Opinion
CV-22-00168-TUC-JAS
12-07-2023
Sabrina Franklin, Plaintiff, v. Hartford Life and Accident Insurance Company, Defendant.
Kristina N. Holmstrom (SBN 023384) OGLETREE, DEAKINS, NASH, SMOAK & STEWART, P.C., Attorneys for Defendant Hartford Life and Accident Insurance Company
Kristina N. Holmstrom (SBN 023384)
OGLETREE, DEAKINS, NASH, SMOAK & STEWART, P.C.,
Attorneys for Defendant Hartford Life and Accident Insurance Company
ORDER
Honorable James A. Soto, United States District Judge
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 (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 record and authority, Plaintiff's motions are granted and the objection is sustained.
The Court notes that Docs. 43 and 57 are duplicative of Docs. 47 and 67.
Because the briefing is adequate and oral argument will not help in resolving this matter, oral argument is denied. See Mahon v. Credit Bureau of Placer County, Inc., 171 F.3d 1197, 1200-1201 (9th Cir. 1999).
Discussion
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 “Plan”) with Defendant. The discovery-related motions at bar primarily pertain to Plaintiff's pursuit of information that may bear on Defendant's conflicts of interest in this case.
As a threshold matter, Defendant is both the administrator of the LTD Plan and the payor under the LTD Plan; the Plan also specifies that Defendant has discretion in evaluating the validity of beneficiaries' claims for LTD benefits under the Plan.
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, e.g., Abatie v. Alta Health & Life Ins. Co., 458 F.3d 955, 965-71 (9th Cir. 2006) (“We have held that an insurer that acts as both the plan administrator and the funding source for benefits operates under what may be termed a structural conflict of interest... On the one hand, such an administrator is responsible for administering the plan so that those who deserve benefits receive them. On the other hand, such an administrator has an incentive 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 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 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 a 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 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 medical and other records. We believe that district courts are well equipped to consider the particulars of a conflict of interest, along with all the other facts and circumstances, to 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 of discretion standard. In making that determination, the [district] court may consider evidence outside the record. We have held that the [district] court may consider evidence 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 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 (9th Cir. 2009) (same); Demer v. IBM Corp. LTD Plan, 835 F.3d 893 (9th Cir. 2016) (same).
Unless otherwise noted by the Court, internal quotes and citations have been omitted when quoting and citing cases throughout this Order.
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 Plaintiffs claim for depositions. Under the circumstances of this case and in light of Ninth Circuit authority, Plaintiffs discovery is warranted and Defendant shall provide this information to Plaintiff by no later than 1/31/24. Likewise, the Court agrees that Plaintiffs position reflected in her other discovery-related motions (Docs. 67, 51) is correct, and therefore Plaintiffs objection (Doc. 51) is sustained, and Defendant shall provide the information sought in Plaintiffs motion (Doc. 67) by no later than 1/31/24.
In light of the holidays, the Court has allotted extra time in this case; the parties are free to extend these deadlines by stipulation.
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 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 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 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 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 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 review the medical record, Dr. Del Valle and Dr. Gordan, have done a substantial number of reviews for MetLife and received significant compensation from MetLife for their services. For 2009 and 2010, Dr. Del Valle performed more than 250 reviews/addendums each year and earned more than $125,000 each year; for the same time period, Dr. Gordan performed between 200-300 reviews/addendums each year and earned more than $175,000 each year. Based on the number of reviews and the amount of compensation, Mr. Demer asserts that the opinions of Dr. Del Valle and Dr. Gordan should be questioned because the doctors had financial incentives to render opinions favorable to MetLife. Mr. Demer further argues that, because MetLife relied on the doctors' opinions in denying him relief, the doctors' conflict is, in effect, imparted to MetLife ... As a preliminary matter, we note that Mr. Demer's argument here is comparable to conventional approaches to discrediting the testimony of retained experts whose objectivity may be challenged based on, e.g., the number of times he or she has served as an expert in support of a party and the amount of compensation received. This alleged conflict of interest is distinct from the purported structural conflict of interest discussed above. The lack of any structural conflict of interest on the part of MetLife does not preclude MetLife from having a conflict of interest based on an IPC's financial interests; the factors that raise the possibility of a structural conflict relate to the incentives applicable to MetLife's claims department, whereas the factors that raise the possibility of a financial conflict relate to the incentives applicable to MetLife's retained experts. Even if MetLife operated with no structural conflict, reliance on the reports of its retained experts who have a financial incentive to make findings favorable to MetLife may warrant skepticism.” In addition, the plaintiff was rebuked for failing to more thoroughly develop further evidence of bias: “To be sure, the lack of more powerful evidence that, e.g., the IPCs had some specific stake in the outcome of Mr. Demer's case ... or of statistics showing a parsimonious pattern of assessments disfavorable to claimants . . . minimizes the weight [assigned] to the conflict of interest as a factor in the overall analysis of whether an abuse of discretion occurred .. . But that lack of such specific evidence does not mean that there is no conflict of interest. Here, we have evidence of not only the frequency of reviews for MetLife but also the significant dollar amounts earned by the reviewers. Furthermore, that Mr. Demer could have, but did not, develop a stronger record of the IPCs' conflict of interest does not mean that there is no conflict.”; “[Plaintiff] objects to the district court's reliance on the declarations from two employees, Gregory Hafner and Laura Sullivan, who describe the affirmative steps taken by MetLife to reduce its structural conflict, on the ground that neither Mr. Hafner nor Ms. Sullivan was disclosed as a witness in MetLife's initial disclosures as required by Federal Rule of Civil Procedure 26. MetLife did not explain its failure to identify witnesses in its mandatory initial disclosures; on the other hand, [Plaintiff] did not explain his failure to take a 30(b)(6) deposition on the structural conflict issue.”); Salomaa v. Honda Long Term Disability Plan, 642 F.3d 666, 674-75 (9th Cir. 2011) (“The administrator of the [long term disability] plan before us has a conflict of interest, as the term is used in ERISA cases, because the insurer acts as both funding source and administrator . . . We know that we are supposed to weigh a conflict of interest in deciding how skeptical to be of the administrator's decision, according varying weight to it depending on other factors, but that is a hard standard to apply. Weighing is a metaphor. Real weighing is done with a scale . . . [O]ur weighing is done without a scale, without the little brass weights, and without a substance to weigh that has any weighable mass . . . Nor is it easy to decide how many metaphorical grams should go on the metaphorical scale when we pretend to weigh conflicts of interest. The misleading precision of the metaphor is indeed a serious concern, because of the special protection the statute gives to insurance companies against claims. An insurance company that approaches claims-handling unfairly in an ERISA plan may have an incentive to be more unfair than, say, a life insurer or auto-liability insurer, because it cannot be subjected to the punitive damages for bad faith that are the bogeymen of insurance companies in those fields. Usually the record does not disclose an insurance company's claims-handling history in other cases or its internal directives to claims managers about how to evaluate claims. Thus we are ordinarily ignorant of much of what we are supposed to weigh. For all we know, the claims administrator evaluating [the plaintiffs] claim would be voted for promotion based on the percentage of claims rejected, or had formed a personal opinion (or her boss had) that all chronic fatigue syndrome claims were fraudulent. . . We must judge the reasonableness of the plan administrator skeptically where, as here, the administrator has a conflict of interest. Even without the special skepticism we are to apply in cases of conflict of interest, deference to the plan administrator's judgment does not mean that the plan prevails. Deference is not a talismanic word that can avoid the process of judgment. The conflict of interest requires additional skepticism because the plan acts as judge in its own cause.”).
Plaintiff correctly argues that there has been no showing of specific prejudice and harm stemming from unsealing the two and three year old vendor and reviewer data at issue in Plaintiff's objection; the presumptive right of public access to such records has not been overcome and this information is hereby ordered unsealed. The Court has attached an unsealed copy of the document in question (Doc. 42-6) to this Order.
The Court notes that Defendant argues that Plaintiff has already sought the information requested in Doc. 67 and such information may not exist. Nevertheless, Defendant shall undertake efforts to obtain the information sought in Doc. 67 going forward by 1/31/24; if such information cannot be obtained (or no longer exists for some reason), Defendant shall file a declaration(s) (under penalty of perjury) specifying all the efforts it undertook to obtain the information in question and why those efforts bore no fruit.
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY'S SUPPLEMENTAL RESPONSES TO PLAINTIFF'S FIRST SET OF REQUESTS FOR PRODUCTION OF DOCUMENTS AND FIRST SET OF INTERROGATORIES
Defendant Hartford Life and Accident Insurance Company (hereinafter “Hartford” or “Defendant”), hereby supplements its response and objects to Plaintiff Sabrina Franklin's (“Plaintiff') First Set of Requests for Production of Documents and First Set of Interrogatories, as follows:
REQUESTS FOR PRODUCTION OF DOCUMENTS
Request for Production No. 1: Produce any and all Documents or Communications that refer in any way to Plaintiff and which are not included within Plaintiff s claim file or ERISA “administrative record.”
Response: Information responsive to this Request for Production is set forth in the claim file that Hartford has produced. Accordingly, pursuant to Federal Rule of Civil Procedure 33(d), Hartford directs Plaintiff to the claim file (otherwise referred to as the “Administrati ve Record”)as that would contain the relevant and substantive information pertaining to the Plaintiff s claim for benefits that is the subject of this lawsuit.
The Administrative Record was previously produced on August 3, 2022.
Supplemental Response: Without foregoing the above objections, Hartford supplements its response as follows: See relevant emails and instant messages (HLAICSFRFP000105-138)(Confidential Subject to Stipulated Protective Order), produced herewith via ShareFile FTP link pursuant to entry of January 27,2023 Stipulated Protective Order (ECF 39).
Request for Production No. 2: For the period January L 2020 through December 31, 2021, produce any and all reports of disability file reviews You have received (either directly or through any external review company or other source) from any of the following reviewers:
• Lucien Parillo, M.D.
• Rajendra Marwah, M.D.
• David Hoenig, M.D.
