Plan under that optional policy. According to the plaintiffs, following Mr. French's death, the Plan initially confirmed that they would receive optional life insurance benefits of T h e f a c t t h a t t h e P l a n a t i s s u e i s o n e g o v e r n e d b y t h e E m p l o y e e R e tir e m e n t I n c o m e S e c u rit y A c t 1 of 1 9 7 4 E RIS A i s u n d i s p u t e d a m o n g t h e p a r ti e s . T h e P l a n p r o v i d e s b a s i c a n d o p ti o n a l lif e i n s u r a n c e b e n e fit s t o e m p l o y e e s o f D a d e B e h ri n g . " " CIVIL ACTION NO. 09-394-C-M2 1 approximately $1,600,000.00;2 however, the Plan later claimed that Mr. French had not provided the requisite evidence of insurability ("EOI") when his coverage exceeded $800,000.00. The Plan therefore paid only $478,058.00 in benefits to the plaintiffs. The plaintiffs filed a claim with the Plan for additional benefits, which was first considered by the Plan's insurer and claims administrator, the Hartford. The Hartford denied the plaintiffs' claim as well as a subsequent appeal of that determination,3 on the basis that the Plan's terms prevented Mr. French's life insurance from exceeding $800,000.00 due to his failure to comply with plan terms by submitting a written application and proof of good health during the relevant period. The plaintiffs next appealed the Hartford's decision to the plan administrator, i.e., the Administrative Committee of the Plan,4 which also upheld the benefits denial for the reasons stated above. The plaintiffs then filed the present suit seeking the additional benefits that they contend they are owed under the policy in question.5 After the filing of this suit, the undersigned entered an ERISA Case Order on June 10, 2010. (R. Doc. 38). In their response to that case order (R. Doc. 49), the plaintiffs B e n e fit s u n d e r M r . F r e n c h s b a s i c lif e i n s u r a n c e p o li c y w e r e p a i d t o a d iff e r e n t n a m e d 2 b e n e fi c i a r y . T h e p l a n a t i s s u e r e q u ir e s t h a t fir s t li n e a p p e a l s o f b e n e fit d e t e r m i n a ti o n s s h o u l d b e s u b m itt e d t o 3 t h e clai m s a d m inistr a t o r f o r r e vie w . T h e A d m i n i s tr a ti v e C o m m itt e e i s t h e P l a n s n a m e d fi d u c i a r y r e s p o n s i b l e f o r r e v i e w i n g b e n e fit 4 d e t e r m i n a ti o n s m a d e b y t h e P l a n s c l a i m s a d m i n i s tr a t o r, t h e H a rtf o r d . I n t h i s s u it, p l a i n tiff s c o n t e w hic h c o ntain s a S u m m ary Pla n D e r e q u ir e d t o p r o vi d e a n E O I b e c a u s e i n s u r a n c e w h e n n e w l y h ir e d w ill n o , R . D o c . 1 , p . 3 , ¶ 9 . P l a i n tiff s f oS f e c e o v e r a g e d u r i n g t h e l a s t t w o 2 als o interprete d th e S P D a n d oth er 5 ' ' nd sc th th u rt th ri p e av he ye docu a t, a c c o r d i n g t o t h e D a d e B e h ri n g E m p l o y e e B e n e fit s H a n d b o o k , ti o n SPD f o r t h e P l a n i n q u e s ti o n , M r. F r e n c h w a s n o t S P D p r o v i d e s t h a t t h o s e w h o a p p l y f o r o p ti o n a l g r o u p t e r m lif e e t o g o t h r o u g h t h e E v i d e n c e o f I n s u r a b ilit y E OI pro c e ss. r a s s e r t t h a t t h e P l a n s d e d u c ti o n o f p r e m i u m s f o r t h e f u ll a m o u n t a r s o f M r . F r e n c h s lif e i n d i c a t e s t h a t t h e P l a n s a d m i n i s t r a t o r s m e n t s a s n o t r e q u iri n g p r o o f o f i n s u r a b ilit y . " " ' ' " ' 2 ' " contended that the administrative record compiled by the Plan and filed herein is incomplete in that it contains little evidence of any of the documents reviewed by the Hartford. The Plan, however, has refused to stipulate that the Hartford's file should be included within the administrative record filed with the Court.6 Through their present motion, plaintiffs seek the right to conduct discovery regarding the "completeness" of the administrative record, contending that "it is clear that many relevant documents which were or must have been in [the] Hartford's records are not in the AR as compiled by the Plan, and because it is possible that parts of important