Clark v. American Electric Power System Long Term Disability Plan

871 F. Supp. 2d 655, 2012 U.S. Dist. LEXIS 102933
CourtDistrict Court, W.D. Kentucky
DecidedJuly 2, 2012
DocketCivil Action No. 4:12cv-00009-JHM
StatusPublished
Cited by6 cases

This text of 871 F. Supp. 2d 655 (Clark v. American Electric Power System Long Term Disability Plan) is published on Counsel Stack Legal Research, covering District Court, W.D. Kentucky primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Clark v. American Electric Power System Long Term Disability Plan, 871 F. Supp. 2d 655, 2012 U.S. Dist. LEXIS 102933 (W.D. Ky. 2012).

Opinion

ORDER

H. BRENT BRENNENSTUHL, United States Magistrate Judge.

This matter is before the court on motion of Plaintiff for leave to conduct discovery. The parties initially informed the court in their Rule 26(f) litigation planning report that they disagreed over the issue of discovery (DN 14). The court instructed them to confer and report the results of their efforts to resolve the disagreement (DN 15). The parties reported they were unsuccessful in resolving their dispute, and proposed a schedule for briefing the issue (DN 20), which the court accepted (DN 21). The subject motion (DN 22) was filed in conformance with that schedule, as were the Defendants’ response (DN 22) and the Plaintiffs reply (DN 23). The matter is now fully briefed.

Background

This matter arises from the termination of benefits under a long-term disability insurance plan. Plaintiff was previously employed by American Electric Power System, and a participant in that company’s long-term disability plan, a plan falling within the coverage of the Employee Retirement Income Security Act of 1974, 29 U.S.C. §§ 1001 et seq. (“ERISA”).1 In 1994, the Plaintiff was determined to be disabled, and received monthly long-term disability benefits until 2010, when the plan claims administrator, Prudential, notified the Plaintiff that it had determined she no longer met the definition of “disability” under the plan. The Plaintiff administratively appealed the determination, and the determination was upheld. Plaintiff then filed the present action, in which she alleges that she is disabled under the long-term plan provisions, and “the decision to terminate Mrs. Clark’s benefits was contrary to the terms of the plan, arbitrary and capricious, and not supported by reliable evidence in the record” (DN 1 at ¶ 21).

Discovery sought by Plaintiff.

In her motion (DN 22), the Plaintiff seeks leave to conduct discovery in the case, and has indicated her desire to obtain information “including but not limited to:”

-The factual basis for Defendant’s affirmative defenses.
-The specific rationale for Defendant’s claims and appeals decisions.
-The Defendant’s compliance with the applicable Department of Labor claims regulations.
[659]*659-The Defendant’s relationship with plan third-party administrator Prudential. -The standard of review, including any delegation of and exercise of discretionary authority.
-The steps taken by Defendant to minimize or eliminate any inherent financial bias.

In her reply pleading (DN 24), Plaintiff further identifies discovery (and states that it is “not intended to be an exhaustive list”) to which she contends she is entitled:

-Defendants’ lack of compliance with the claims regulations requirement that the plan establish written “claims procedures [that] contain administrative processes and safeguards designed to ensure and verify that benefit claim determinations are made in accordance with governing plan documents and that, where appropriate, the plan provisions have been applied consistently with respect to similarly situated claimants.”
-Defendants’ lack of compliance with the plan requirement that in considering Mrs. Clark’s appeal that the “review ... afford no deference to the initial benefit determination.”
-Defendants’ failure to comply with the plan requirement that it ensure any medical opinion relied upon in denying Mrs. Clark’s appeal (or terminating her benefits) be made by a health professional with appropriate training and experience.
-Defendants did not utilize, and have failed to file with the Court, the applicable plan documents in effect at the time of Mrs. Clark’s commencement of benefits. Moreover, assuming the later filed documents are applicable, Defendants have not produced any documentation demonstrating any proper amendment, including notice to plan participants such as Mrs. Clark.
-Defendants’ refusal to disclose the name of the reviewing licensed psychiatrist/psychologist so that Mrs. Clark’s raw data could be reviewed as part of her appeal.
-Defendants’ refusal to provide, or include in the record, all communications between itself, Prudential, Psybar, Yohmann (claim reviewer) and Kolbell (appeal reviewer) concerning Mrs. Clark’s disabling conditions.
-Defendants’ failure to provide, or include in the record, all of the data (raw data, testing, etc.) prepared by Yohmann as part of his examination.
-Defendants’ use of Kolbell for a medical opinion in direct violation of Kentucky’s licensing requirements for medical professionals.
-Defendants’ use of a reasonable standard as opposed to an “accurate” standard in deciding Mrs. Clark’s appeal.

Defendant opposes discovery, contending that, in an action brought under ERISA, the Court’s review of a plan administrator’s decision to terminate benefits is confined to the administrative record, and no discovery may be conducted outside the record. Defendant primarily relies upon Wilkins v. Baptist Healthcare Sys., Inc., 150 F.3d 609 (6th Cir.1998) for support.

Scope of discovery permitted in an ERISA case.

That a district court’s review of a plan administrator’s determination is limited to the proof contained in the administrative record, with only limited exception, is well recognized within the Sixth Circuit:

“The general rule is that a district court should base its review of an ERISAbased claim of an alleged denial of benefits solely upon the administrative record. The rationale for this rule is that a limited review serves ERISA’s pur[660]*660pose of providing a method for workers and beneficiaries to resolve disputes over benefits inexpensively and expeditiously. Considering evidence that was not presented to the administrator would impair the achievement of that goal. Nevertheless, a limited exception to the general rule provides that a court may consider evidence outside the administrative record if that evidence is offered in support of a procedural challenge to the administrator’s decision, such as an allegation of bias or a lack of due process.”

Busch v. Hartford Life and Acc. Ins. Co., 2010 WL 3842367, 2010 U.S. Dist. LEXIS 101881 (E.D.Ky.2010) (citing Wilkins, supra, at 619; Perry v. Simplicity Eng’g, 900 F.2d 963, 967 (6th Cir.1990)).

An allegation of a due process violation triggers the exception to the ERISA discovery rule. The due process inquiry is directed to whether the reviewer gave the claimant a full and fair hearing. This inquiry, however, is only relevant to the Court’s determination of whether the reviewer’s decision is entitled to deference. Cramer v. Appalachian Regional Healthcare, Inc., 2012 WL 996583, 2012 U.S. Dist.

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Cite This Page — Counsel Stack

Bluebook (online)
871 F. Supp. 2d 655, 2012 U.S. Dist. LEXIS 102933, Counsel Stack Legal Research, https://law.counselstack.com/opinion/clark-v-american-electric-power-system-long-term-disability-plan-kywd-2012.