Response: Hartford objects to this Request for Production as the question seeks private, confidential, and highly protected medical reports of individuals who are not a part} to thu kiwsia;, nor are their claims at issue in this lawsuit. Hartford further objects on the grounds that the disclosure sought would constitute a direct violation of H1PAA and other federal privacy laws that protect sensitive and confidential medical information. Hartford further objects to the extent this Request for Production seeks information which is beyond the reasonable scope of discovery in this ERISA case by seeking any and all reports of disability file reviews generated by Dr. Lucien Parillo, Dr. Rajendra Marwah and Dr. David Hoenig, none of which are employed by Hartford and spanning a two year period of time. Hartford further objects to as this request is overly broad in scope, unduly burdensome and oppressive. The reports sought have no relevance to the whether Hartford abused its discretion in determining that Plaintiff had not met her burden of proving disability and entitlement to benefits beyond February 18,2021. which is the subject of this lawsuit and this request is not proportional to the needs of this case.
Request for Production No. 3: For the period January 1. 2020 through December 31, 2021, produce any and all reports of disability file reviews You have received from any of the following Third Party Review Companies:
• MLS or the MLS Group of Companies
• ECN or Exam Coordinators Network
Response: Hartford objects to this Request for Production as the question seeks private, confidential, and highly protected medical reports of individuals who are not a party to this lawsuit, nor are their claims at issue in this lawsuit. Hartford further objects on the grounds that the disclosure sought would constitute a direct violation of HIPAA and other federal privacy laws that protect sensitive and confidential medical information. Hartford further objects to the extent this Request for Production seeks information which is beyond the reasonable scope of discovery in this ERISA case by seeking any and all reports of disability file reviews generated by MLS Group of Companies (“MLS”) or Exam Coordinators Network (“ECN”) over a two year period of time. Both MLS and ECN operate as independent third party companies that engage with independent doctors to perform a medical peer review. Hartford further objects as this request is overly broad in scope, unduly burdensome, and oppressive. The requested reports pertain to the individualized claims of other claimants which have no relevance to the long term disability claim brought by Plaintiff. The request bears no relevance to whether Hartford abused its discretion in determining that Plaintiff had not met her burden of proving disability and entitlement to benefits beyond February 18, 2021, which is the subject of this lawsuit and thus this request is not proportional to the needs of this case.
Request for Production No. 4: For the period January 10, 2014 through the present, produce any and all policies and procedures that You changed or instituted in response to the court decisions in Demer v. I.B.M. Corp. LTD Plan, 835 F.3d 893 (9th Cir. 2016) or Hertz v. Hartford Life and Accident Ins. Co., 991 F.Supp.2d 1121 (D. Nev. 2014).
Response: Hartford objects to this Request for Production as the question seeks proprietary and trade secret information of Hartford that has no direct impact on how the Plaintiff s claim for LTD benefits was adjudicated. Hartford further objects as this Request for Production seeks policies and procedures put in place following two cases that span nine (9) years' time from January 10, 2014 through December 2022, making this Request for Production overly broad in time and scope and in consideration of the duration of Plaintiffs LTD claim. Hartford further objects to this Request for Production as unduly burdensome, beyond the scope of discovery in this ERISA case and not proportional to the needs of this case. The question in this case is whether Plaintiff met her burden of proving disability and entitlement to benefits beyond February 18, 2021, and this Request has no bearing on that issue. To the extent Hartford's legal department provided legal advice that impacted any “policies and procedures” that advice would be privileged. Without waiving the foregoing objection, Hartford states that updates and changes to internal policies and procedures are made on an ongoing basis and based on a number of factors, both externally and internally, to allow Hartford to fairly adjudicate claims at an individual claims level.
Request for Production No. 5: For the period January 10, 2014 through the present, produce any and all Documents of Communications that refer or relate in any way to Your maintaining records of disability file reviewer findings on claims to track, document, or show the reviewers' neutrality in practice.
Response: Hartford objects to this Request for Production as the question is overly broad in seeking all “Documents” and “Communications” in any form that pertain to maintaining records of disability file reviewer findings in order to track, document, or show the reviewers' neutrality in practice and has no direct impact on how the Plaintiff s claim for LTD benefits was adjudicated. Hartford further objects as this Request for Production seeks records that span nine (9) years' time from January 10,2014 through December 2022, making this Request for Production overly broad in time and scope and in consideration of the duration of Plaintiff s LTD claim. Hartford further objects to this Request for Production as unduly burdensome, beyond the scope of discovery in this ERISA case and not proportional to the needs of this case. The question in this case is whether Hartford abused its discretion in determining that Plaintiff had not met her burden of proving disability and entitlement to benefits beyond February 18, 2021, and this Request has no bearing on that issue.
Request for Production No. 6: For the period January 10, 2014 through the present, produce any and all Documents or Communications between You and any of the following Third Party Review Companies that refer or relate in any way to ensuring the neutrality in practice of the reviewers retained by those Third Party Review Companies:
• MLS or the MLS Group of Companies
• ECN or Exam Coordinators Network
Response: Hartford objects to this Request for Production as the question seeks documents between Hartford and two independent Third Party Review Companies, MLS and ECN, and contains proprietary and trade secret information of Hartford that has no direct impact on how the Plaintiffs claim for LTD benefits was adjudicated and does not pertain to whether Hartford abused its discretion in determining that Plaintiff had not met her burden of proving disability and entitlement to benefits beyond February 18, 2021. Hartford further objects as this Request for Production seeks documents that span nine (9) years' time from January 10, 2014 through December 2022 and in consideration of the duration of Plaintiff s LTD claim, making this Request for Production overly broad in time and scope. Hartford further objects to this Request for Production as unduly burdensome, beyond the scope of discovery in this ERISA case and not proportional to the needs of this case. Without waiving the foregoing objection, Hartford ensures neutrality in practice of the reviewers retained by MLS and ECN through proprietary and confidential contract provisions.