plan documents (such as the policy) as well as documentation of basic things such as the death of Mr. French are missing from the AR." Plaintiffs propose to serve the Hartford with a subpoena duces tecum to produce its entire file relating to their claim and appeals, including a certified copy of the policy. They represent that, if the records produced by the Hartford pursuant to that subpoena appear complete, no further discovery will be necessary; however, if the records do not appear complete, plaintiffs will proceed with a A c c o r d i n g t o t h e p l a i n tiff s p r e s e n t m o ti o n , t h e o n l y d o c u m e n t s i n c l u d e d i n t h e a d m i n i s tr a ti v e 6 r e c o r d t h a t a r e c l e a rl y p a rt o f t h e a d m i n i s tr a ti v e r e v i e w c o n d u c t e d b y H a rtf o r d a r e fi v e l e tt e r s b e t w e e n p l a i n tiff s a n d H a r tf o r d , a ll o f w h i c h a p p e a r t o h a v e b e e n c a r b o n c o p i e d t o D a d e B e h ri n g . , R. D o c. 5 3 - 1 , p . 3 . T h e p l a i n t i f f s n o t e t h a t t h e a d m i n i s t r a t i v e r e c o r d d o e s n o t c o n t a i n a n u m b e r o f t h Se e d e o c u m e n t s s u c h a s in s ura n c e t y p i c a ll y s e e n w it h i n a d m i n i s t r a ti v e r e c o r d s i n o t h e r E R I S A b e n e fit s c l a i m s c a s e s a p p li c a ti o n s , a d e a t h c e r tifi c a t e , e m a il s f r o m o r t o t h e c l a i m s a d m i n i s t r a t o r , r e c o r d s o f t e l e p h o n e c o n v e r s a ti o n s , r e c o r d s o f c o m m u n i c a ti o n s b y t h e c l a i m s a d m i n i s tr a t o r w it h t h e P l a n o r o t h e r e n titi e s , a c e r tifi e d c o p y o f t h e p o li c y i n q u e s ti o n , a n d / o r i n t e r n a l l o g s f r o m t h e c l a i m s a d m i n i s t r a t o r s fil e s . P l a i n tiff s c o n t e n d t h a t o t h e r r e l e v a n t d o c u m e n t s a r e li k e l y t o b e f o u n d i n H a r tf o r d s fil e s . F o r e x a m p l e , t h e y r e f e r e n c e s e v e r a l e m a il s t h a t p l a i n tiff, L i n d a F r e n c h , e x c h a n g e d w it h t h e H a r tf o r d i n J a n u a r y 2 0 0 6 t h a t a r e n o t i n c l u d e d i n t h e a d m i n i s t r a ti v e r e c o r d a s d e s i g n a t e d b y t h e P l a n . A d d iti o n a ll y , p l a i n tiff s a s s e r t t h a t t h e H a rtf o r d m u s t h a v e r e c e i v e d t h e c o m p l e t e d v e r s i o n o f t h e C l a i m s F o r m ; y e t, it i s n o t c o n t a i n e d w it h i n t h e a d m i n i s t r a ti v e r e c o r d . F u r t h e r m o r e , w h il e i n a n o t h e r d o c u m e n t w it h i n t h e a d m i n i s t r a ti v e r e c o r d DB 5 6 , t h e H a r tf o r d s t a t e s t h a t it h a d r e c e i v e d i n f o r m a ti o n t h a t M a r ti n F r e n c h e l e c t e d v o l u n t a r y lif e i n s u r a n c e o f 5 ti m e s s a l a r y i n 1 9 9 6 , t h e H a rtf o r d s s o u r c e f o r t h a t i n f o r m a ti o n i s n o t i n c l u d e d i n t h e a d m i n i s t r a ti v e r e c o r d . F i n a ll y , t h e p l a i n tiff s c o n t e n d t h a t p a r t s o f t h e C N A p o li c y a r e a l s o p o s s i b l y m i s s i n g fr o m t h e a d m i n i s tr a ti v e r e c o r d . " ' ` ' " " " ' " ' " " " " ' " " 3 " corporate deposition of the Hartford. Finally, plaintiffs seek an extension of time to conduct such discovery relative to the Hartford and to respond to the Plan's presently pending motion for summary judgment. As mentioned above, also before the Court is a Motion to Strike and [for] Leave to File Sur-reply to Plaintiff's reply memorandum relating to the plaintiffs' motion to conduct discovery. Through that motion, the Plan seeks to have the Court strike portions of plaintiff's reply memorandum on the ground that it allegedly asserts "new arguments, which inappropriately address plaintiffs' claims on the merits" and which should "not be considered by this Court as they were raised for the first time in plaintiffs' reply memorandum," and seeks leave to file additional arguments responding to plaintiff's reply memorandum. While it is true that plaintiffs set forth contentions