McGahey v. Harvard University Flexible Benefits Plan

260 F.R.D. 10, 2009 U.S. Dist. LEXIS 83405, 2009 WL 2974758
CourtDistrict Court, D. Massachusetts
DecidedSeptember 14, 2009
DocketCivil Action No. 08-10435-RGS
StatusPublished
Cited by6 cases

This text of 260 F.R.D. 10 (McGahey v. Harvard University Flexible Benefits Plan) is published on Counsel Stack Legal Research, covering District Court, D. Massachusetts primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
McGahey v. Harvard University Flexible Benefits Plan, 260 F.R.D. 10, 2009 U.S. Dist. LEXIS 83405, 2009 WL 2974758 (D. Mass. 2009).

Opinion

MEMORANDUM AND ORDER ON PLAINTIFF’S RULE 56(f) MOTION FOR FURTHER DISCOVERY

STEARNS, District Judge.

Plaintiff Rosemary McGahey brought this action pursuant to the Employee Retirement Income Security Act (ERISA), 29 U.S.C. § 1001, et seq., seeking disability benefits under a self-insured employee benefit plan sponsored by Harvard University. McGahey received benefits for twenty-four months until June 30, 2006, when Harvard determined that she was no longer disabled from any occupation. Both McGahey and Harvard moved for summary judgment. In addition to her motion for summary judgment, McGa-hey filed a motion for further discovery pursuant to Fed.R.Civ.P. 56(f). A hearing on the three motions was held on September 3, 2009.

DISCUSSION

For a Rule 56(f) motion to be successful, a party must put forward sufficient evidence to show that additional discovery is necessary, feasible, and can be outcome-determinative.

In all events, the proffer should be authoritative; it should be advanced in a timely manner; and it should explain why the party is unable currently to adduce the facts essential to opposing summary judgment. When, as is often the case, the reason relates to incomplete discovery, the party’s explanation must take a special form: it should show good cause for the failure to have discovered the facts sooner; it should set forth a plausible basis for believing that specified facts, susceptible of collection within a reasonable time frame, probably exist; and it should indicate how the emergent facts, if adduced, will influence the outcome of the pending summary judgment motion.

Resolution Trust Corp. v. North Bridge As-socs., Inc., 22 F.3d 1198, 1203 (1st Cir.1994). “In determining whether material is ‘discoverable,’ the court should consider not only whether the material actually exists, but the burdens and expenses entailed in obtaining the material.” Fennell v. First Step Designs, Ltd., 83 F.3d 526, 532 (1st Cir.1996). Discovery pursuant to Rule 56(f) is not granted as a matter of right. Ayala-Gerena v. Bristol Myers-Squibb Co., 95 F.3d 86, 92 (1st Cir.1996).

McGahey’s Previous Discovery Request

The court previously denied a request by McGahey for discovery outside the administrative record. See McGahey v. Harvard Univ. Flexible Benefits Plan, 2009 WL 799464 (D.Mass. Mar.25, 2009). “The longstanding rule in the First Circuit [for an ERISA benefits appeal] holds that ‘some very good reason is needed to overcome the strong presumption that the record on review is limited to the record before the administrator.’” Id. at *2, quoting Liston v. Unum Corp. Officer Severance Plan, 330 F.3d 19, 23 (1st Cir.2003). In denying McGahey’s initial motion for discovery, the court explicitly left open the door for reconsideration of McGahey’s request: “If a showing of the improper intrusion of a conflict of interest in the administrator’s decision making process can be made at the summary judgment stage, McGahey may file a motion pursuant to Fed.R.Civ.P. 56(f).” Id. at *3.1

McGahey’s Current 560 Motion

In its March 25, 2009 discovery order, the court addressed at length the Supreme Court’s discussion of the impact of structural conflicts on the review of ERISA benefits appeals in Metropolitan Life Ins. Co. v. Glenn, — U.S. — , 128 S.Ct. 2343, 171 L.Ed.2d 299 (2008). Structural conflicts are held to exist (as is the case here) where a “plan administrator both evaluates claims for benefits and pays benefits claims.” Id. at [12]*122348. Glenn holds that district courts are to “take account of [the structural conflict] as a factor in determining the ultimate adequacy of the record’s support for the agency’s own factual conclusion.” Id. at 2352. “Although Glenn identifies a structural conflict of interest as a factor to consider when reviewing an administrator’s benefits decision, it gives little guidance for dealing with requests for discovery.” McGahey, supra, at *2. The March 25, 2009 order articulated the court’s view of the relevant factors post-Glenn for allowing discovery when a conflict of interest is alleged.

[I]n light of Glenn, this court will consider, among other factors, the extent to which the record discloses efforts to insulate the claims review process from institutional financial considerations; the thoroughness and consistency of the explanation of the denial; the care with which the claimant’s own physician’s opinions were treated; and, if the administrator relied on the opinion of independent experts, the extent to which these experts were in fact truly independent.

Id. (emphasis added).

The last factor is the most relevant to McGahey’s 56(f) motion. The court is persuaded that McGahey is entitled to some additional discovery related to the opinions of three experts who performed independent medical examinations (IME) for Harvard: George McManama, M.D., Stuart J. Clay-man, Ph.D., and Hyman Glick, M.D. These three experts stand apart from the other fourteen experts and treating physicians who opined on McGahey’s disability because of them diagnosis of McGahey with “symptom magnification,” or, less politely, faking. At least on the surface, this opinion is difficult to reconcile with the diagnoses of McGahey’s treating physicians who are sufficiently convinced of her complaints of pain to prescribe powerful (and potentially addictive) painkillers like OxyContin and Percocet.

In a close case like this one, with multiple medical experts with diametrically opposed opinions, and inconsistent determinations among Harvard, the Social Security Administration (SSA), and the Massachusetts Department of Industrial Accidents (DIA), some further inquiry is warranted.2 Accordingly, the court will order Harvard to produce for the period from February 1, 2004 to May 31, 2007:(1) the total number of IME reports it commissioned from Drs. McMana-ma, dayman, and Glick; (2) the raw number of claims that each of these doctors recommended be denied; and (3) the raw number of claims that each of these doctors recommended be allowed.

Missing Affidavit in McGahey’s 56(f) Motion

As a separate ground for denial, Harvard challenges the form of McGahey’s 56(f) motion. Fed.R.Civ.P. 56(f) allows a court to order a continuance of a motion for summary judgment “[i]f a party opposing the motion shows by affidavit that, for specified reasons, it cannot present facts essential to justify its opposition.” (Emphasis added).

Free access — add to your briefcase to read the full text and ask questions with AI

Related

Wilson v. Pharmerica Corp. Long Term Disability Plan
102 F. Supp. 3d 373 (D. Massachusetts, 2015)
Reich v. U.S. Department of Energy
784 F. Supp. 2d 15 (D. Massachusetts, 2011)
Boyson v. Dartmouth Hitchcock, et al.
2010 DNH 077 (D. New Hampshire, 2010)
McGahey v. Harvard University Flexible Benefits Plan
685 F. Supp. 2d 168 (D. Massachusetts, 2009)

Cite This Page — Counsel Stack

Bluebook (online)
260 F.R.D. 10, 2009 U.S. Dist. LEXIS 83405, 2009 WL 2974758, Counsel Stack Legal Research, https://law.counselstack.com/opinion/mcgahey-v-harvard-university-flexible-benefits-plan-mad-2009.