Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-cand-3_14-cv-05295/USCOURTS-cand-3_14-cv-05295-6/pdf.json

Nature of Suit Code: 791
Nature of Suit: Employee Retirement Income Security Act (ERISA)
Cause of Action: 29:1001 E.R.I.S.A.: Employee Retirement

---

ORDER (No. 3:14-cv-05295-JST (LB))

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

United States District Court

Northern District of California

UNITED STATES DISTRICT COURT

NORTHERN DISTRICT OF CALIFORNIA

San Francisco Division

ERIC NGUYEN,

Plaintiff,

v.

SUN LIFE ASSURANCE COMPANY OF 

CANADA,

Defendant.

Case No. 3:14-cv-05295-JST (LB)

ORDER ON JOINT DISCOVERY 

LETTER

[ECF No. 30]

INTRODUCTION

This is an ERISA benefits-denial case. The assigned district judge has referred it to the 

undersigned to resolve a discovery dispute. Plaintiff Eric Nguyen was covered by an employeebenefits plan for which defendant Sun Life both served as the insurer and made the claims 

decisions. (See ECF No. 30 at 1.)1The plaintiff made claims under the plan for short-term and 

long-term disability benefits “based on upper[-]extremity pain syndromes, diagnosed as thoracic 

outlet syndrome . . . and other occipital, thoracic and cervical pain conditions.” (Id.) Sun Life 

denied the plaintiff‟s claims “and upheld those denials on appeal.” (Id.) The plaintiff has sued Sun 

Life to recover benefits under 29 U.S.C. § 1132(a)(1)(B).

 

1 Record citations refer to material in the Electronic Case File (“ECF”); pinpoint citations are to 

the ECF-generated page numbers at the tops of the documents.

Case 3:14-cv-05295-JST Document 48 Filed 10/27/15 Page 1 of 21
2

ORDER (No. 3:14-cv-05295-JST (LB))

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

United States District Court

Northern District of California

The administrative record, the material on which Sun Life made and then confirmed its 

decision, appears to consist mainly of the medical records, evaluations, and opinions of the 

plaintiff‟s numerous treating physicians. The plaintiff says that this material shows that he was 

disabled and entitled to benefits. The record also contains the opinions of four physicians whom 

Sun Life retained, as outside consultants, to review the plaintiff‟s claim; all four concluded that he 

was not disabled. (See ECF No. 30 at 5-7.)

The plaintiff now seeks to discover material beyond the administrative record. He has 

propounded interrogatories and requests for production to Sun Life, and proposes to take 

depositions. (ECF No. 30-1 to -4.) His proposed discovery covers three topics: 1) The 

completeness of the administrative record; 2) The “policies and guidelines” that Sun Life followed 

(or should have followed) in assessing his claim; and 3) The relationship between Sun Life and its 

four outside medical reviewers. (See id. at 5-7.) On the last point, the plaintiff wishes to discover 

material that he believes will show that the outside reviewers were “biased” in Sun Life‟s favor —

essentially, because Sun Life paid them. (See id.)

The undersigned concludes that, under governing Ninth Circuit law, the plaintiff is not entitled

to most of this discovery. (Exceptions are noted where appropriate in the Analysis below.) The 

plaintiff has not “clearly established” that evidence outside the existing administrative record is 

“necessary to conduct an adequate de novo review of the benefit decision.” See Opeta v. Nw. 

Airlines Pension Plan, 484 F.3d 1211, 1217 (9th Cir. 2007) (emphasis removed). The undersigned 

therefore partly grants and partly denies the plaintiff‟s requested discovery.

* * *

GOVERNING LAW

The parties have stipulated that the district judge will review de novo Sun Life‟s decision to 

deny Mr. Nguyen benefits. (ECF No. 30 at 1.) Where de novo review applies, “no further 

preliminary analytical steps are required,” and the district court “simply proceeds to evaluate 

whether the plan administrator correctly or incorrectly denied benefits.” Abatie v. Alta Health & 

Life Ins. Co., 458 F.3d 955, 963 (9th Cir. 2006) (en banc); accord Gonda v. Permanente Med. 

