United States District Court, D. Maine
ORDER ON MOTION FOR DISCOVERY AND MOTION TO
C. Nivison U.S. Magistrate Judge.
action, Plaintiff seeks to recover benefits from her
employer's disability insurance plan under the Employee
Retirement Income Security Act of 1974 (ERISA), 29 U.S.C.
§ 1001 et seq.
matter is before the Court on Plaintiff's request to
modify the administrative record and to conduct discovery.
(Motion, ECF No. 13.) Following a review of the pleadings and
after consideration of the parties' arguments, I grant in
part the motion.
served as a finance manager for Kaplan University for more
than eight years. Plaintiff suffers from a degenerative
spinal condition for which she has undergone multiple
surgeries, including a cervical spinal fusion and multiple
lumbar laminectomies, and suffers from vision difficulties,
Cushing's syndrome, Sjogren's syndrome, and adrenal
insufficiency. Plaintiff maintains that as the result of her
medical conditions, she experiences extreme exhaustion and
Plaintiff's employment at Kaplan University, she
participated in a disability insurance plan. The plan is
self-funded by its sponsor, Defendant Graham Holdings Company
(hereinafter “the Sponsor”). The Sponsor entered
into an administrative services agreement with Defendant
Prudential (hereinafter “Defendant”). Pursuant to
the agreement, Defendant administers claims for disability
benefits under the plan. Although Defendant decides whether a
particular disability claim must be paid, the disability
benefits are paid out of a trust that is funded by the
6, 2015, Plaintiff stopped working and filed a claim for
short- and long-term disability benefits. Defendant approved
Plaintiff's claim for short-term disability and paid
benefits for the short-term disability period, through
September 30, 2017. On October 2, 2017, Defendant suspended
payments, initially based on Plaintiff's failure to
provide certain records, and then based on a determination
that Plaintiff could perform her prior sedentary occupation.
Regarding Plaintiff's fatigue, according to Plaintiff,
Defendant maintains that “one would generally not
expect to equate fatigue with sustained inability to work . .
. .” (Plaintiff's Reply at 3, ECF No. 16.)
Beginning on January 23, 2018, Plaintiff initiated several
appeals regarding her claim for long-term benefits, but
Defendant upheld its decision that she was not entitled to
continued benefits. Plaintiff subsequently commenced this
is the exception, rather than the rule, in an appeal of a
plan administrator's denial of ERISA benefits.”
Ferry v. Prudential Ins. Co. of Am., No. CIV.
10-211-P-S, 2010 WL 4363381, at *1 (D. Me. Oct. 28, 2010), on
reconsideration, No. 2:10-CV-211-GZS, 2011 WL 322000 (D. Me.
Jan. 30, 2011). “The decision to which judicial review
is addressed is the final ERISA administrative
decision.” Orndorf v. Paul Revere Life Ins.
Co., 404 F.3d 510, 519 (1st Cir. 2005). “Because
full-blown discovery would reconfigure that record and
distort judicial review, courts have permitted only modest,
specifically targeted discovery in such cases.”
Denmark v. Liberty Life Assur. Co. of Bos., 566 F.3d
1, 10 (1st Cir. 2009). “[A]t least some very good
reason is needed to overcome the strong presumption that the
record on review is limited to the record before the
administrator.” Liston v. Unum Corp. Officer
Severance Plan, 330 F.3d 19, 23 (1st Cir. 2003).
seeks leave to obtain the following discovery from
Defendants: (1) internal guidelines, memoranda, rules,
regulations, and policies concerning fatigue, Cushing's
syndrome, Sjogren's syndrome, and adrenal insufficiency;
(2) financial records concerning the income paid to the
referral service and the two medical reviewers; and (3)
documents addressing Defendant's alleged incentives, such
as performance indicators and criteria for claims
Internal Guidelines, Memoranda, Policies
have a right to discover the contents of the administrative
record if they are unsure whether all relevant information
has been included.” Grady v. Hartford Life
& Acc. Ins. Co., No. CIV 08-339-P-H, 2009 WL 700875,
at *6 (D. Me. Mar. 12, 2009). “A document, record, or
other information shall be considered
‘relevant'” if it:
(i) Was relied upon in making the benefit determination;
(ii) Was submitted, considered, or generated in the course of
making the benefit determination, without regard to whether
such document, record, or other information was relied ...