Joyner v. Continental Casualty Co.

837 F. Supp. 2d 233, 2011 WL 6382567
CourtDistrict Court, S.D. New York
DecidedDecember 19, 2011
DocketNo. 11 Civ. 6005 (JSR)
StatusPublished
Cited by10 cases

This text of 837 F. Supp. 2d 233 (Joyner v. Continental Casualty Co.) is published on Counsel Stack Legal Research, covering District Court, S.D. New York primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Joyner v. Continental Casualty Co., 837 F. Supp. 2d 233, 2011 WL 6382567 (S.D.N.Y. 2011).

Opinion

MEMORANDUM ORDER

JED S. RAKOFF, District Judge.

Plaintiff Ramona Joyner brings this suit challenging the denial of her long-term disability insurance benefits claim under the Employee Retirement Income Security Act of 1974 (“ERISA”), 88 Stat. 891. In connection with her claims, plaintiff seeks discovery beyond the scope of the administrative record of defendant Hartford Life Group Insurance Company (“Hartford”), successor-in-interest to named defendant Continental Casualty Co. (“Continental”). Defendant objects to any extra-record discovery. After the initial scheduling conference in this case, held on October 12, 2011, the Court directed the parties to submit letter briefing defending their respective positions on the standard of review and discovery outside the administrative record. Both parties submitted their briefs on October 19, 2011, and their responses to each other’s brief one week later, on October 26, 2011.

Having carefully considered the parties’ briefs, the Court determines that limited discovery on some of the issues plaintiff raises is warranted. In particular, the Court concludes that plaintiff can seek discovery on two issues. First, plaintiff may seek discovery of any further plan documents that show whether defendant Hartford was a proper “named fiduciary” identified in “the plan instrument” as required by ERISA. See 29 U.S.C. 1102(a)(2). Second, in accordance with the Supreme Court’s direction in Met. Life Ins. Co. v. Glenn, 554 U.S. 105, 128 S.Ct. 2343, 171 L.Ed.2d 299 (2008), plaintiff may seek discovery on the issue of Hartford’s alleged [237]*237conflict of interest as both payor and evaluator of plaintiffs disability claim, limited to document requests and a deposition of a Hartford representative pursuant to Rule 30(b)(6). Fed.R.Civ.P. 30(b)(6). All of plaintiffs other requests for discovery are hereby denied. Additionally, the Court concludes that the appropriate standard of review is an arbitrary and capricious standard, as Hartford had discretionary authority to interpret the terms of the plan. See Fay v. Oxford Health Plan, 287 F.3d 96, 104 (2d Cir.2002) (holding where insurer has discretionary authority, the benefits decision is reviewed under the arbitrary and capricious standard).

“Point I” of plaintiffs submission seeks discovery to ascertain whether Hartford was properly delegated discretionary authority to determine plaintiffs eligibility for benefits and to interpret the terms and provisions of the policy, and whether Hartford is the proper “named fiduciary” with the right to review, evaluate and decide plaintiffs appeal of her denied disability claim. Letter Brief of Plaintiff Ramona Joyner dated Oct. 19, 2011 (“PL Br.”) at 2. The Court must address three separate questions contained in plaintiffs “Point I”: first, whether the Plan originally conferred discretionary authority on Continental Casualty; second, whether Continental transferred that authority to defendant Hartford, the successor-in-interest to Continental’s group disability business, when Hartford purchased the disability plan at issue; and third, whether Hartford was a “named fiduciary” that could provide plaintiff with a “full and fair review” of her claim pursuant to 29 U.S.C. § 1133(2).

As to the question of whether the Plan conferred discretionary authority on Continental Casualty, ho further discovery is necessary. The “Group Long Term Disability Certificate” clearly states that “When making a benefit determination under the policy, We have discretionary authority to determine Your eligibility for benefits and to interpret the terms and provisions of the policy.” Hartford Letter Brief dated Oct. 19, 2011 (“Def. Br.”) Ex. A, at 6. “We” in the Certificate is defined by the contract to mean the “Continental Casualty Company, Chicago, Illinois.” PI. Br., Ex. 1 at 17. This clear language shows the Plan vests discretionary authority in Continental. See Krauss v. Oxford Health Plans (N.Y.), Inc., 517 F.3d 614, 622-23 (2d Cir.2008) (holding that reservation of discretion must be “clear” but need not use the words “discretion” or “deference”).

Plaintiff, however, argues that because this Certificate is admittedly not the “Policy,” Def. Br. Ex. A at 6, “it is not a governing plan document and of no force or effect.” PI. Br. at 4-5; see CIGNA Corp. v. Amara, — U.S. -, 131 S.Ct. 1866, 1878, 179 L.Ed.2d 843 (2011) (holding “summary documents” do not constitute the terms of the plan for purposes of § 502(a)(1)(B)). But CIGNA is inapplicable to this case. In CIGNA, the Supreme Court held that the insurer’s Summary Plan Description, a document required by 29 U.S.C. § 1022(a), did not constitute the terms of the plan for purposes of ERISA § 502(a)(1)(B). Id. Here, however, the Certificate is not designated a Summary Plan Description, nor does it comport with the SPD requirements outlined in 29 U.S.C. § 1022. Further, the integration clause in the Group Policy states “The policy, the Employer’s application, Your certificate of coverage, and Your application, if any, and any other attached papers, form the entire contract between the parties.” PI. Br. Ex. 1, at 15. Thus, unlike a Summary Plan Description, this Certificate, according to the plain language of the Policy, is part of the plan’s terms and is [238]*238“legally binding,” and thus gives Continental discretionary authority to interpret the plan. See CIGNA, 131 S.Ct. at 1877-78 (refusing to “make the language of a plan summary legally binding”).

Turning to whether Continental transferred its discretionary authority to Hartford when Hartford purchased Continental’s group disability business, Hartford has provided this Court and Joyner with the asset purchase documents for that transaction, filed under seal. See Protective Order dated Oct. 31, 2011. Those documents show that the CNA Group Life Assurance Company (“CNA”), the reinsurer of Continental’s group health insurance businesses, was purchased by Hartford Life, Inc. and Hartford Life and Accident Insurance Company (“Hartford Inc.”) and that CNA would administer the insurance plans sold to Hartford Inc., including the instant plan. See Declaration of Leslie T. Soler (“Soler Decl.”) Ex. A at JOYNER 002623-24, 002628, 002647 CONFIDENTIAL.1 As part of the Administrative Services Agreement entered into between Continental and CNA, CNA, the Administrator, was appointed to perform claim adjustment services for the policies. See Soler Decl. Ex. B § 4.01. In its role as Administrator, the Administrative Services Agreement states CNA would, among other responsibilities:

[Rjeview all Claims and determine whether the Claimant is eligible for benefits and if so, the nature and extent of such benefits. Such determination shall be made (i)

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