Supplemental Response: Hartford supplements its response as follows pursuant to entry of January 27, 2023 Stipulated Protective Order (ECF 39): The contract between Hartford and the medical vendor companies contains a provision and requires at a minimum each report including the medical consultant reviewer attestation of expertise, qualifications, independence, and impartiality. See also MLS and Genex Contracts (HLAICSFRFP000001-88)(Confidential Subject to Stipulated Protective Order), produced herewith via ShareFile FTP link.
Request for Production No. 7: For the period January 10, 2014 through the present, produce any and all Documents or Communications that track, document, or show the following reviewers' neutrality in practice and/or which track, document, or show the rate or percentage of time the following reviewers opined that a long-term disability claimant did or did not have work-related restrictions and limitations:
• Lucien Parillo, M.D.
• Rajendra Marwah, M.D.
• David Hoenig, M.D.
Response: Hartford objects to this request for production seeking documents showing Communications and statistics of Dr. Lucien Parillo, Dr. Rajendra Marwah and Dr. David Hoenig, as overly broad in time and scope, seeking over nine (9) years of information not related to whether Hartford abused its discretion in determining that Plaintiff had not met her burden of proving disability and entitlement to benefits beyond February 18,2021, which is the subject of this lawsuit and this request is not proportional to the needs of this case. Hartford further objects as this request is unduly burdensome and beyond the scope of discovery in this ERISA case. Hartford further objects to producing information showing the rate or percentage of time that Dr. Parillo, Dr. Marwah and Dr. Hoenig opined that a long-term disability claimant did or did not have work-related restrictions and limitations as this information is irrelevant to the Plaintiff s claim in this lawsuit, the information sought is not proportional to the needs of this case and unduly burdensome. Notwithstanding said objection, Hartford has in place confidential contracts with independent third party vendors to ensure that reviews are impartial and based on an objective review in the area of specialty based on the medical records. Hartford does not directly refer claims for evaluation to the independent reviewing physicians. Rather, Hartford forwards requests for external reviews to third party vendor companies and those vendors, in turn, independently assign the independent reviewing physicians to ensure neutrality in the review process.
Supplemental Response: Without foregoing the above objections, Hartford supplements its response as follows pursuant to entry of January 27, 2023 Stipulated Protective Order (ECF 39): Hartford does not track the percentage of time that peer reviewing physicians opined that a long term disability claimant did or did not have work-related restrictions and limitations.
Request for Production No. 8: For the period January 1, 2020 through the present, produce any and all claim metrics or claim tracking documents or tools that include or incorporate data or information relating to Plaintiff s claim.
Response: Hartford objects to this request for production as the information sought on claim metrics and claim tracking documents or tools as it relates to Plaintiff s claim is overly broad and beyond the reasonable scope of discovery in this ERISA case. Hartford further objects as the information sought may be proprietary and confidential and constitute trade internal trade secret documentation. Notwithstanding said objection, Hartford states that the claim documentation that was reviewed for purposes of making a claim decision on Plaintiff s claim is contained in the Administrative Record that has been produced.
Request for Production No. 9: Produce any and all documents that refer or relate to reserves relating to Plaintiffs long-term disability claim.
Response: Hartford objects to this request for production seeking information on reserves relating to Plaintiffs long-term disability claim as overly broad, unduly burdensome, disproportionate to the needs of this case, and not reasonably calculated to lead to the discovery of admissible evidence, and thus, outside the scope of permissible discovery. Hartford further objects as this request is unduly burdensome and beyond the scope of discovery in this ERISA case. Hartford further objects to this request for production on the grounds that it seeks information irrelevant to the parties' claims or defenses, not reasonably calculated to lead to the discovery of admissible evidence and not proportional to the needs of the case. Notwithstanding said objection, Hartford states that the employees involved in the claim decision process for the plaintiff s claim for long term disability benefits had no access to reserve information. Reserves and other company financial information are irrelevant to the plaintiffs claim. In evaluating claims under employee benefit plans insured by Hartford, it is Hartford's practice and intention to review such claims fairly, without regard to the manner in which the plan is funded, and to consistently award benefits on claims that are entitled to payment pursuant to the provisions of the applicable benefit plan while consistently denying claims that are not entitled to such payments. Hartford does not provide its Ability Analysts, Managers and Appeals Specialists with any incentives, remuneration, bonuses, awards, achievements, or other recognition based in whole or in part upon the denial or termination of claims. Hartford's claims decision-makers are paid fixed salaries and performance bonuses that are wholly unrelated to the number of claims paid or claims denied. Hartford's claims and appeals decision-makers are evaluated on the quality and accuracy of their claims decisions in accordance with the applicable plan/policy documents. Hartford does not discourage its claims and appeals decision-makers from paying legitimate claims. Hartford's claims and appeals decisionmakers are not involved in Hartford's financial decisions, including, but not limited to, any review or analysis of Hartford's financial performance, or the financial performance or claims experience of any particular long term disability plan insured by Hartford. Hartford's claims department and appeals unit are completely separate business units from the financial and underwriting departments. Neither the claims department nor the appeals unit seeks approval from Hartford's financial underwriters in connection with their decision-making on claims for disability benefits. Hartford's financial and underwriting departments do not advise or influence the claims department or appeals unit with respect to the denial or termination of a claimant's benefits. Indeed, these units are kept separate from each other. The office of the Chief Financial Officer of Hartford, and its affiliate, subsidiary or parent companies, do not have any involvement and do not participate in claims decisions on disability benefits at any level.
