Carlson v. Reliance Standard Life Insurance Company

Filing 36

MEMORANDUM AND ORDER: Pending before the Court is the Motion to Supplement the Administrative Record (THE "Motion to Supplement") (Docket No. 29 ), filed by Plaintiff Christine Carlson (the "Plaintiff" or "Carlson"). Defendant Reliance Standard Life Insurance Company (the Defendant or Reliance Standard) opposes the Motion to Supplement. See Docket Nos. 30 and 33. For the reasons discussed herein, the Motion to Supplement is GRANTED. Within thirty (30) days of the date of this Order, Plaintiff shall supplement the administrative record in this proceeding with (i) the OME Amendment Report and (ii) the final investigative report prepared on behalf of Plaintiff, including witness statements. Signed by Magistrate Judge Barbara D. Holmes on 9/19/2016. (DOCKET TEXT SUMMARY ONLY-ATTORNEYS MUST OPEN THE PDF AND READ THE ORDER.)(eh)

IN THE UNITED STATES DISTRICT COURT
FOR THE MIDDLE DISTRICT OF TENNESSEE
NASHVILLE DIVISION
CHRISTINE A. CARLSON
Plaintiff
v.
RELIANCE STANDARD LIFE
INSURANCE COMPANY
Defendant

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Case No. 3:15-0200

MEMORANDUM AND ORDER
Pending before the Court is the Motion to Supplement the Administrative Record (THE
“Motion to Supplement”) (Docket No. 29), filed by Plaintiff Christine Carlson (the “Plaintiff” or
“Carlson”). Defendant Reliance Standard Life Insurance Company (the “Defendant” or “Reliance
Standard”) opposes the Motion to Supplement. See Docket Nos. 30 and 33.1 For the reasons
discussed herein, the Motion to Supplement is GRANTED. Within thirty (30) days of the date of
this Order, Plaintiff shall supplement the administrative record in this proceeding with (i) the OME
Amendment Report and (ii) the final investigative report prepared on behalf of Plaintiff, including
witness statements.
Background
Plaintiff brought suit against Defendant alleging that Defendant failed to pay benefits
owing to Plaintiff under a group life insurance policy covering Plaintiff’s late husband, Barak
Carlson, in violation of the Employer Retirement Income Security Act of 1974 (“ERISA”). 2

Plaintiff’s Motion to Supplement was not accompanied by a memorandum of law as required by
Local Rule 7.01(b). As directed by the Court (Docket No. 31), Plaintiff filed a reply to Defendant’s
response in opposition to the Motion to Supplement, which set forth Plaintiff’s legal arguments and
supporting authority (Docket No. 32).
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Plaintiff originally sued Defendant in state court alleging violations of the Tennessee Consumer
Protection Act. See Docket No. 1-1. Defendant removed the state court action to this Court pursuant to 28
U.S.C. § 1331, 29 U.S.C. § 1132(e) and 28 U.S.C. § 1441. See Docket No. 1. Plaintiff later amended her
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Among other things, Plaintiff alleges that Defendant failed to properly review relevant information
and that Defendant’s decision-making process did not provide Plaintiff with a full and fair review.
See Docket No. 12 at 3-4 and ¶¶ 19, 22, 23, 24.
The following facts relevant to the pending Motion to Supplement are undisputed.3
Decedent Carlson was a participant in the group life insurance plan issued to Camber Corporation,
Mr. Carlson’s employer. Amended Complaint and Answer at ¶ 5. Mr. Carlson was insured for
$250,000 in group life coverage, and was separately insured for $250,000 in accidental risk
benefits. Amended Complaint and Answer at ¶ 8 and 9. Plaintiff is the sole beneficiary under the
policy insuring the life of Mr. Carlson. Amended Complaint and Answer at ¶ 10.
On October 20, 2012, Mr. Carlson died from a gunshot wound while hunting with a family
member. Amended Complaint and Answer at ¶ 11-15. The initial final report by the Metro
Nashville Police Department (the “MNPD”), who responded to the scene and the office of the
Medical Examiner (the “OME”) stated Mr. Carlson’s cause of death as suicide. Amended
Complaint and Answer at ¶ 16-17.
On March 15, 2013, Plaintiff made a claim for voluntary risk benefits under the group life
policy. AR0001 (Docket No. 20 at 1).4 By letter dated August 8, 2013, Defendant initially denied
Plaintiff’s claim based on the stated cause of death as suicide. AR105-06 (Docket No. 20-1at 5-