concerning the merits of their case in the "Factual Background" section of their reply memorandum (pages 1-4), the Court finds that those contentions are merely a response to the Plan's presentation of its own contentions relating to the merits of this case in the "Factual Background" section of the Plan's opposition to plaintiffs' motion to conduct discovery, and as a result, such is not a basis for striking plaintiffs' reply memorandum. The Court does note, however, that both parties' contentions relating to the merits of the case have no particular relevance to the plaintiffs' present motion to conduct discovery, and the Court therefore has given little, if any, consideration to those assertions in addressing plaintiffs' motion. Because the Plan's sur-reply memorandum contains arguments relevant to the motion to conduct discovery, however, leave to file that memorandum will be granted, and the arguments presented therein will be considered by the Court. 4 LAW & ANAYLSIS ERISA provides federal courts with jurisdiction to review benefits determinations made by fiduciaries or plan administrators. See, 29 U.S.C. §1132(a)(1)(B). Thus, in the present case, the Court is reviewing the benefits determination that was made by the plan administrator for the Dade Behring ERISA Plan, which, as noted above, is called the Administrative Committee.7 At the time that a plan administrator considers a claim for benefits, it has the obligation to identify the evidence in the administrative record,8 and the claimant must be afforded a reasonable opportunity to contest whether the record is complete. Estate of Bratton v. National Union Fire Ins. Co. of Pittsburgh, PA, 215 F.3d 516, 521 (5th Cir. 2000). Thus, according to Fifth Circuit precedent, "the administrative record consists of relevant information made available to the plan administrator prior to the complainant's filing of a lawsuit and in a manner that provides the administrator with a fair opportunity to consider it." Id.9 The Fifth Circuit has specifically noted that a plaintiff can request that additional evidence be added to the administrative record prior to the plan administrator's consideration of that record as long as such evidence is made a part of the T h e C o u rt i s n o t r e v i e w i n g a n y d e c i s i o n s m a d e b y t h e c l a i m s a d m i n i s tr a t o r, t h e H a rtf o r d . 7 It i s t h e p l a n a d m i n i s t r a t o r s r e s p o n s i b ilit y t o c o m p il e a r e c o r d t h a t h e i s s a ti s fi e d i s s u ffi c i e n t f o r his d e cisio n. ,2005 W L 4891214 N . D . T e x . 2 0 0 G 5 riffi, n q vu . o Ri a y t h e o n C o m p a n y L , o an t g 5 T2 e1 r. m D is a b ilit y P l a n N o . 5 5 8 tng 8 " " E s t a t e o f B r a tt o n , 1 8 8 F.3 d 2 8 7, 2 9 9 5 th C i r . 1 9 9 9 en banc n o ti n g 9 t h a t p l a i n t Si f e s e ,c V ne ge aa svi .l y N p a r t e l s Le ifn et I n s .o r S a eb rl ve s .e , v Ii nd ce . n c e t o t h e p l a n a d m i n i s t r a t o r , a n d h o l d i n g t h a t , [ b ] e f o r e f a fav fili n g s u it, t h e c l a i m a n t s l a w y e r c a n a d d a d d iti o n a l e v i d e n c e t o t h e a d m i n i s t r a ti v e r e c o r d s i m p l y b y s u b m itti n g it t o t h e a d m i n i s tr a t o r i n a m a n n e r t h a t g i v e s t h e a d m i n i s tr a t o r a f a ir o p p o rt u n it y t o c o n s i d e r it ; , at *2 A lt h o u g h c ir c u m s t a n c e s c a n b e e n v i s i o n e d i n w h i c h a m i s c r e a n t p l a n en a d m i n Si s et e a a lsr o , n G driffi ny i n g a c l a i m c o n c e a l s e v i d e n c e t h a t , i f d i s c l o s e d , w o u l d h a v e c a s t e d d o u b t o n i t s r to i d e cisio n, s u c h e vid e n c e f o r e x a m p l e , a m e d i c a l r e p o rt f a v o ri n g t h e c l a i m a n t i s t y p i c a ll y e q u a ll y a v a il a b l e t o t h e c l a i m a n t, w h o h a s a ri g h t t o i n c l u d e it i n t h e a d m i n i s t r a ti v e r e c o r d p ri o r t o t h e p l a n a d m inistr a t o r s d e cisio n . ' ' " ' ' " 5 " " record in time to allow the administrator a fair opportunity to consider it. Id. A claimant, however, is not permitted to explore, through discovery