Group, Inc., 300 F.R.D. 609, 613 (N.D. Cal. 2014).

Case 3:14-cv-05295-JST Document 48 Filed 10/27/15 Page 2 of 21
3

ORDER (No. 3:14-cv-05295-JST (LB))

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

United States District Court

Northern District of California

This affects the range of permissible evidence. De novo review of an ERISA benefits denial is 

“based on the evidence in the administrative record and „other evidence as might be admissible 

under the restrictive rule of Mongeluzo [v. Baxter Travenol Long Term Disability Benefit Plan, 46 

F.3d 938 (9th Cir. 1995)].‟” Opeta, 484 F.3d at 1217. In Mongeluzo, the Ninth Circuit “held that 

extrinsic evidence could be considered only under certain limited circumstances.” Opeta, 484 F.3d 

at 1217. “[T]he district court should exercise its discretion to consider evidence outside of the 

administrative record „only when circumstances clearly establish that additional evidence is 

necessary to conduct an adequate de novo review of the benefit decision.” Id. (quoting in part 

Mongeluzo, 484 F.3d at 944) (quoting in turn Quesinberry v. Life Ins. Co. of N. Am., 987 F.2d 

1017, 1025 (4th Cir. 1993) (en banc) (emphasis in Opeta).

Borrowing from Quesinberry, the Ninth Circuit in Opeta described “a non-exhaustive list of 

exceptional circumstances where evidence beyond the administrative record could be considered 

necessary”:

claims that require consideration of complex medical questions or 

issues regarding the credibility of medical experts; the availability 

of very limited administrative review procedures with little or no 

evidentiary record; the necessity of evidence regarding interpretation 

of the terms of the plan rather than specific historical facts; 

instances where the payor and the administrator are the same 

entity and the court is concerned about impartiality; claims which 

would have been insurance contract claims prior to ERISA; and 

circumstances in which there is additional evidence that the claimant 

could not have presented in the administrative process.

Opeta, 484 F.3d at 1217 (quoting Quesinberry, 987 F.2d at 1027) (emphases added).

Even where such circumstances exist, however, new evidence is not “required.” Quesinberry, 

987 F.2d at 1027. “A district court may well conclude that the case can be properly resolved on the 

administrative record without the need to put the parties to additional delay and expense.” Id. As 

Judge Conti of this district observed: “[T]o further ERISA‟s policy of keeping proceedings 

inexpensive and expeditious, the Ninth Circuit has placed significant restrictions” — i.e., the 

“narrow circumstances” outlined in Opeta — “on district courts‟ ability to consider evidence 

outside the administrative record.” Gonda, 300 F.R.D. at 613 (citing Mongeluzo, 46 F.3d at 943). 

The Ninth Circuit itself has “emphasized” that “[i]n most cases only the evidence that was before 

the plan administrator at the time of determination should be considered.” Opeta, 484 F.3d at 1217 

Case 3:14-cv-05295-JST Document 48 Filed 10/27/15 Page 3 of 21
4

ORDER (No. 3:14-cv-05295-JST (LB))

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

United States District Court

Northern District of California

(quotation omitted).

These admissibility limits also constrain discovery:

 The Ninth Circuit‟s decision in Opeta dealt with the issue of 

whether evidence outside the record is admissible rather than 

whether the evidence is discoverable. Nevertheless, courts in this 

district have held that in light of Opeta’s limits on admissibility of 

evidence in de novo cases and the ERISA‟s policy of keeping 

proceedings inexpensive and expeditious, it is appropriate to place 

similar limits on discovery.

Polnicky v. Liberty Life Ass. Co., No. C 13-1478 SI, 2014 U.S. Dist. LEXIS 29123, *5-*6 (N.D. 

Cal. Mar. 15, 2014) (quoting in part Rowell v. Aviza Tech. Health & Welfare Plan, No. C 10-5656 

PSG, 2012 U.S. Dist. LEXIS 16957, *13-14 n. 26 (N.D. Cal. Feb. 10, 2012) and citing Knopp v. 

Life Ins. Co. of N. Am. C-09-0452 CRB (EMC), 2009 U.S. Dist. LEXIS 120267, *7 (N.D. Cal. 

