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Knight v. Prudential Insurance Co. of America

United States District Court, D. Maine

February 13, 2019



          John C. Nivison U.S. Magistrate Judge.

         In this 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.

         The 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.

         Background [1]

         Plaintiff 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 fatigue.

         During 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 Sponsor.

         On July 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 action.


         “Discovery 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).

         Plaintiff 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 specialists.

         A. Internal Guidelines, Memoranda, Policies

         “[C]laimants 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 ...

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