in an ERISA lawsuit, what information a plan administrator "should have considered" in making its benefits determination. Instead, the claimant is only permitted to discover the information that the plan administrator "did consider" in making its decision. Griffin, at *2. In fact, once an ERISA lawsuit is filed and the administrative record that the plan administrator considered has been filed with the court, the district court may not stray from that record except under two (2) limited circumstances: (1) the admission of evidence related to how an administrator has interpreted terms of the plan in other instances, and (2) evidence, including expert opinion, that assists the district court in understanding the medical terminology or practice related to a claim. Id. Neither of those exceptions appear to be applicable in the present matter. According to the Plan, in the present case, the Administrative Committee's review and denial of plaintiffs' claim for additional life insurance benefits rested solely upon the fact that no evidence existed within the Plan's documents showing that Mr. French submitted a written application and proof of good health in compliance with the Plan's terms within the relevant time period. The Plan therefore contends that the administrative record in this case is complete because it consists of the Plan's documents concerning Mr. French and the Plan's terms during the relevant years.10 Prior to the Administrative Committee considering that record during the administrative appeals process and before this suit was The a 10 b eca use, accord w as refu n d e d th P l a i n tiff s d o n o t a s s e rti o n t h a t t h d m ini in g to e c o rr c h a ll e e ded s tr a ti v e th e Pla e ct a m o n g e th e u c ti o n s r e c o r d , a s fil e d w it h t h e n , t h e A d m i n i s tr a ti v e C o u n t o f c e r t a i n p a y r o ll d e a m o u nt of th e refu n d e d w e r e m a d e in e rr o r. C o u rt, a l s o m m itt e e w d u c ti o n s t h p a y r o ll d e c an at du o ntain te d to w ere c ti o n s s M r. F r ensure a ll e g e d l , b ut th e en th y y ch at w it dis s Mr hh pu pa .F eld te y r o ll r e c o r d s re n c h s e state b y e rr o r. th e Pla n s ' ' 6 ' filed, the plaintiffs never raised any argument that the administrative record was incomplete, or more specifically, that the Hartford documents referenced in their present motion should have been included within the administrative record. As such, the additional documents that plaintiffs seek to have added to the administrative record herein were apparently not considered by the Administrative Committee in making its benefits determination, and as a result, the Court cannot consider those additional documents in deciding whether the Administrative Committee's determination was an abuse of discretion. According to the Plan, the first time that the plaintiffs referenced the fact that the Hartford documents should have been included in the administrative record is in response to the undersigned's ERISA Case Order in this suit, and the Plan's counsel specifically attests that plaintiffs' counsel stated that he is seeking such documents now, even though he does not know their significance to this litigation, because he wants to "include as much information as possible into the administrative record prior to the filing of dispositive motions by both parties." See, Declaration of Prashant Kolluri, R. Doc. 56-1. Such a basis for discovery is not permissible in an ERISA case under the Fifth Circuit jurisprudence discussed above. It appears that plaintiff's counsel is seeking, at this late date, to have included in the administrative record, documents that he believes the Administrative Committee "should have considered," rather than what it "did consider" ­ an argument that should have been raised and resolved during the administrative appeals process at a time when the committee would have had a fair opportunity to consider the Hartford documents.11 12 As such, plaintiffs' present motion to conduct discovery will be denied. I n t h e ir r e p l y m e m o r a n d u m , p l a i n tiff s a r g u e t h a t t h e y s h o u l d n o w b e g i v e n a n o p p o rt u n it y , 