complaint to allege violations of ERISA. See Docket No. 12. This Court has original subject matter
jurisdiction over this action pursuant to 28 U.S.C. § 1331 and 29 U.S.C. § 1132(e) as a civil action founded
upon a claim of right arising under the laws of the United States. This Court also has diversity jurisdiction
pursuant to 28 U.S.C. § 1332 because there is complete diversity between Plaintiff, who is domiciled and
is a citizen of New Jersey, and Defendant, which is an Illinois corporation with a main office in
Pennsylvania. In addition, the amount in controversy exceeds $75,000. Venue is appropriate here because
the qualifying event giving rise to the dispute occurred in Davidson County, Tennessee.
3
These undisputed facts are taken from Plaintiff’s Amended Complaint (the “Amended
Complaint”) (Docket No. 12) and Defendant’s Answer to Amended Complaint (the “Answer”) (Docket
No. 13). These facts are also relevant to the merits of Plaintiff’s claims. They are examined here only for
the Court’s evaluation of whether Plaintiff has sufficiently demonstrated a colorable claim or claims to
satisfy the Wilkins exception discussed below.
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The Administrative Record is found at Docket Entry No. 20.

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6). Plaintiff (through her counsel) timely requested on October 1, 2013, a formal review of the
denial, as instructed in the denial letter. AR0109 (Docket No. 20-1 at 9). Plaintiff’s requested
review asserted that Mr. Carlson’s death resulted from an accidental gunshot wound, not a suicide.
Id. In that same correspondence dated October 1, 2013, Plaintiff advised Defendant that she
intended to submit additional information to Defendant following her investigation into the
circumstances of Mr. Carlson’s death. Id. On October 23, 2013, the Appeals Specialist assigned
by Defendant to handle Plaintiff’s claim requested that Plaintiff submit any additional information
by November 23, 2013, after which time the review would “move forward.” AR0048 (Docket
No. 20 at 48).
On November 21, 2013, Plaintiff requested additional time to submit additional
information. AR0141 (Docket No. 20-1 at 41). In response, Defendant allowed Plaintiff until
December 13, 2013, to provide any additional information, again stating that after that date,
Defendant would “move forward with [its] review.” AR0049 (Docket No. 20 at 49). By letter
dated December 13, 2013, Plaintiff provided additional information to Defendant, but noted that
her investigation was ongoing with an anticipated completion date of “the middle of January
2014.” AR0144 (Docket No. 20-1 at 44). Plaintiff’s December 13, 2013 correspondence further
stated that she would “continue to send information as acquired” with a request that Defendant
send notice that it was “keeping this matter in an open status.” Id. There does not appear to have
been a response specifically directed to this December 13, 2013 letter. However, on January 14,
2014, Defendant sent an “update” letter to Plaintiff, notifying her that Defendant had elected to
take the allowed additional 60 days (beyond the original 60 days from the date of the appeal) in
which to make a final decision. AR0050 (Docket No. 20 at 50). The January 14 correspondence
further stated that Defendant was still in the process of completing its review. Id.

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On January 16, 2014, Defendant notified Plaintiff that it would be submitting the claim for
review by an independent physician. AR0155 (Docket No. 20-1 at 55). By letter dated January 25,
2014, Defendant requested specific additional information—incident photographs, autopsy
photographs and any information regarding testing of the gun—from Plaintiff. AR0159 (Docket
No. 20-1 at 59).5 This same letter notified Plaintiff that it was tolling “the statutory time frames
for reaching an appeal determination” until receipt of the requested information. Id.
Following this letter, the requested information was provided beginning on January 27,
2014, with the last information provided on February 24, 2014, and received by Defendant on
February 28, 2014. AR0651 through AR0673 (Docket No. 20-9 at 1-23) and AR0764 (Docket
No. 20-11 at 14). On March 21, 2014, Defendant notified Plaintiff that its review of the denial of
benefits was complete and of its determination that its original decision to deny benefits was
appropriate. AR0054 (Docket No. 20 at 54) and AR0775 (Docket No. 20-11 at 25).
Plaintiff alleges that Defendant failed to reasonably and properly review all relevant
information. Specifically, Plaintiff asserts that Defendant was aware of Plaintiff’s ongoing
investigation and stated intent to submit additional information, but arbitrarily closed the appeal
before Plaintiff had submitted all of the additional information. The precise information that
Plaintiff contends Defendant failed to consider are an amended OME report revising the cause of
Mr. Carlson’s death to “could not be determined” and a final investigative report with statements
of witnesses with knowledge of the circumstances surrounding Mr. Carlson’s death.