Request for Production No. 10: Produce your complete claims manual.
Response: Hartford objects to this Request for Production that broadly seeks the complete claims manual utilized by Hartford as overly broad in scope and time. Hartford further objects to this Request on the grounds that it is unduly burdensome, oppressive, and not reasonably calculated to lead to the discovery of evidence relevant to the claims and defenses of the parties, and not proportional to the needs of the case since it seeks all rules, guidelines, manuals, etc. involving administration and processing of all disability claims regardless of whether or not such documentation has any connection with, or was used in, Plaintiff5s claim. Hartford further objects to this Request on the grounds that it seeks confidential, proprietary, and commercially sensitive information without a showing of need and prior to entry of an appropriate protective order.
Subject to and without waiving the foregoing objections, Hartford states that it maintains a collection of technical reference tools and best practices for the administration of Disability claims (the “Claim Reference Manual”). The Claim Reference Manual is a product of Defendant's 200 years of experience and expertise in the insurance industry, and extensive research conducted by several different departments within Hartford over an extended period of time. The Claim Reference Manual expressly states the following: “[n]ot for use with the public or other industry professionals. Not for duplication or distribution outside The Hartford. ©2022 The Hartford. Company confidential, for internal distribution only.” Hartford's employees must be granted access to the Claim Reference Manual by the company and such access is password protected. Hartford does not disseminate the Claim Reference Manual to the general public or to its insureds. Moreover, disclosure of the Claim Reference Manual to Hartford's competitors would harm Defendant's competitive advantage in the insurance industry. Hartford further objects to this Request on the ground that the majority of information contained in the Claim Reference Manual is not applicable to the Plaintiffs claim for disability and, therefore, not relevant to this action.
Answering further, Hartford states that the Administrative Record includes the relevant portion of the Claim Reference Manual for the relevant time period that was relied upon in adjudicating Plaintiffs claim. Specifically, the Termination of Benefits letter dated February 18, 2021 contains the relevant portion of the Claim Reference Manual as cited on Page 4 that was utilized in reviewing Plaintiffs claim for long-term disability benefits. The Termination of Benefits letter is contained in the Administrative Record which has been produced.
Supplemental Response: Without foregoing the above objections, Hartford supplements its response as follows: See Index of Topics for KMT, Claims Excellence Standards, and Claims Excellence Reference (HLAICSFRFP000089-104)(Confidential Subject to Stipulated Protective Order), produced herewith via ShareFile FTP link pursuant to entry of January 27, 2023 Stipulated Protective Order (ECF 39).
INTERROGATORIES
Interrogatory No. 1: For each calendar year for the period January 1, 2020 through December 31, 2021, please state the total amounts You paid for disability file reviews (either directly or through any external review company or other source) from: Lucien Parillo, M.D.; Rajendra Marwah, M.D.; David Hoenig, M.D.
Response: Hartford objects to the extent Plaintiff is seeking internal statistics on the total amounts paid for disability file reviews either directly or through an external review company or other source) for Dr. Lucien Parillo, Dr. Rajendra Marwah and Dr. David Hoenig as the information sought constitutes or contains confidential, proprietary, and/or trade secret information. Hartford further objects on the basis that the request seeks information outside the permissible scope of discovery, as set forth in Fed.R.Civ.P. 26(b)(1), because the amount of money paid by Hartford for disability file reviews for the three doctors referenced above has no bearing on the Plaintiffs claim for disability benefits or whether Hartford abused its discretion in determining that Plaintiff had not met her burden of proving disability and entitlement to benefits beyond February 18,2021. The information sought is neither relevant to the structural conflict nor proportional to the needs of the case, considering the importance of the issues at stake, the importance of discovery in resolving the issues, and whether the burden or expense of discovery outweighs its likely benefits. Notwithstanding the foregoing objection, Hartford further objects to this interrogatory as the amounts paid are not paid to individual physicians but rather to a third party reviewing company and are entirely irrelevant, would fail to provide or lead to any meaningful information, and the burden of attempting to comply with such requests is contrary to ERISA's goal of promptly resolving disputes. Additionally, the request is overbroad and burdensome as not limited to the plaintiffs long term disability claim. Accordingly, Plaintiffs request for discovery here amounts to a fishing expedition.
Supplemental Response: Without foregoing the above objections, Hartford supplements its response as follows pursuant to entry of January 27, 2023 Stipulated Protective Order (ECF 39):
a. Lucien Parillo, M.D.
2020 -163 $100,961
2021-87 $45,744.06
b. Rajendra Marwah, MJ).
2020-15 $14,152.33
2021 - .18 $13,598.75
c. David Hoenig, M.D.
2020 - 331 $254,930.38
202.1-220 $194,969.53
d. Charles Brock, M.D.
