Opinion
CIVIL ACTION NO. 08-11813-RGS.
September 14, 2009
MEMORANDUM AND ORDER ON PLAINTIFF'S MOTION TO COMPEL THE PRODUCTION OF DOCUMENTS
Plaintiff Pauline Monast brought this action pursuant to the Employee Retirement Income Security Act (ERISA), 29 U.S.C. § 1001, et seq., seeking non-income, long-term disability (LTD) benefits funded by defendant Johnson Johnson. Monast was deemed eligible for non-income, LTD benefits from October 1, 2007, until February 15, 2008. Her benefits were terminated when her counsel failed to submit documentation of her eligibility to a third-party plan administrator, defendant Reed Group. Monast seeks discovery to determine whether a "structural conflict" improperly influenced the administrator's decision to deny her appeal.
Monast seeks extensive discovery in two areas: (1) financial documents related to the structure of Johnson Johnson's LTD plan; and (2) eight years of administrative statistics relating to the appeals of decisions denying benefits because of documentation failures. Monast argues that she is entitled to discovery under a recent Supreme Court decision, Metro. Life Ins. Co. v. Glenn, 128 S.Ct. 2343 (2008).Glenn held that a reviewing court in an ERISA case should "take account of [structural conflicts] as a factor in determining the adequacy of the record's support for the agency's own factual conclusion." Id. at 2352. An ERISA structural conflict exists where an employer "both funds the plan and evaluates the claims."Id. at 2348. Though the command is clear, Glenn "gives little guidance for dealing with [related] requests for discovery."McGahey v. Harvard Univ. Flexible Benefits Plan, 2009 WL 799464, at *2 (D. Mass. Mar. 25, 2009).
Still valid First Circuit precedent discussing the right to discovery in ERISA cases 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." Liston v. Unum Corp. Officer Severance Plan, 330 F.3d 19, 23 (1st Cir. 2003). That "very good reason" has been interpreted by this courtpost-Glenn to allow discovery "only where a plaintiff makes a threshold showing that the denial of benefits was improperly influenced by the administrator's [structural] conflict of interest." McGahey, supra, at *2 (emphasis added). In other words, it is not sufficient for a plaintiff to simply show the existence of a conflict. To be entitled to discovery, she must also show that the conflict had a distorting effect on the administrator's decision to deny or terminate her benefits. See Denmark v. Liberty Life Assurance Co., 556 F.3d 1, 10 (1st Cir. 2009) ("The majority opinion in Glenn fairly can be read as contemplating some discovery on the issue of whether a structural conflict has morphed into an actual conflict.").
In the absence of a mandated test, this court has said that in reviewing ERISA discovery requests
[it] 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.McGahey, supra at *2. The parties initially dispute whether a structural conflict exists at all. Defendants argue that the LTD income benefits plan is employee-funded and therefore without structural blemish. Monast counters that the non-income LTD benefits (for example, medical insurance) are funded by Johnson Johnson and rely on the determinations of the same plan administrator. Assuming arguendo that a structural conflict does in fact exist, Monast's sole potentially relevant discovery request seeks "a listing of all appeals for LTD benefits appealing a denial of LTD benefits for a late submission and the decisions on such appeals" for the years 2000 through 2007.
Specifically, Monast's requests numbered 3, 4, 5, 6, and 15 seek financial information to prove a structural conflict.
The request does not match any of the factors previously set out by the court. That is not, however, fatal because "[b]enefits decisions arise in too many contexts, concern too many circumstances, and can relate in too many different ways to conflicts . . . to come up with a one-size-fits-all procedural system." Glenn, 128 S. Ct. at 2351. What is fatal is Monast's failure to articulate how the information she seeks will show an improper extraneous influence on the administrator's decision making. There is no dispute as to the facts surrounding Monast's untimely failure to submit the documentation required by the plan. Nor is there any dispute about the plan's provisions regarding the termination of benefits for such failure. Regardless of what the sum total of the outcome of similar appeals might show (lenient treatment of all late submissions but Monast's, the uniform rejection of all late submissions, or the acceptance of some and the rejection of others), the result would reveal nothing more than the administrator's exercise of discretion.
Under the arbitrary and capricious standard, which by all appearances applies to this case, the decision of the plan administrator will be upheld even where contrary evidence might suggest a different result, so long as the decision "is plausible in light of the record as a whole, . . . or, put another way, whether the decision is supported by substantial evidence in the record." Leahy v. Raytheon Co., 315 F.3d 11, 17 (1st Cir. 2002). "Substantial evidence . . . means evidence reasonably sufficient to support a conclusion. Sufficiency, of course, does not disappear merely by reason of contradictory evidence. . . . [The] question [is] not which side [the court] believe[s] is right, but whether [the administrator] had substantial evidentiary grounds for a reasonable decision in its favor." Doyle v. Paul Revere Life Ins. Co., 144 F.3d 181, 184 (1st Cir. 1998). A termination of benefits for the failure to comply with the requirement that a claimant document her eligibility can hardly be termed "arbitrary and capricious."
ORDER
For the foregoing reasons, Monast's motion to compel the production of documents is DENIED. Pursuant to the Scheduling Order, in the absence of any identified experts, the court reminds the parties that summary judgment motions are due on October 2, 2009.SO ORDERED