Dec. 28, 2009)); accord Gonda, 300 F.R.D. at 613 (“It makes little sense to allow broad and costly 

discovery when the court‟s review of the merits is limited . . . .”); see Brice v. Life Ins. Co. of N. 

Am., No. C 10-4204 JSW, 2011 U.S. Dist. LEXIS 77525, *1 (N.D. Cal. Jul. 18, 2011) (ERISA‟s 

goals of cost reduction and prompt claim disposition mean that “courts cannot allow discovery in 

ERISA actions for the denial of benefits to be as broad . . . as in other types of cases”).

The decision to allow extrinsic discovery under these rules lies in the court‟s discretion. See 

Opeta, 484 F.3d at 1213.

* * *

ANALYSIS

The discussion below considers the plaintiff‟s requests, arranged by topic, in increasing order 

of analytical complexity. Part 1 addresses the completeness of the administrative record; Part 2, 

Sun Life‟s policies and guidelines. Part 3 discusses the complexity of the medical issues that this 

case presents; it is an argument that the plaintiff raises but does not elaborate. Part 4 reaches the 

harder question of the “bias” and lack of “credibility” that the plaintiff believes may have tainted 

the work of Sun Life‟s outside medical reviewers. This last issue absorbs most of the plaintiff‟s 

efforts here (see ECF No. 30 at 5-8); it is the issue on which district-court precedent, though 

ostensibly following the same Ninth Circuit standard (Opeta), has divided most noticeably; and it 

is this issue that has consumed most of the undersigned‟s thinking. The final Part 5 of this order 

Case 3:14-cv-05295-JST Document 48 Filed 10/27/15 Page 4 of 21
5

ORDER (No. 3:14-cv-05295-JST (LB))

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

United States District Court

Northern District of California

then turns back to explain the two most salient analytical considerations that guided the 

undersigned‟s decision on the issue of the outside reviewers‟ credibility. Essentially, Part 5 tries to 

explain why Opeta compels the conclusions reached on the record here, and why granting the 

requested discovery would depart, if not from the superficial, than from the substantive dictate of 

the Ninth Circuit‟s rule in this area.

* * *

1. Completeness of the Administrative Record

The plaintiff does not directly dispute Sun Life‟s statement that it has “produced the entire 

Administrative Record.” (See ECF No. 30 at 2.) He does ask for “any portions of his complete file 

in this matter [that have] not yet [been] provided.” (Id. at 7.) “For instance,” he writes, “Sun Life 

alleges that the administrative record contains communications with Mr. Nguyen‟s medical 

providers, however there is no evidence of Sun Life doctors contacting treating physicians in the 

record.” (Id.)

There is no dispute that Sun Life “must produce the entire administrative record.” Duran v. 

Cisco Sys., 258 F.R.D. 375, 382 (C.D. Cal. 2009). More fully stated, “ERISA requires that 

claimants be given access to „all documents, records, and other information relevant to the 

claimant‟s claim for benefits.‟” Bourland v. Hartford Life & Acc. Ins. Co., 2014 U.S. Dist. LEXIS 

134813, *9 (W.D. Wash. 2014) (quoting in part 29 C.F.R. § 2650.503-1(h)(2)(iii)). Information is 

“relevant” in this context 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 upon in making the benefit determination; 

iii. Demonstrates compliance with the administrative processes and safeguards 

required pursuant to paragraph (b)(5) of this section in making the benefit 

determination; or 

iv. In the case of a group health plan or a plan providing disability benefits,

constitutes a statement of policy or guidance with respect to the plan 

concerning the denied treatment option or benefit for the claimant's diagnosis, 

without regard to whether such advice or statement was relied upon in making 

the benefit determination.

29 C.F.R. § 2650.503-1(m)(8); Bourland, 2014 U.S. Dist. LEXIS 134813 at *9-*10.

Case 3:14-cv-05295-JST Document 48 Filed 10/27/15 Page 5 of 21
6

ORDER (No. 3:14-cv-05295-JST (LB))

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

United States District Court

Northern District of California

The communications that the plaintiff mentions would seem to fall under at least two of these 

categories: material that was “relied on in making the benefit determination”; and material 

“generated in the course of making the benefit determination.” If any such material exists and has 

not yet been produced to the plaintiff, including communication between Sun Life or its agents 

and the plaintiff‟s medical providers, that material is part of the administrative record and must be 

produced.