2020 - 63 $54,610.60
2021 - 68$67,303.02
Interrogatory No. 2: For each calendar year for the period January 1, 2020 through December 31,2021. please state the total amounts You paid for disability file reviews from each of the following Third Party Review Companies: MLS or MLS Group of Companies: ECN or Exam Coordinators Network.
Response: Hartford objects to the extent Plaintiff is seeking internal statistics on die total amounts paid for disability file reviews from Third Party Review Companies, MLS Group of Companies (“MLS”) or Exam Coordinators Network (“ECN”) as the information sought constitutes or contains confidential, proprietary, and/or trade secret, information. Hartford further objects on the basis that the request seeks information outside the permissible scope of discovery, as set forth in Fed.R.Civ.P. 26(b)(1), because the amount of money paid by Hartford for disability file reviews to MLS or ECN has no bearing on the Plaintiff's claim for disability benefits or whether Hartford abused its discretion in determining that Plaintiff had not met her burden of proving disability and entitlement to benefits beyond February 18, 2021, and the information sought is neither relevant to the structural conflict nor proportional to the needs of the case, considering the importance of the issues at stake, the importance of discovery in resolving the issues, and whether the burden or expense of discovery outweighs its likely benefits. Accordingly, Plaintiffs request for discovery here amounts to a fishing expedition.
Supplemental Response: Without foregoing the above objections, Hartford supplements its response as follows pursuant to entry of January 27, 2023 Stipulated Protective Order (ECF 39):
a. MLS Group of Companies
2020-3477 $1,564,974
2021-2358 $886,150
b. Exam Coordinators Network
2020 - 2403 $2,211,348
2021-3356 $2,810,670
Interrogatory No. 3: Please state the total reserves on Plaintiff s claim. If the reserve amounts changed over time, please state the reserve amount on each and every date the reserve was set, revised, eliminated, or recovered.
Response: Hartford objects to this Interrogatory seeking information on reserves relating to Plaintiffs long-term disability claim as overly broad, unduly burdensome, disproportionate to the needs of this case, and not reasonably calculated to lead to the discovery' of admissible evidence, and thus, outside the scope of permissible discovery. Hartford further objects as this request is unduly burdensome and beyond the scope of discovery in this ERISA case. Hartford further objects to this request for production on the grounds that it seeks information irrelevant to the parties' claims or defenses, not reasonably calculated to lead to the discovery of admissible evidence and not proportional to the needs of the case. Notwithstanding said objection, Hartford states that the employees involved in the claim decision process for the plaintiff s claim for long term disability benefits had no access to reserve information. Reserves and other company financial information are irrelevant to Plaintiffs claim. In evaluating claims under employee benefit plans insured by Hartford, it is Hartford's practice and intention to review such claims fairly, without regard to the manner in which the plan is funded, and to consistently award benefits on claims that are entitled to payment pursuant to the provisions of the applicable benefit plan while consistently denying claims that are not entitled to such payments. Hartford does not provide its Ability Analysts, Managers and Appeals Specialists with any incentives, remuneration, bonuses, awards, achievements, or other recognition based in whole or in part upon the denial or termination of claims. Hartford's claims decision-makers are paid fixed salaries and performance bonuses that are wholly unrelated to the number of claims paid or claims denied. Hartford's claims and appeals decision-makers are evaluated on the quality and accuracy of their claims decisions in accordance with the applicable plan/policy documents. Hartford does not discourage its claims and appeals decision-makers from paying legitimate claims. Hartford's claims and appeals decision-makers are not involved in Hartford's financial decisions, including, but not limited to, any review or analysis of Hartford's financial performance, or the financial performance or claims experience of any particular long term disability plan insured by Hartford. Hartford's claims department and appeals unit are completely separate business units from the financial and underwriting departments. Neither the claims department nor the appeals unit seeks approval from Hartford's financial underwriters in connection with their decision-making on claims for disability benefits. Hartford's financial and underwriting departments do not advise or influence the claims department or appeals unit with respect to the denial or termination of a claimant's benefits. Indeed, these units are kept separate from each other. The office of the Chief Financial Officer of Hartford, and its affiliate, subsidiary or parent companies, do not have any involvement and do not participate in claims decisions on disability benefits at any level.
Interrogatory No. 4: For each calendar year for the period January 1, 2020 through December 31,2021, please state the total amount of reserves saved, recovered, or eliminated based on reviews by from: Lucien Parillo, M.D.; Rajendra Marwah, M.D.; David Hoenig, M.D.