11 t h r o u g h d i s c o v e r y , t o d e t e r m i n e w h e t h e r t h e a d m i n i s t r a ti v e r e c o r d c o m p il e d b y t h e A d m i n i s t r a ti v e C o m m itt e e i s c o m p l e t e , a n d t h e y c a n d o s o o n l y b y b e i n g p r o v i d e d w it h t h e H a r tf o r d s fil e s . P l a i n tiff s a r e 7 ' in c o rr e a d m ini d u ri n g p ri o r t o ct a str a th e thi s t o t h e ir ti m i n g . ti v e r e c o r d a n d t o a d m i n i s tr a ti v e a p s s u it b e i n g fil e d . H a rtf o r d L if e G r o u p I n s . C o . W hen co on an ad re vie w b th e b e n e e x c e p ti o e x plainin e x c e p ti o d e c li n e d Th di pe Th ,2 ea sco als eF 010 pp ve pr ift r o p ri a t e ti m e f o r t h e m t o r/r e q u e s t t h a t a d d iti o n a l o c e s s p ri o r t o t h e A d m i n h C ir c u it r e c e n tl y s p o k e W L 1 8 3 4 3 1, **5-6 5 th C rais e th e e vid e n c e i s tr a ti v e C o n this is s ir. 2 0 1 0 su e of e in clu m m itt e e once , w h erei is b o u e co d in p e rf g ain n it s t a th de e a m th or in te plete n e ss of th e at record w as m i n g it s r e v i e w a n d d Mt h c e D f o o nl l ao l d i vn .g : w n d u c ti n g a b u m i n i s tr a ti v e r e li m it e d t o f a fit s d e c i s i o n . n s to this rule g m e dic al ter ns have been to a d o pt a ny s e o f d i s c r e ti o n r e v i e w o f a d e c o r d , w e h a v e g e n e r a ll y r e q cts k n o w n to th e pla n a d m ini H o w e v e r, w e h a v e r e c o g niz [ e x c e p ti o n s r e l a t e d t o e it h e r m s a n d p r o c e d u r e s r e l a ti n g t ju d g e d o n a c a s e-b y-c a s e b p er s e rule s in this are a. e n i a l o f b e n e fit s b a s e d u ir e d t h a t t h e s c o p e o f s tr a t o r a t t h e ti m e o f e d c e r t a i n li m it e d i n t e r p r e ti n g t h e p l a n o r o t h e c l a i m ]. T h e s e a sis, a n d w e h a v e W h e n c o m p ili n g t h e a d m i n i s t r a ti v e r e c o r d , t h e p l a n a d m i n i s t r a t o r m u s t i d e n tif y w h a t e v i d e n c e c o n s tit u t e s t h e a d m i n i s tr a ti v e r e c o r d , a n d t h e c l a i m a n t m u s t h a v e a r e a s o n a b l e o p p o rt u n it y t o c o n t e s t w h e t h e r t h a t r e c o r d i s c o m p l e t e . W h il e t h e a d m i n i s t r a ti v e r e c o r d i s g e n e r a ll y li m it e d t o r e l e v a n t i n f o r m a ti o n m a d e a v a il a b l e p ri o r t o t h e c o m p l a i n a n t s fili n g o f a l a w s u it a n d i n a m a n n e r t h a t g i v e s t h e a d m i n i s tr a t o r a f a ir o p p o rt u n it y t o c o n s i d e r it, w e h a v e a tt e m p t e d t o a v o i d a b u s e o r m i s t a k e b y a ll o w i n g t h e c l a i m a n t s l a w y e r [t o ] a d d a d d iti o n a l e v i d e n c e t o t h e a d m i n i s tr a ti v e r e c o r d s i m p l y b y s u b m itti n g it t o t h e a d m i n i s tr a t o r i n a m a n n e r t h a t g i v e s t h e a d m i n i s tr a t o r a f a ir o p p o rt u n it y t o c o n s i d e r it. W e h a v e b e e n c l e a r, h o w e v e r, t h a t t h e d i s tri c t c o u rt i s p r e c l u d e d fr o m r e c e i v i n g e v i d e n c e t o r e s o l v e d i s p u t e d m a t e ri a l f a c t s a f a c t t h e a d m i n i s t r a t o r r e li e d o n t o r e s o l v e t h e m e r i t s o f t h e c l a i m i t s i. ef .. H a d t h e d i s t r i c t c o u r t n o t r e m a n d e d el t o [t h e p l a n a d m i n i s tr a t o r] f o r f u rt h e r i n v e s ti g a ti o n o f [ a p h y s i c i a n s ] o p i n i o n , t h e q u e s ti o n o f w h e t h e r [t h e a d d iti o n a l e v i d e n c e ] s h o u l d b e i n c l u d e d i n t h e a d m i n i s tr a ti v e r e c o r d w o u l d b e c l e a r: t h e a d m i n i s tr a ti v e r e c o r d c l o s e d w h e n [t h e c l a i m a n t] fil e d s u it i n J u n e 2 0 0 6 . T h e [ a d d iti o n a l e v i d e n c e ] d o e s n o t f a ll i n t o t h e t w o a c k n o w l e d g e d e x c e p ti o n s : e v i d e n c e i n t e r p r e ti n g t h e p l a n o r e x p l a i n i n g m e d i c a l t e r m s a n d p r o c e d u r e s . " " " ' " " " " " ' ' Id . [ c it a ti o n s o m itt e d ]. 