Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-cand-3_07-cv-03772/USCOURTS-cand-3_07-cv-03772-2/pdf.json

Nature of Suit Code: 791
Nature of Suit: Employee Retirement Income Security Act (ERISA)
Cause of Action: 29:1132 E.R.I.S.A.: Employee Benefits

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United States District Court

For the Northern District of California

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IN THE UNITED STATES DISTRICT COURT

FOR THE NORTHERN DISTRICT OF CALIFORNIA

DAVID WALKER,

Plaintiff,

 v.

METROPOLITAN LIFE INSURANCE

COMPANY, KAISER PERMANENTE

FLEXIBLE BENEFITS PLAN, 

and DOES 1 through 10, inclusive,

Defendants. /

No. C 07-03772 WHA

ORDER GRANTING LIMITED

DISCOVERY

INTRODUCTION

In this ERISA action, plaintiff David Walker sued defendants Metropolitan Life

Insurance Company and Kaiser Permanente Flexible Benefits Plan (the “Plan”) for denying his

claim for disability benefits. Defendants moved for summary judgment on the ground that the

claim administrator did not wrongfully deny the claim. In his opposition, plaintiff seeks further

discovery regarding MetLife’s conflict of interest in denying his claim. For the reasons stated

below, the request for discovery is GRANTED.

STATEMENT

Plaintiff worked as a Local Area Network administrator for Kaiser Foundation Hospitals

and was a participant in the Plan. According to the Plan’s Summary Plan Description (“SPD”),

“MetLife is the insurer and third party administrator for the Employee life, Dependent life and

Long-Term Disability insurance plans . . . In the event of a Long-Term Disability, you must

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For the Northern District of California

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 Unless indicated otherwise, internal citations are omitted from all cites.

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also provide this information to MetLife, the administrator for Long-Term Disability claims”

(ADMIN 163–64). In short, MetLife both funded the benefits to be paid under the Plan and,

as claims administrator, determined eligibility for benefits. Defendants do not deny this fact. 

They state in their reply brief that the SPD “discloses that LTD [long-term disability] benefits

are insured by MetLife” and referred to “MetLife, the LTD claim administrator” (Reply 2).

ANALYSIS

Plaintiff argues that he is entitled to obtain evidence through discovery regarding

MetLife’s conflict of interest. “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.” Abatie v. Alta Health & Life Ins. Co., 458 F.3d 955, 970 (9th Cir. 2006). 

Plaintiff further cites Welch v. Metropolitan Life Ins. Co., 480 F.3d 942, 949 (9ths Cir. 2007),

for the proposition that a plaintiff has a right to discovery to show a conflict of interest.1

While the Ninth Circuit in Welch did not explicitly hold that a plaintiff had the right to

discovery; it held that a plaintiff may have some discovery. “Because an ERISA plaintiff may

be permitted to supplement the administrative record with evidence of a conflict of interest on

the part of the defendant, we agree with [plaintiff] that some discovery aimed at demonstrating a

conflict of interest may have been appropriate.” Welch, 480 at 949–50 (emphasis in original). 

It is up to the district court’s discretion as to whether or not an ERISA plaintiff may take

additional discovery to show conflict of interest.

This order finds that plaintiff should be allowed further discovery. Plaintiff alleges that

MetLife was conflicted; MetLife both funded the plan and determined whether or not to pay

benefits. Plaintiff also contends that MetLife relied on the faulty reports of biased medical

reviewers. This is the kind of potential conflict that justifies granting more discovery. 

The Ninth Circuit has “require[d] abuse of discretion review whenever an ERISA plan grants

discretion to the plan administrator, but a review informed by the nature, extent, and effect on

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 The parties dispute what standard should be used when reviewing MetLife’s denial-of-benefits

decision. “When a plan confers discretion, abuse of discretion review applies; when it does not, de novo review

applies.” Abatie, 458 F.3d at 965. Plaintiff argues that de novo review, the default standard in ERISA, applies

because the Plan failed to adequately delegate discretion to MetLife. This issue need not be reached until

discovery has been taken regarding MetLife’s potential conflict of interest.

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the decision-making process of any conflict of interest that may appear in the record. 

This standard applies to the kind of inherent conflict that exists when a plan administrator both

administers the plan and funds it, as well as to other forms of conflict.” Abatie, 458 F.3d at 967. 

As discussed earlier, a district court may consider extrinsic evidence to consider the conflict of

interest. This will help us determine how much weight to give an alleged conflict of interest

when reviewing MetLife’s denial-of-benefits decision. Because more discovery is needed on

this matter, this order will not yet reach a decision on the merits.2

Plaintiff will be reminded, however, that “such discovery must be narrowly tailored and

cannot be a fishing expedition.” Groom v. Standard Ins. Co., 492 F. Supp. 2d 1202, 1205 (C.D.

Cal. 2007). It must be limited to requests that are relevant to the “nature, extent, and effect on

the decision-making process of any conflict of interest.” Furthermore, any decision on the

merits “must rest on the administrative record once the conflict (if any) has been established,

by extrinsic evidence or otherwise.” Abatie, 458 F.3d at 970.

CONCLUSION

Plaintiff’s request to conduct limited discovery on the issue of whether MetLife’s

determination was influenced by a conflict of interest is GRANTED. The Court approves the

general discovery plan laid out by plaintiff’s counsel. Deposition and document discovery is

also appropriate on the extent to which MetLife and medical reviewers were aware of any

anti-claimant track record by the doctor in question.

Discovery shall be completed by MAY 15, 2008. Plaintiff can then file a cross-motion

for summary judgment and a supplemental opposition to defendant’s original motion for

summary judgment by MAY 22, 2008. Defendant’s opposition to the cross-motion and reply to

the original summary judgment motion are due on JUNE 5, 2008. Plaintiff’s reply to the

cross-motion is due on JUNE 12, 2008. The hearing on this matter is set for JUNE 26, 2008.

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Please turn immediately to discovery so there will be enough time to resolve any

discovery disputes should they arise.

IT IS SO ORDERED.

Dated: February 14, 2008. 

WILLIAM ALSUP

UNITED STATES DISTRICT JUDGE

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