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This letter refers to previous communications, which appears to have been a conversation between
the Appeals Specialist and Plaintiff’s attorney, as referenced in an email on January 21, 2014, from the
Appeals Specialist to the outside reviewer. AR0157 (Docket No. 20-1 at 57).

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Analysis
In the ERISA context, the district court’s review of the correctness of a benefits
determination made by the administrator or fiduciary is ordinarily limited to the administrative
record. Perry v. Simplicity Engineering, a Div. of Lukens General Indus., Inc., 900 F.2d 963, 966
(6th Cir. 1990). However, the recognized exception to this rule is when the “evidence is offered
in support of a procedural challenge to the administrator’s decision, such as lack of due process
afforded by the administrator or alleged bias on its part.” Wilkins v. Baptist Healthcare System,
Inc., 150 F.3d 609, 619 (6th Cir. 1996). The extent to which allegations of procedural defects are
enough to allow evidence outside the administrative record is, as noted by Judge Trauger, uncertain
at best. Kinsler v. Lincoln Nat. Life Ins. Co., 660 F.Supp.2d 830, 836 (M.D. Tenn. 2009) (alleged
lack of due process or alleged bias are enough to establish that the evidence is relevant, and
therefore discoverable).
The Johnson v. Connecticut General Life Ins. Co. case relied upon by Defendant adds little
clarity to this question. In that case, the Sixth Circuit expressly declined to require a threshold
evidentiary showing of bias as a prerequisite to application of the Wilkins exception. Johnson v.
Connecticut General Life Ins. Co., 324 Fed.Appx. 459, 2009 WL 928590 at *6 (6th Cir. 2009).
The Johnson court did however intimate that something more than mere allegations may be
required. Id.
Here, the gravamen of Plaintiff’s action is that she notified Defendant of additional
information, which it arbitrarily failed to take into account, and under the plain language of the
ERISA claims procedures, that failure prevents a finding that Defendant provided Plaintiff with a
reasonable opportunity for a full and fair review. See 29 C.F.R. § 2560.503-1(h)(2)(iv). Plaintiff
also claims that Defendant deliberately disregarded this information so that it could close her claim

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without payment of any benefits, which Plaintiff alleges was in bad faith and demonstrates bias.
Plaintiff seeks to supplement the administrative record with the additional information she
intended to submit to Defendant, but was precluded from doing so by Defendant’s decision on her
appeal. If Johnson requires a heightened showing of a colorable procedural challenge, it has been
met in this case. Thus, on the limited issue of Plaintiff’s request to supplement the administrative
record, the Court finds the requested supplementation is appropriate.
Defendant argues that the OME’s Amendment Report is irrelevant because it is not binding
on Defendant. The Court disagrees as to relevancy.6 The Court also disagrees with Defendant’s
additional argument that the witness statements with which Plaintiff seeks to supplement the
administrative record are new information. On November 21, 2013, Plaintiff’s attorney sent a letter
to the Appeals Specialist responsible for Plaintiff’s claim that Plaintiff was in the process of
obtaining witness statements and other reports.

AR0142 (Docket No. 20-1 at 42).

On

December 13, 2013, Plaintiff again referred to witness interviews and statements. AR0143-44
(Docket No. 20-1 at 43-44).
For purposes of supplementation of the record, Plaintiff has offered enough to support her
procedural challenges. Whether or not Plaintiff can prevail on the merits of her claims is a
determination left for another day.
Conclusion
Plaintiff has made a sufficient showing for the Court to consider the offered evidence.
Plaintiff shall therefore be permitted to supplement the administrative record. Within thirty (30)
days of the date of this Order, Plaintiff shall supplement the administrative record in this

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To be clear, the Court simply finds that the supplemental information is offered in support of
Plaintiff’s colorable procedural claims, and is relevant for that purpose.

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proceeding with (i) the OME Amendment Report and (ii) the final investigative report prepared
on behalf of Plaintiff, including witness statements.
Any party objecting to this decision may file a motion for review by the District Judge in
accordance with Fed.R.Civ.P.72(a) and Local Rule 72.02(b). The motion for review shall be
served and filed in accordance with Rules 5 and 7 of the Fed.R.Civ.P. and applicable local rules.
The motion for review shall be filed within fourteen (14) days after entry of this Memorandum
and Order. The motion for review shall state with particularity that portion of this Memorandum
and Order for which review is sought and shall be accompanied by sufficient documentation to
apprise the District Judge of the basis for the appeal. Any other party wishing to respond shall file
a response within fourteen (14) days after served with a copy of the motion for review.
It is SO ORDERED.

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BARBARA D. HOLMES
United States Magistrate Judge

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