12 T h e C o u rt ,2008 N h oo rtu hl d A b me e aril co a w e d t o s l A d m i n i s tr a ti v e C o m m a ll o w e d t o d i s c o v e r h hi m to c o m p are th e c fil e w a s i n f a c t a p a r t d e t e r m i n a ti o n . T h e c " ag W co itt is lai of ou r e e s w it h t h e P l a n t h a t t h e c a s e c it e d b y t h e p l a i n tiff s , L 2794807 N . D . T e x . 2 0 0 8 , d o e s n o t s u p p o r t t h e p l Ca i on pt i uf f ss v .p L is fi ei I nn st . h Ca t o . h oe f y o to t n d u c t d i s c o v e r y i n t h i s s u it c o n c e r n i n g d o c u m e n t s t h a t w e r e n o t c o n s i d e r e d b y t h e e e i n m a k i n g it s b e n e fit s d e t e r m i n a ti o n . A lt h o u g h t h e p l a i n tiff i n was c l a i m f i l e d u r i n g h i s E R I S A l a w s u i t , t h a t d i s c o v e r y w a s p e r m i t t e d Cs o p up s y t o a l l o w im l m fil e t o t h e a d m i n i s t r a ti v e r e c o r d fil e d i n t h e s u it a n d t o c l a rif y w h e t h e r t h e c l a i m t h e a d m i n i s tr a ti v e r e c o r d u p o n w h i c h t h e p l a n a d m i n i s tr a t o r h a d b a s e d it s b e n e fit s r t s p e c ifi c a ll y n o t e d t h a t, t o t h e e x t e n t t h e p l a i n tiff s o u g h t h i s c l a i m fil e t o c h a ll e n g e 8 ' The Court notes that, instead of seeking discovery in the context of this lawsuit, the remedy that the plaintiffs should have sought is to have this case remanded to the Administrative Committee so that it can consider the additional evidence contained in the Hartford file.13 The Court advises, however, that, in order to obtain remand, plaintiffs need to demonstrate that remand would not be futile and that the Hartford file documents in question would supply the Administrative Committee with additional information that could potentially change its prior benefits determination. This case should not be remanded t h e c o m p o s iti o n o f t h e a d m i n i s t r a ti v e r e c o r d fil e d w it h t h e c o u r t o r t o a tt e m p t t o i n j e c t b e f o r e t h e c o u r t a n y d o c u m e n t a r y it e m s t h a t h a d n o t b e e n i n c l u d e d i n t h e a d m i n i s tr a ti v e r e c o r d c o n s i d e r e d b y t h e p l a n a d m i n i s t r a t o r , s u c h r e q u e s t f o r t h e c l a i m fil e w a s ir r e l e v a n t. I n t h e p r e s e n t c a s e , p l a i n tiff s a r e n o t s e e k i n g t h e H a rtf o r d d o c u m e n t s a t i s s u e i n o r d e r t o c o m p a r e t h e m t o t h e a d m i n i s tr a ti v e r e c o r d t o d e t e r m i n e w h e t h e r t h e y w e r e c o n s i d e r e d b y t h e A d m i n i s tr a ti v e C o m m itt e e . P l a i n tiff s d o n o t d i s p u t e t h a t t h e A d m i n i s t r a ti v e C o m m itt e e c h o s e n o t t o c o n s i d e r t h e H a r tf o r d fil e i n m a k i n g it s b e n e fit s d e c i s i o n . I n s t e a d , t h r o u g h t h e p r e s e n t m o ti o n , p l a i n tiff s a r e s e e k i n g t o c h a ll e n g e t h e i n f o r m a ti o n t h a t t h e A d m i n i s t r a ti v e C o m m itt e e c o n s i d e r e d a n d t o i n j e c t b e f o r e t h e C o u rt a d d iti o n a l d o c u m e n t a r y e v i d e n c e t h a t t h e A d m i n i s tr a ti v e C o m m itt e e d i d n o t c o n s i d e r, w h i c h i s i m p e r m i s s i b l e i n a n E R I S A s u it u n d e r F ift h C ir c u it j u ri s p r u d e n c e . , 1 5 F.3 d 1 3 0 2, 1 3 0 9 5 th C i r . 1 9 9 4 If a d i s tri c t c o u rt fi n d s t h a t 13 t h e p l a n a d S m ei en , s D r ua h o or n h va . d T i en xs au cf o , i Ie n n ct . e v i d e n c e b e f o r e i t t o d e t e r m i n e w h e t h e r t h e i n s u r e d m e t t h e p l a n it t f ic d e fi n iti o n o f d i s a b ilit y , t h e a p p r o p ri a t e r e li e f i n t h a t i n s t a n c e i s r e m a n d o f t h e c a s e t o t h e p l a n a d m i n i s t r a t o r w it h i n s tr u c ti o n s t o t a k e a d d iti o n a l e v i d e n c e ; , 2 6 1 F.S u p p.2 d E.D.T e x. 2 0 0 3 w h e r e t h e p l a i n t i f f a r g B le ud mt h v . t St p e cp tr au n m s Ra ed s t a nui rs at rn t t i Gv re o r ue pc , o Ir nd c .w a s a n u a