* * *

2. Policies, Procedures, Guidelines

The plaintiff also “seeks the policies, procedures and guidelines applied to his claim.” (ECF 

No. 30 at 8.) He correctly argues that ERISA regulations “require production of any „internal rule, 

guideline, protocol, or other similar criterion‟ relied upon in making an adverse decision.” (Id.) 

(quoting in part 29 C.F.R. § 2560.503-1(g)(v)(8)). The regulation reproduced earlier also covers 

this topic. Most generally, policies and guidelines may be “relied upon,” or at least “considered,” 

in “making the benefit determination.” See 29 C.F.R. § 2560.503-1(m)(8)(i)-(ii). The same 

regulation compels production of material that constitutes a “statement of policy or guidance with 

respect to the plan concerning the denied . . . benefit . . . .” 29 C.F.R. § 2560.503-1(m)(8)(iv). 

Finally, the regulation makes “relevant” (and so mandates the production of) “information” that 

“[d]emonstrates compliance with the administrative processes and safeguards required pursuant to 

paragraph (b)(5) of this section . . . .” 29 C.F.R. § 2560.503-1(m)(8)(iii). This “paragraph (b)(5)” 

mandates that a plan‟s “claims procedure” have “administrative processes and safeguards designed 

to ensure and to verify that benefit claim determinations are made in accordance with governing 

plan documents and that, where appropriate, the plan provisions have been applied consistently 

with respect to similarly situated claimants.” 29 C.F.R. § 2560.503-1(b)(5).

The plaintiff‟s “policies and guidelines” request elicits a three-pronged holding. First, insofar 

as ERISA regulations require Sun Life to give the plaintiff copies of relevant policies and 

guidelines, and to the extent that Sun Life has not already produced this material, it is ordered to 

do so. See Knopp, 2009 U.S. Dist. LEXIS 120267 at *10-*11; Bourland, 2014 U.S. Dist. LEXIS 

134813 at *8-*10; Polnicky, 2014 U.S. Dist. LEXIS 29123 at *11-*12 (citing Knopp, supra, and 

Case 3:14-cv-05295-JST Document 48 Filed 10/27/15 Page 6 of 21
7

ORDER (No. 3:14-cv-05295-JST (LB))

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

United States District Court

Northern District of California

Rowell, 2012 U.S. Dist. LEXIS 16957 at *11).

Second, beyond the policy documents themselves, the plaintiff is not entitled to extra-record 

discovery into whether and why Sun Life followed, or failed to follow, its own policies and 

guidelines in assessing the plaintiff‟s claims. As multiple courts have noted, this is irrelevant on de 

novo review. Another judge in this district recently wrote: “Even if Defendants failed to follow 

claim procedures or guidelines, that failure might reflect upon the integrity and accuracy of the 

administrator‟s review of [the plaintiff‟s] disability claim, but that review is entitled to no 

deference on de novo review and is therefore irrelevant.” Knopp, 2009 U.S. Dist. LEXIS 120267 

at *10; accord Polnicky, 2014 U.S. Dist. LEXIS 29123 at *11-*12 (calling irrelevant to de novo 

review whether administrator “took a more aggressive approach” under its policies and guidelines 

to avoid paying “high benefit amount”); cf. Gonda, 300 F.R.D. at 315 (“fail[ing] to see relevance” 

of policies and history of policy changes). (The only limitation on this may lie in 29 C.F.R. 

§ 2560.503-1(b)(5) and (m)(8)(iii). Those subsections compel the production of information that 

“[d]emonstrates compliance with the administrative processes and safeguards” employed “to 

ensure and to verify that benefit claim determinations are made in accordance with governing plan 

documents and that, where appropriate, the plan provisions have been applied consistently with 

respect to similarly situated claimants.” If Sun Life has documentary material responsive to that

limited requirement, it must produce it.)