Response: Hartford objects to this Interrogatory seeking information on reserves relating to any and all claims administered by Hartford and not specific to Plaintiff s long-term disability claim as overly broad, unduly burdensome, disproportionate to the needs of this case, and not reasonably calculated to lead to the discovery of admissible evidence, and thus, outside the scope of permissible discovery. Hartford further objects as this request is unduly burdensome and beyond the scope of discovery in this ERISA case. Hartford further objects to this request for production on the grounds that it seeks information irrelevant to the parties' claims or defenses, not reasonably calculated to lead to the discovery of admissible evidence and not proportional to the needs of the case. Notwithstanding said objection, Hartford states that the employees involved in the claim decision process for Plaintiffs claim for long term disability benefits had no access to reserve information. Reserves and other company financial information are irrelevant to the plaintiff s claim. In evaluating claims under employee benefit plans insured by Hartford, it is Hartford's practice and intention to review such claims fairly, without regard to the manner in which the plan is funded, and to consistently award benefits on claims that are entitled to payment pursuant to the provisions of the applicable benefit plan while consistently denying claims that are not entitled to such payments. Hartford does not provide its Ability Analysts, Managers and Appeals Specialists with any incentives, remuneration, bonuses, awards, achievements, or other recognition based in whole or in part upon the denial or termination of claims. Hartford's claims decision-makers are paid fixed salaries and performance bonuses that are wholly unrelated to the number of claims paid or claims denied. Hartford's claims and appeals decision-makers are evaluated on the quality and accuracy of their claims decisions in accordance with the applicable plan/policy documents. Hartford does not discourage its claims and appeals decision-makers from paying legitimate claims. Hartford's claims and appeals decision-makers are not involved in Hartford's financial decisions, including, but not limited to, any review or analysis of Hartford's financial performance, or the financial performance or claims experience of any particular long term disability plan insured by Hartford. Hartford's claims department and appeals unit are completely separate business units from the financial and underwriting departments. Neither the claims department nor the appeals unit seeks approval from Hartford's financial underwriters in connection with their decision-making on claims for disability benefits. Hartford's financial and underwriting departments do not advise or influence the claims department or appeals unit with respect to the denial or termination of a claimant's benefits. Indeed, these units are kept separate from each other. The office of the Chief Financial Officer of Hartford, and its affiliate, subsidiary or parent companies, do not have any involvement and do not participate in claims decisions on disability benefits at any level.
Interrogatory No. 5: For each calendar year for the period January 1, 2020 through December 31,2021, please state the total amount of reserves saved, recovered, or eliminated based on disability reviews received from MLS or MLS Group of Companies, and ECN or Exam Coordinators Network.
Response: Hartford objects to this Interrogatory seeking information on reserves relating to any and all claims administered by Hartford and not specific to Plaintiffs long-term disability claim as overly broad, unduly burdensome, disproportionate to the needs of this case, and not reasonably calculated to lead to the discovery of admissible evidence, and thus, outside the scope of permissible discovery. Hartford further objects as this request is unduly burdensome and beyond the scope of discovery in this ERISA case. Hartford further objects to this request for production on the grounds that it seeks information irrelevant to the parties' claims or defenses, not reasonably calculated to lead to the discovery of admissible evidence and not proportional to the needs of the case. Notwithstanding said objection, Hartford states that the employees involved in the claim decision process for Plaintiffs claim for long term disability benefits had no access to reserve information. Reserves and other company financial information are irrelevant to the plaintiff s claim. In evaluating claims under employee benefit plans insured by Hartford, it is Hartford's practice and intention to review such claims fairly, without regard to the manner in which the plan is funded, and to consistently award benefits on claims that are entitled to payment pursuant to the provisions of the applicable benefit plan while consistently denying claims that are not entitled to such payments. Hartford does not provide its Ability Analysts, Managers and Appeals Specialists with any incentives, remuneration, bonuses, awards, achievements, or other recognition based in whole or in part upon the denial or termination of claims. Hartford's claims decision-makers are paid fixed salaries and performance bonuses that are wholly unrelated to the number of claims paid or claims denied. Hartford's claims and appeals decision-makers are evaluated on the quality and accuracy of their claims decisions in accordance with the applicable plan/policy documents. Hartford does not discourage its claims and appeals decision-makers from paying legitimate claims. Hartford's claims and appeals decision-makers are not involved in Hartford's financial decisions, including, but not limited to, any review or analysis of Hartford's financial performance, or the financial performance or claims experience of any particular long term disability plan insured by Hartford. Hartford's claims department and appeals unit are completely separate business units from the financial and underwriting departments. Neither the claims department nor the appeals unit seeks approval from Hartford's financial underwriters in connection with their decision-making on claims for disability benefits. Hartford's financial and underwriting departments do not advise or influence the claims department or appeals unit with respect to the denial or termination of a claimant's benefits. Indeed, these units are kept separate from each other. The office of the Chief Financial Officer of Hartford, and its affiliate, subsidiary or parent companies, do not have any involvement and do not participate in claims decisions on disability benefits at any level.
Interrogatory No. 6: Please state the name of each and every Document or Communication that tracks claim statistics or metrics. Such statistics or metrics may include, but are not limited to, claim approval or denial numbers or rates, appeal approval or denial numbers or rates, claim termination numbers or rates, claim recovery numbers or rates, liability acceptance rates, expectations or plans for various claim metrics, historical claim statistics, or any other such metrics.
Response: Hartford objects to this interrogatory as overly broad, unduly burdensome, disproportionate to the needs of this case, and not reasonably calculated to lead to the discovery of admissible evidence, and thus, outside the scope of permissible discovery. Hartford further objects as this request is unduly burdensome and beyond the scope of discovery in this ERISA case. Hartford further objects to this request for production on the grounds that it seeks information irrelevant to the parties' claims or defenses, not reasonably calculated to lead to the discovery of admissible evidence and not proportional to the needs of the case. Hartford objects to this request as overly broad, unduly burdensome, disproportionate to the needs of this case under the proportionality calculation set forth in the Federal Rule of Civil Procedure 26(b)(1), and not reasonably calculated to lead to the discovery of admissible evidence, and thus, outside the scope of permissible discovery under the Federal Rules of Civil Procedure because it seeks information about Hartford's administration of claims other than Plaintiffs that has no bearing on the ultimate issue in this case, which is whether Hartford abused its discretion in determining that Plaintiff had not met her burden of proving disability and entitlement to benefits beyond February 18, 2021,.
