E v. ANTHEM BLUE CROSS AND BLUE SHIELD

Filing 38

PROCEDURAL ORDER - Response to Procedural Order due by 4/8/2016. By JUDGE D. BROCK HORNBY. (mnw)

UNITED STATES DISTRICT COURT
DISTRICT OF MAINE
ADELE E.,
PLAINTIFF
v.
ANTHEM BLUE CROSS AND
BLUE SHIELD,
DEFENDANT

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CIVIL NO. 2:15-cv-01-DBH

PROCEDURAL ORDER
In assessing the parties’ cross motions for judgment on the administrative
record, I am perplexed as to some of the documents and the terminology that
they use.
In the plaintiff’s Motion to Modify the Administrative Record and for
Discovery (ECF No. 18), she asserted that she had not received all the Plan
documents and that the Certificate of Coverage alone was not the Plan or a
summary plan description, as those documents are defined by ERISA. Id. at 6.
In granting this aspect of the plaintiff’s motion, Magistrate Judge Rich ordered
the defendant to file more Plan-related documents. Mem. of Decision & Order
on Pl.’s Mot. to Modify R. & for Disc. at 5 (ECF No. 25). But the subsequent filing
came to the court from the plaintiff and did not identify which documents were
Plan documents as opposed to the other documents she had requested, namely
documents related to the denial of her second-level internal appeal and

information regarding medical reviewers. See Suppl. to the Admin. R. by Adele
E. (ECF No. 29).
The parties and the documents themselves refer variously (and at times
interchangeably) to the Policy, the Plan, the Certificate of Coverage, the Summary
Plan Description, the Group Contract, and the Group Agreement. I understand
that the plaintiff’s father’s employer established the Plan and that the defendant
insures and administers it.

What is the document or documents in the

administrative record that establishes what the Plan provisions were at the time
for which the plaintiff sought benefits? What provision designates the defendant
Anthem Blue Cross and Blue Shield as the Administrator of the Plan?
If the parties wish simply to stipulate that the Certificate of Coverage
constitutes all the provisions of the employer-adopted Plan and that Anthem
Blue Cross and Blue Shield is the Plan Administrator (that seems to be the
assumption both parties are making at this stage), and therefore I need not look
for or consult other documents, then the parties need to inform the court of such
a stipulation.
The parties shall respond to this Procedural Order by April 8, 2016.
SO ORDERED.
DATED THIS 22ND DAY OF MARCH, 2016
/s/D. Brock Hornby
D. BROCK HORNBY
UNITED STATES DISTRICT JUDGE

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