Third, the plaintiff rolls into his request for policies and guidelines material concerning “Sun 

Life‟s relationships with third[-]party reviewers.” (ECF No. 30 at 8.) For the reasons set out in Part 

4, below, the plaintiff is not entitled to investigate the “bias” or “credibility” of Sun Life‟s outside 

consultants. (At least he may not go beyond the existing administrative record to make that 

investigation.) The material that is barred from discovery under the discussion below cannot be 

obtained through the side door by asking for “policies and guidelines.” If the “policies and 

guidelines” describe general administrative rules governing how and when Sun Life uses thirdparty medical reviewers, that material may be discoverable.2 Most of what the plaintiff has asked 

 

2

This seems to be the information the plaintiff has in mind when he points to the “written 

discovery” of “procedures for oversight of third[-]party reviewers” that the court allowed in Eisner

Case 3:14-cv-05295-JST Document 48 Filed 10/27/15 Page 7 of 21
8

ORDER (No. 3:14-cv-05295-JST (LB))

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

United States District Court

Northern District of California

for, however, in connection with “Sun Life‟s relationships with third[-]party reviewers” — such as 

how many times Sun Life has hired a specific consultant (ECF No. 30-2 at 5-6), how much Sun 

Life has paid them (ECF No. 30-1 at 6-8; ECF No. 30-2 at 5-6), and the contracts embodying 

these things (ECF No. 30-1 at 6-7) — would not constitute “policies” or “guidelines” discoverable 

under this part of the analysis.

A particular word is needed concerning the plaintiff‟s fourth Request for Production. The 

plaintiff discusses this request in connection with “policies and guidelines.” (ECF No. 30 at 8.) On 

its face, though, it asks for material that would seem to be protected under the attorney-client 

privilege or the attorney work-product doctrine. (See ECF No. 30-1 at 5.)3The plaintiff argues that 

such material “fall[s] outside the attorney[-]client privilege under the fiduciary exception.” (ECF 

NO. 30 at 8.) The issue is moot: to this request, Sun Life answers that there are “no responsive 

documents.” (Id. at 3.)

* * *

In sum, insofar as ERISA regulations require Sun Life to produce its policies and guidelines, 

and to the extent that those have not yet been produced, Sun Life must produce them. The plaintiff 

cannot obtain discovery (beyond the administrative record itself) into whether Sun Life did or did 

not follow its policies and guidelines in handling his claims. Nor is the plaintiff entitled to 

extrinsic discovery into Sun Life‟s relationship with the outside medical reviewers that it hired to 

review the plaintiff‟s claims, as discussed in Part 4, below.

* * *

3. Complex Medical Questions

The plaintiff briefly suggests that “this is a complicated medical case, given the overlapping 

and comorbid conditions suffered by Mr. Nguyen, the many surgeries he has undergone over the 

years, and the copious records describing intricate medical procedures.” (ECF No. 30 at 6.) 

 

v. Prudential Ins. Co. of Am., No. 12-cv-01238-JST, 2013 U.S. Dist. LEXIS 65090 (N.D. Cal. 

May 4, 2013). (See ECF No. 30 at 8.)

3

The fourth RFP asks for: “Any and all DOCUMENTS evidencing any and all attorney-client 

COMMUNICATION and attorney memoranda, guidelines and opinions RELEVANT to the 

CLAIMS at any time before the adverse decision.” (ECF No. 30-1 at 5) (capitals original).

Case 3:14-cv-05295-JST Document 48 Filed 10/27/15 Page 8 of 21
9

ORDER (No. 3:14-cv-05295-JST (LB))

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

United States District Court

Northern District of California

Presumably, the plaintiff means to invoke Opeta’s category of situations in which “complex 

medical questions” permit extrinsic discovery. See Opeta, 484 F.3d at 1217. The court does not 

think that the facts, or the plaintiff‟s fleeting glance off this topic, justifies discovery under Opeta.

The court does not doubt that this case involves complex medical issues. But there seems to be 

ample record proof from which the district judge can adequately review Sun Life‟s decision. The 

administrative record (according to Sun Life; and the plaintiff does not dispute this) contains over 

6000 pages of documents. (See ECF No. 30 at 2.) By the plaintiff‟s description, the record 

comprises an “avalanche” of material from “dozens” of physicians supporting his claim (ECF No.

