Caldwell v. Life Insurance

165 F.R.D. 633, 1996 U.S. Dist. LEXIS 3888, 1996 WL 146490
CourtDistrict Court, D. Kansas
DecidedMarch 27, 1996
DocketCivil Action No. 93-2550-GTV
StatusPublished
Cited by9 cases

This text of 165 F.R.D. 633 (Caldwell v. Life Insurance) is published on Counsel Stack Legal Research, covering District Court, D. Kansas primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Caldwell v. Life Insurance, 165 F.R.D. 633, 1996 U.S. Dist. LEXIS 3888, 1996 WL 146490 (D. Kan. 1996).

Opinion

MEMORANDUM AND ORDER

RUSHFELT, United States Magistrate Judge.

Before the court is a Motion For Protective Order (doc. 75) filed by defendant Life Insurance Company of North America (LINA). Pursuant to Fed.R.Civ.P. 26(e), LINA seeks an order limiting the scope of discovery “to the information in the claim administrator’s file and for such other and further relief as the Court deems just and appropriate.” Plaintiff opposes the motion.

On March 19, 1996 the court held the final pretrial conference in this case. Plaintiff appeared through his counsel, William P. Ronan. Defendant LINA appeared through its counsel, James A. Durbin. The parties set forth the nature of the ease, their factual contentions and legal theories, and the remaining issues of fact and law.

This action arises under the Employee Retirement Income Security Act of 1974 (ERISA), 29 U.S.C. § 1132(a)(1)(B). Plaintiff seeks to recover disability benefits allegedly due him under a group policy of disability insurance provided to him through his employment with former defendant Western Atlas International. He contends that he has demanded payment of benefits, but defendant has denied his claim. He further contends that defendant has failed and refused to provide him -with information for submitting his claim for review. He also contends that defendant did not review the denial of his claim.

LINA contends that plaintiff is entitled to no benefits, pursuant to the employee welfare benefit plan, insurance policy, summary plan description, or ERISA. It claims that plaintiff is not disabled. It contends, furthermore, that it has provided a full review of the claim of plaintiff, pursuant to ERISA and a court-ordered stay and review.1

One issue of fact yet to be determined is whether the denial or review or failure to review the claim of plaintiff by defendant was arbitrary and capricious. Issues of law still in need of resolution include the following: (1) what standard of review is to be utilized by the court; (2) whether the plan administrator provided plaintiff with a full and fair review of the claim denial; and (3) whether the court may consider evidence outside the administrative record.

The only discovery pending are depositions of Dr. John W. Ellis and Ima Jean Caldwell, the wife of plaintiff.2 This discovery has been stayed, pursuant to D.Kan. Rule 26.2, pending resolution of the motion now before [636]*636the court.3 Plaintiff requested that Dr. Ellis bring all medical records or reports regarding plaintiff or his wife to his deposition. (See Notice To Take Deposition Duces Tecum, doc. 72.)

Defendant LINA argues that this case is to be resolved solely upon the administrative record. Consequently, it contends the discovery sought by plaintiff is overly broad and irrelevant. It would go beyond the claims file and the administrative record. Defendant thus argues that the requested discovery constitutes annoyance and oppression, imposes undue burden and expense, and justifies a protective order.

Plaintiff claims that the court upon de novo review may examine evidence beyond the administrative record. He asserts, furthermore, that the court should deny the request for protective order even under an arbitrary and capricious standard of review, “because absent the information which [he] intends to obtain in the evidentiary depositions, [he] will be denied a full and fair review of his case.” He suggests that 29 U.S.C. § 1133 requires a fiduciary to afford him a reasonable opportunity for a full and fair review. He contends that he has not been provided such opportunity. He suggests, furthermore, that the court is not limited to the administrative file when the decision-maker was arbitrary and capricious in not obtaining additional evidence.

“[A] denial of benefits challenged under § 1132(a)(1)(B) is to be reviewed under a de novo standard unless the benefit plan gives the administrator or fiduciary discretionary authority to determine eligibility for benefits or to construe the terms of the plan.” Firestone Tire & Rubber Co. v. Bruch, 489 U.S. 101, 115, 109 S.Ct. 948, 956, 103 L.Ed.2d 80 (1989).

Although the Supreme Court did not discuss the meaning of de novo review in Bruch, we believe that Bruch contemplates that the district court will review the administrator’s decision ... without deference to the decision or any presumption of correctness, based on the record before the administrator. Thus, Bruch does not require district courts to hear and consider evidence not presented to the plan administrator in connection with a claim. This view is consistent with the proper judicial role in ERISA cases and precedent.
... In the ERISA context, the role of the reviewing federal court is to determine whether the administrator or fiduciary made a correct decision, applying a de novo standard. Nothing in the legislative history suggests that Congress intended that federal district courts would function as substitute plan administrators, a role they would inevitably assume if they received and considered evidence not presented to administrators concerning an employee’s entitlement to benefits. Such a procedure would frustrate the goal of prompt resolution of claims by the fiduciary under the ERISA scheme.

Shaw v. Mutual Benefit Life Ins. Co., No. 89-4261-R, 1991 WL 80181, at *2 (D.Kan. Apr. 9, 1991) (quoting Perry v. Simplicity Eng’g, 900 F.2d 963, 966-67 (6th Cir.1990)) (citation omitted).

A primary goal of ERISA was to provide a method for workers and beneficiaries to resolve disputes over benefits inexpensively and expeditiously. Permitting or requiring district courts to consider evidence from both parties that was not presented to the plan administrator would seriously impair the achievement of that goal. If district courts heard evidence not presented to plan administrators, employees and their beneficiaries would receive less protection than Congress intended.

Sandoval v. Aetna Life & Cas. Ins. Co., 967 F.2d 377, 380 (10th Cir.1992) (quoting Perry, 900 F.2d at 967) (citation omitted).

“The role of a reviewing federal district court is to determine whether the ERISA plan administrator or fiduciary made a correct decision based on the record before it at the time the decision was made.” Ford v. Metropolitan Life Ins. Co., 834 F.Supp. [637]*6371272, 1277 (D.Kan.1993). A “district court’s review of a denial is limited to the record before the plan administrator at the time it reached its decision.” Bass v. Prudential Ins. Co. of Am., No. CIV.A. 89-2356, 1990 WL 136807, at *1 n. 1 (D.Kan. Aug. 23, 1990).

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Bluebook (online)
165 F.R.D. 633, 1996 U.S. Dist. LEXIS 3888, 1996 WL 146490, Counsel Stack Legal Research, https://law.counselstack.com/opinion/caldwell-v-life-insurance-ksd-1996.