he l mi a 697 i n c o m p l e t e s h a m a n d t h a t t h e c o u rt s h o u l d c o n s i d e r e v i d e n c e o u t s i d e t h e a d m i n i s tr a ti v e r e c o r d . T h e c o u rt h e l d t h a t t h e p r o p e r r e m e d y f o r a n i n c o m p l e t e a d m i n i s tr a ti v e r e c o r d i s t o r e m a n d t o t h e p l a n a d m i n i s tr a t o r, n o t c o n s i d e r a ti o n o f e v i d e n c e o u t s i d e t h e a d m i n i s tr a ti v e r e c o r d b y a d i s tri c t c o u rt. S i n c e t h e p l a i n tiff h a d n o t r e q u e s t e d t h a t t h e c a s e b e r e m a n d e d t o t h e p l a n a d m i n i s tr a t o r a n d , f u rt h e r, s h e a s s e rt e d t h a t e it h e r a ll a d m i n i s t r a ti v e r e m e d i e s h a d b e e n e x h a u s t e d o r t h a t t h e p u r s u it o f a d m i n i s t r a ti v e r e m e d i e s w o u l d h a v e b e e n f u til e , t h e c o u r t w a s l e ft w it h li m iti n g it s r e v i e w t o t h e a d m i n i s t r a ti v e r e c o r d i n c o n s i d e ri n g t h e p l a i n tiff s E R I S A c l a i m ; , 1 2 1 F.3 d 1 9 8, 2 0 2 n. 5 5 th C i r . 1 9 9 7 [I]f e it h e r B fa a r h t au na l v .d e R v y e -l Ro op nm , eI nn c .i s n e c e s s a r y , i t m a y m o v e t o r e m a n d t o t h e p l a n p a rt y c o n c l u d e s t h a t a d d iti o n a l c t a d m inistr a t o r f o r f u rt h e r f a ct u al d e v elo p m e n t ; , 9 7 F.3 d 8 5, 8 8-8 9 5 th C ir. 1 9 9 6 r e m a n d f o r t h e p l a n a d m i n i s t r a t o r t M oc ll en rs v . e Er l n Ce aw m e p v oi d Ae lnu c me i, ni un m l u Cd o . g t e s t i m o n y o f o o id c in v o c a ti o n a l r e h a b ilit a ti o n e x p e r t, w a s a p p r o p ri a t e ; , 7 2 F.3 d 1 0 6 6, 1 0 7 1-7 2 2 d C ir. 1 9 9 5 r e m a n d f o r t h e p l a n a d m i n i s t r a t o r M t ilo l ec r o vn . s U d ne it e n d e W ee lf a dr e n Fc ue ni ds a p p r o p r i a t e u n l e s s i t ir w vi e , 4 7 1 F.S u p p.2 d 7 2 4 E.D.T e x. 2 0 0 6 re m a n din g th e w o u l d b e a u s e l e s s f o r m a lit y ; As br aa tt eo r v . o Hr a rtr ft oh re dr c o n s i d e r a t i o n i n l i g h t o f t h e f a c t t h a t t h e a d m i n i s t r a t o r p l a i n tiff s c a s e t o t h e p l a n a d m i n i t f fu d i d n o t c o n s i d e r a p h y s i c i a n s r e p o r t, it s f a il u r e t o t a k e i n t o a c c o u n t a ll o f t h e li m it a ti o n s o f t h e p l a i n tiff s c o n d iti o n , a n d it s r e li a n c e u p o n a p p a r e n tl y fl a w e d t e s t r e s u lt s . " ' ' " ' ' " 9 ' merely for the purpose of "includ[ing] as much information as possible into the administrative record prior to the filing of dispositive motions by both parties" or simply to delay this litigation. At present, it appears that at least some of the documents the plaintiffs seek to have included in the administrative record simply establish facts that are already undisputed in this matter (such as Mr. French's death certificate or documentation evidencing the fact that Mr. French elected voluntary life insurance of five times his salary in 1996) and/or are so vaguely described that the undersigned is unable to determine whether they would provide additional relevant information to the Administrative Committee.14 Thus, in the event plaintiffs should subsequently seek remand of this case to the plan administrator for consideration of additional evidence, they will need to come forward with a more thorough description of the documents they are seeking to have the Administrative Committee review and an explanation as to why they believe such documents could potentially alter the Administrative Committee's decision and/or evidence or jurisprudence indicating that the documents composing the claims administrator's file in this matter should have automatically been a part of the administrative record considered by the plan administrator when it made its benefits determination during the administrative appeals process.15 F or exa m u s e it d o e s n o t m u n i c a ti o n s b e t e e n t h e H a rtf o r c o n tri b u t e d r e l la n s ter m s re q a n c e b e n e fit s e 14 beca co m b etw have th e P in s ur p l e , a lt h o in