30 at 5-6) — and, of course, it contains the contrary assessments of Sun Life‟s third-party medical 

reviewers. 

The plaintiff does not elaborate his “complicated medical case” point. He does not explain 

how the material already in the record fails to elucidate any particular medical issue, or how the 

existing record otherwise lacks information that a court would need to decide for itself whether he 

was disabled. To the contrary, the plaintiff‟s own argument suggests that the existing 

administrative record permits a decision in his favor. He cites “copious records describing intricate 

medical procedures.” (ECF No. 30 at 6.) He calls Sun Life‟s adverse decision “incredible” given 

the “thoroughly documented medical support by [his] treating physicians.” (Id. at 5.) And he 

describes “the support of dozens of doctors who have personally treated him — an avalanche of 

gold-standard support by . . . specialists who have clinically demonstrated the objective and 

subjective severity of his conditions.” (Id. at 6) (emphasis added). In other words, it is not that the 

plaintiff feels the existing record inadequate to support a de novo decision; he just thinks that it 

supports a decision in his favor.

The plaintiff has not “clearly established” that, because of “complex medical questions,” 

evidence beyond the administrative record is “necessary” for an adequate de novo review of his 

claim.

* * *

Case 3:14-cv-05295-JST Document 48 Filed 10/27/15 Page 9 of 21
10

ORDER (No. 3:14-cv-05295-JST (LB))

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

United States District Court

Northern District of California

4. Sun Life’s Relationship With Outside Medical Reviewers

The heart of the plaintiff‟s discovery requests asks to delve into information concerning the 

relationship between Sun Life and the outside medical consultants that the insurer hired to review 

(and who ultimately suggested denying) his claim. (See ECF No. 30-1 at 5-8; ECF No. 30-2 at 5-

8.) With these requests the plaintiff asks Sun Life to produce material reflecting (for example) how 

many times it has hired the medical reviewers in the past five years, how much it has paid them, 

how many times it has denied claims based on their opinions, evaluations it has made of their 

work, and the contracts reflecting their employment. The plaintiff would also depose Sun Life on 

these points. (ECF No. 30-3 at 5; ECF No. 30-4 at 6-7.)

* * *

4.1 Structural Conflict of Interest & Impartiality

Again, “Sun Life was the insurer for the Plan and made the claims decisions.” (ECF No. 30 at 

1.) It both paid the claims, in other words, and decided which claims would be paid. Sun Life thus 

had what the case law calls a “structural conflict of interest.” See, e.g., Tarasovsky v. Stratify, Inc., 

No. C 11-03359 WHA, 2012 U.S. Dist. LEXIS 69921, *14 (N.D. Cal. May 18, 2012) (quoting 

Montour v. Hartford Life & Acc. Ins. Co., 588 F.3d 623, 630-31 (9th Cir. 2009)); Nolan v. Heald 

College, 745 F. Supp. 2d 916, 921 (N.D. Cal. 2010). Such a conflict exists whenever the “same 

entity that funds an ERISA plan also evaluates claims.” Tarasovsky, 2012 U.S. Dist. LEXIS 69921 

at *14; accord, e.g., Nolan, 745 F. Supp. 2d at 921. Because the plan administrator in such a case 

“is also the insurer, . . . by denying benefits, the administrator retains money for itself.” Montour, 

588 F.3d at 630. In Opeta, the Ninth Circuit recognized this as an “exceptional circumstance[]” in 

which additional evidence “could be considered necessary.” Opeta, 484 F.3d at 1217 (“where the 

payor and the administrator are the same entity and the court is concerned about impartiality”).

The plaintiff invokes this ground to bolster his primary claim that Sun Life‟s outside medical 

reviewers were biased. He writes that Opeta permits extrinsic discovery in de novo cases that 

present “„issues regarding the credibility of medical experts,‟ particularly involving a conflict of 

interest such as in this case, where Sun Life acts as both the claims decision maker and plan 

funder.” (See ECF No. 30 at 5) (quoting in part Opeta, 484 F.3d at 1217) (emphasis added).