Whether a claimant meets the subject plan's definition of disability is a fact-intensive determination that is based upon all the evidence in the administrative record and the implicated provisions of the applicable plan documents. Each claim is analyzed individually and without consideration of other claims. Specifically, the Hartford claims person reviewing each claim considers independent reviewing physicians' opinions in conjunction with the governing policy's terms and conditions, as well as many other considerations in a claims file, in reaching his or her decision as to whether the claimant meets the governing policy's definition of disability. No two claims are identical, and in making a disability determination, a Hartford claims person considers all factual, medical, and vocational evidence submitted by a claimant or obtained by Hartford for a particular claim. Hartford objects to this request as overly broad, unduly burdensome, disproportionate to the needs of this case under the proportionality calculation set forth in the Federal Rule of Civil Procedure 26(b)(1), and not reasonably calculated to lead to the discovery of admissible evidence, and thus, outside the scope of permissible discovery under the Federal Rules of Civil Procedure because it seeks information about non-ERISA governed claims. Plaintiff s claims is governed by ERISA and like other claims governed by ERISA, was administered in accordance with the well-established rules of administration of ERISA-governed claims. Accordingly, non-ERISA claims that were not administered in accordance with the well-established rules of administration of ERISA-governed claims that have no bearing on the ultimate issue in this case, which is whether Hartford abused its discretion in terminating Plaintiff s claim.
Hartford objects to this request as vague, ambiguous, and unduly burdensome because it is unable to determine what meaning(s) Plaintiff has assigned to the undefined, and thereby, unclear terms “liability acceptance rates,” “expectations,” “plans,” “claims.” and “any other such metrics”.
Hartford objects to this request as disproportionate to the needs of this case, and, consequently, outside the scope of permissible discovery under the proportionality calculation set forth in the Federal Rules of Civil Procedure. The marginal, if any, probative value of the requested information is outweighed by the potential burden and costs of providing the requested information. Courts recognize that determining whether other claims are “comparable” to the subject claim “could create a morass of secondary and remote arguments” and that “[t]he utility of such expansive discovery is likely in all but the most unusual cases to be outweighed by the burdensomeness and costs involved.” Murphy v. Deloitte & Touche Group Ins. Plan, 619 F.3d 1151, 1164, n. 9 (10th Cir. 2010).
Approval and denial rates, on their own, do not prove that Hartford was arbitrarily approving and denying claims, or Plaintiffs specific long-term disability claim. Claims may have been approved, paid for years, and then terminated because the claimant no longer met the subject policy's definition of disability. Additionally, claims may be denied or terminated for a number of reasons, including: (1) the claimant became disabled before he or she was covered under the plan, (2) the claimant died before the benefit effective date, (3) the claimant returned to work during the elimination period, (4) the claimant never provided the requested information such that Hartford was unable to make a claim decision, (5) the claimant died after the claim was approved and while benefits were being paid, (6) the claimant returned to work after the claim was approved and while benefits were being paid, (7) the claimant refused to submit to an independent medical examination as required under the plan, (8) the claimant was not under the regular care of a physician as required by policy language. In sum, approval, denial, and termination rates, without context, are meaningless.
Discovery regarding approval and denial rates would necessarily require discovery of the underlying facts of each decision to determine if it is comparable to the termination of Plaintiffs claim, and thereby, relevant to this case. To do this would require Hartford to manually review the file for every claims administered by Hartford. Claim files contain hundreds and sometimes thousands of pages of material. The burden and expense of this work would far exceed any probative value of such discovery or be disproportionate to the amount in controversy. Such a task would also significantly impact Hartford's business as it would have to use its employees to complete the task, all of whom would have to suspend or add to their regular job responsibilities.
Notwithstanding said objections, Hartford states that the documentation related to Plaintiffs claim for disability benefits is contained in the Administrative Record which has been produced.
Interrogatory No. 7: With respect to each Document identified in response to Non- Uniform Interrogatory No. 6, above, please identify which classes of employees each Document is provided or made available to [for example, if a Document exists titled “Weekly Tracking Report” and that Document is provided to Managers and Assistant Vice Presidents, You are being asked identify the document (“Weekly Tracking Report”) and state to whom it is provided or made available (“provided to Managers and Assistant Vice Presidents”)].
Response: Hartford hereby incorporates by reference as if fully set forth herein the Response to Non-Uniform Interrogatory No. 6 above. Hartford further objects as identifying classes of employees associated with Documents that are available is overly broad, unduly burdensome, disproportionate to the needs of this case, and not reasonably calculated to lead to the discovery of admissible evidence, and thus, outside the scope of permissible discovery.
Notwithstanding said objection, Hartford states that the documentation related to Plaintiff s claim for disability benefits is contained in the Administrative Record which has been produced.