Franklin v. Hartford Life and Accident Insurance Company

CourtDistrict Court, D. Arizona
DecidedDecember 7, 2023
Docket4:22-cv-00168
StatusUnknown

This text of Franklin v. Hartford Life and Accident Insurance Company (Franklin v. Hartford Life and Accident Insurance Company) is published on Counsel Stack Legal Research, covering District Court, D. Arizona primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Franklin v. Hartford Life and Accident Insurance Company, (D. Ariz. 2023).

Opinion

6 IN THE UNITED STATES DISTRICT COURT 7 FOR THE DISTRICT OF ARIZONA 9 Sabrina Franklin, No. CV-22-00168-TUC-JAS 10 Plaintiff, ORDER 11 v. Hartford Life and Accident Insurance 3 Company, 14 Defendant. 15 Pending before the Court are three motions filed by Plaintiff: motion to compel || (Doc. 47), motion to enforce completeness of the administrative record/motion to compel 17|| (Doc. 67),! and objection to Defendant’s designation of certain information as confidential □□ (Doc. 51). Upon review of the motions, oppositions, replies, attachments, and pertinent 19|| record and authority, Plaintiffs motions are granted and the objection is sustained.* 20 || Discussion 21 This is an ERISA case whereby Plaintiff alleges that Defendant wrongfully denied her long term disability benefits under her Long Term Disability policy “(LTD Plan” or 23 || “Plan’) with Defendant. The discovery-related motions at bar primarily pertain to Plaintiffs pursuit of information that may bear on Defendant’s conflicts of interest in this || case. 26 As a threshold matter, Defendant is both the administrator of the LTD Plan and the 27 |) \ The Court notes that Docs. 43 and 57 are duplicative of Does. 47 and 67. 2 Because the briefing is adequate and oral argument will not help in resolving this matter, oral argument is 28 denied. See Mahon v. Credit Bureau of Placer County, Inc., 171 F.3d 1197, 1200-1201 (9 Cir. 1999).

1|| payor under the LTD Plan; the Plan also specifies that Defendant has discretion in 2}| evaluating the validity of beneficiaries’ claims for LTD benefits under the Plan. 3 In such circumstances, Defendant has a structural conflict of interest and Plaintiff is entitled to discovery relating to conflicts of interest as the Court must weigh any conflicts in determining whether Defendant abused its discretion in denying Plaintiff benefits. See, 6|| e.g., Abatie v. Alta Health & Life Ins. Co., 458 F.3d 955, 965-71 (9" Cir. 2006)* (“We have 7\| held that an insurer that acts as both the plan administrator and the funding source for 8 || benefits operates under what may be termed a structural conflict of interest... On the one 9|| hand, such an administrator is responsible for administering the plan so that those who 10|| deserve benefits receive them. On the other hand, such an administrator has an incentive 11]| to pay as little in benefits as possible to plan participants because the less money the insurer pays out, the more money it retains in its own coffer . . . [In these circumstances, a district || court’s review for an abuse of discretion is] informed by the nature, extent and effect on 1411 the decision-making process of any conflict of interest ... A district court, when faced with all the facts and circumstances, must decide in each case how much or how little to credit 16]| the plan administrator's reason for denying insurance coverage. An egregious conflict may weigh more heavily (that is, may cause the court to find an abuse of discretion more readily) than minor, technical conflict might. But in any given case, all the facts and circumstances must be considered ... We recognize that abuse of discretion review, with any conflict . . . weighed as a factor .. . is indefinite. We believe, however, that trial courts are familiar with the process of weighing a conflict of interest. For example, in a bench trial the court 22 || must decide how much weight to give to a witness' testimony in the face of some evidence of bias. What the district court is doing in an ERISA benefits denial case is making something akin to a credibility determination about the insurance company's or plan administrator's reason for denying coverage under a particular plan and a particular set of 26 || medical and other records. We believe that district courts are well equipped to consider the 27|| particulars of a conflict of interest, along with all the other facts and circumstances, to || 3 Unless otherwise noted by the Court, internal quotes and citations have been omitted when quoting and citing cases throughout this Order. -2-

1 || determine whether an abuse of discretion has occurred ... A subtler question arises when a[district] court must decide how much weight to give a conflict of interest under the abuse 31} of discretion standard. In making that determination, the [district] court may consider 4|| evidence outside the record. We have held that the [district] court may consider evidence 51} beyond that contained in the administrative record that was before the plan administrator, to determine whether a conflict of interest exists that would affect the appropriate level of judicial scrutiny ... The district court may, in its discretion, consider evidence outside the || administrative record to decide the nature, extent, and effect on the decision making 9} process of any conflict of interest; the decision on the merits, though, must rest on the administrative record once the conflict (if any) has been established, by extrinsic evidence or otherwise.”); Montour v. Hartford Life & Accident Ins. Co, 588 F.3d 623 (9% Cir. 2009) 12|| (same); Demer v. IBM Corp. LTD Plan, 835 F.3d 893 (9% Cir. 2016) (same). 13 Regarding these issues, Plaintiff’s motion (Doc. 47) seeks an Order from the Court compelling Defendant to: produce 100 prior reports from MLS and from ECN for the years □□ 2020 and 2021; produce 100 prior reports from each of Dr. Parillo, Dr. Marwah, and Dr. Hoenig for the years 2020 and 2021; produce internal claim metrics and tracking documents; and produce the claim and appeal adjusters who decided Plaintiff's claim for 18 || depositions. Under the circumstances of this case and in light of Ninth Circuit authority, Plaintiff's discovery is warranted and Defendant shall provide this information to Plaintiff by‘ no later than 1/31/24.° Likewise, the Court agrees that Plaintiff's position reflected in 21 * In light of the holidays, the Court has allotted extra time in this case; the parties are free to extend these deadlines by stipulation. 22 > See id; see, e.g., Abatie, 458 F.3d at 968 (“A straightforward abuse of discretion analysis allows a court to tailor its review to all the circumstances before it... The level of skepticism with which a court views a 23 conflicted administrator's decision may be low if a structural conflict of interest is unaccompanied, for example, by any evidence of malice, of self-dealing, or of a parsimonious claims-granting history. A court 24 may weigh a conflict more heavily if, for example, the administrator provides inconsistent reasons for denial ... fails adequately to investigate a claim or ask the plaintiff for necessary evidence . . . fails to credit a 25 claimant's reliable evidence .. . or has repeatedly denied benefits to deserving participants by interpreting plan terms incorrectly or by making decisions against the weight of evidence in the record.”); Montour, 588 F.3d at 633-634 (discussing “signs of bias” exhibited by the defendant LTD plan administrator and criticizing the plaintiff as he “did not submit any extrinsic evidence of bias, such as statistics regarding [the 271 LTD plan administrator’s] rate of claims denials or how frequently it contracts with the file reviewers it employed in this case.”); Demer, 835 F.3d at 899-903 (Discussing conflicts of interest relating to the 28 defendant LTD plan administrator: “[Plaintiff] Mr. Demer claims [Defendant] MetLife operated under a conflict of interest because two of the IPCs [i.e., Independent Physician Consultants] that MetLife hired to

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Bluebook (online)
Franklin v. Hartford Life and Accident Insurance Company, Counsel Stack Legal Research, https://law.counselstack.com/opinion/franklin-v-hartford-life-and-accident-insurance-company-azd-2023.