clu d e e w e e n th e d a n d th e e v a nt info u ir e d M r. xc e e din g u g h th e m a il s t o H a rtf o r p l a i n tiff r m a ti o n French $ 8 0 0,0 p l a i n tiff s c o n t e n d t h a t t h e a d m i n i s tr a ti v e r e c o r d i s i n c o m p l e t e a n d fr o m t h e H a rtf o r d , r e c o r d s o f t e l e p h o n e c o n v e r s a ti o n s , d a n d t h e P l a n , a c e r tifi e d c o p y o f t h e p o li c y i n q u e s ti o n , a n d e s , t h e p l a i n tiff s h a v e n o t s h o w n h o w a n y o f t h o s e d o c u m e n t s w t h a t c o u l d i m p a c t t h e A d m i n i s tr a ti v e C o m m itt e e s d e t e r m i n a ti o t o s u b m it a w ritt e n a p p li c a ti o n a n d p r o o f o f g o o d h e a lt h t o o b t a 0 0 . 0 0 a n d t h a t h e f a il e d t o s u b m it t h a t d o c u m e n t a ti o n . ' m a il s o uld n th at i n lif e A lt h o u g h p l a i n tiff s r e l y u p o n a s t a t e m e n t m a d e b y t h e P l a n s c o r p o r a t e c o u n s e l i n a l e tt e r t o t h e 15 p l a i n tiff s d a t e d J u l y 2 4 , 2 0 0 6 f o r t h e p r o p o s iti o n t h a t t h e e n tir e fil e o f t h e H a r tf o r d s h o u l d h a v e b e e n c o n s i d e r e d b y t h e A d m i n i s tr a ti v e C o m m itt e e i n c o n d u c ti n g it s b e n e fit s d e t e r m i n a ti o n , t h e u n d e r s i g n e d ' 10 ' Accordingly; IT IS ORDERED that the Motion for Leave to Conduct Discovery on Administrative Record is DENIED and the Motion For Extension of Time (R. Doc. 53) filed by plaintiffs, Linda French and Ann French Gonsalves, is hereby GRANTED and plaintiffs are granted an additional thirty (30) days from date of this Order. IT IS FURTHER ORDERED that the Motion to Strike and [for] Leave to File SurReply (R. Doc. 58) filed by defendant, the Dade Behring Life Insurance Plan, is GRANTED IN PART, in that the Plan is granted leave to file its sur-reply memorandum, and DENIED IN PART, in that no portion of plaintiffs' reply memorandum shall be struck from the record. Signed in chambers in Baton Rouge, Louisiana, November 18, 2010. MAGISTRATE JUDGE CHRISTINE NOLAND c a n n o t s a y t h a t s u c h s t a t e m e n t r e q u ir e d t h e A d m i n i s tr a ti v e C o m m itt e e t o d o s o . I n t h a t l e tt e r, c o r p o r a t e c o u n s e l s t a t e d t h a t t h e A d m i n i s t r a ti v e C o m m itt e e s r e v i e w o f b e n e fit d e t e r m i n a ti o n s i s li m it e d t o e n s u ri n g t h a t T h e H a r tf o r d f o ll o w e d p r o p e r p r o c e d u r e a n d c o n s i d e r e d a ll r e l e v a n t i n f o r m a ti o n i n m a k i n g it s b e n e fit s d e t e r m i n a ti o n u n d e r t h e t e r m s o f t h e P l a n s c o n tr a c t o f i n s u r a n c e . S h e w e n t o n t o s a y t h a t, i n m a k i n g it s d e c i s i o n , t h e A d m i n i s t r a ti v e C o m m itt e e r e v i e w e d T h e H a r tf o r d s d e c i s i o n a n d a ll r e l e v a n t m a t e ri a l s i n c l u d i n g p l a n d o c u m e n t s , p a y r o ll r e c o r d s a n d P l a n c o m m u n i c a ti o n s t o e m p l o y e e s . , R. D o c. 5 7-2, D B 8 5 . T h e C o u r t c a n n o t f i n d t h a t h e r s t a t e m e n t r e q u i r e d t h e A d m i n i s t r a t i v e C o m m i t t Se ee et o r e v i e w e v e r y d o c u m e n t, r e g a r d l e s s o f it s r e l e v a n c e , c o n t a i n e d i n t h e H a r tf o r d s fil e r e l a ti n g t o p l a i n tiff s c l a i m p ri o r t o m a k i n g it s d e c i s i o n . I n s t e a d , a ll t h a t s t a t e m e n t a p p e a r s t o h a v e r e q u ir e d i s t h a t t h e A d m i n i s t r a ti v e C o m m itt e e r e v i e w t h e H a rtf o r d s b e n e fit s d e c i s i o n a n d t h o s e d o c u m e n t s t h a t t h e A d m i n i s tr a ti v e C o m m itt e e c o n s i d e r e d r e l e v a n t t o t h a t d e c i s i o n . ' " ' ' " ' " ' 11 ' "

Disclaimer: Justia Dockets & Filings provides public litigation records from the federal appellate and district courts. These filings and docket sheets should not be considered findings of fact or liability, nor do they necessarily reflect the view of Justia.


Why Is My Information Online?