Case 3:14-cv-05295-JST Document 48 Filed 10/27/15 Page 10 of 21
11

ORDER (No. 3:14-cv-05295-JST (LB))

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

United States District Court

Northern District of California

The court does not think that, merely by pointing to Sun Life‟s dual role as plan administrator 

and payer, the plaintiff has “clearly established” that additional discovery is “necessary” to an 

“adequate de novo review of the benefits decision.” Two points might be made here.

First, Sun Life‟s “structural conflict of interest” does not alone warrant extrinsic discovery. See 

Bourland, 2014 U.S. Dist. LEXIS at *6 (“Under de novo review, [the insurer‟s] alleged conflict of 

interest is irrelevant.”); Abatie, 458 F.3d at 963 (de novo review asks whether benefits were 

correctly denied, “without reference to whether the administrator operated under a conflict of 

interest”). Defendants in ERISA cases have often served as both plan administrator and plan 

funder. The situation appears to be common. That a defendant acted as both administrator and 

payer thus cannot qualify, on its own, as an “exceptional circumstance” under Opeta’s “restrictive” 

rule. The Gonda court, in this vein, refused to accept the notions that “discovery on an insurer‟s 

conflict of interest is always permissible or that a conflict of interest has any direct bearing on the 

merits analysis in a de novo review.” Gonda, 300 F.R.D. at 614 (discussing Waggener v. Unum 

Life Ins. Co. of Am., 238 F. Supp. 2d 1179 (S.D. Cal. 2002)). Other cases have similarly held that a 

plan administrator‟s motives are “irrelevant” on de novo review. See Knopp, 2009 U.S. Dist. 

LEXIS 120267 at *10 (denying discovery into insurer‟s conflict of interest); Bourland, 2014 U.S. 

Dist. LEXIS 134813 at *6. The undersigned largely agrees. The question on de novo review is 

generally not why the insurer reached the decision it did — whether from misanthropy, 

incompetence, or a miserly grip on “its” funds. The de novo question is more direct; it is “simply” 

whether, given the administrative record, the plaintiff was entitled to benefits. See, e.g., Abatie, 

458 F.3d at 963.

Second, it is far from clear that an insurer‟s “structural conflict of interest” speaks to whether 

outside medical reviewers “biased” their own decisions in favor of the plan administrator. The link 

that the plaintiff draws between the two (see ECF No. 30 at 5) is too casual, in any case, does not 

hold up to closer analysis, and does not justify additional discovery under Opeta. The court is 

aware that one decision took an approach similar to the plaintiff‟s on this point. In Knopp, too, the 

court linked the issues of outside-reviewer bias and the plan administrator‟s structural conflict of 

interest:

Case 3:14-cv-05295-JST Document 48 Filed 10/27/15 Page 11 of 21
12

ORDER (No. 3:14-cv-05295-JST (LB))

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

United States District Court

Northern District of California

[T]he Court concludes that Ms. Knopp has made an adequate 

showing that she is entitled to some discovery which could bear 

directly and substantially on the credibility of the medical reviewers 

engaged by the insurer, issues potentially enhanced by the potential 

conflict of interest here — the insurer/payor and plan administrator 

appear to be affiliated with each other.

Knopp, 2009 U.S. Dist. LEXIS 120267 at *8-*9 (emphasis added). Knopp then ordered the 

defendants to produce any “performance evaluations” of and, more generally, “information about 

the [outside] medical consultants,” “including their relationship with Defendants”; the court called 

the latter material “closely related to the issue of conflict of interest.” Id. at *8.

The undersigned respectfully disagrees with this aspect of Knopp. An insurer‟s conflict of 

interest, on the one hand, and the “bias” and “credibility” of outside reviewers, on the other, are 

distinct issues. Doctrinally, Opeta does not link medical-reviewer “credibility” to a plan 

administrator‟s “conflict of interest.” See Opeta, F.3d at 1217-18. Opeta does not suggest that the 

latter enhances the former, so that cases involving a “structural conflict of interest” more readily 

admit of extrinsic discovery into the “credibility” of outside medical reviewers. See id. The 

plaintiff‟s contrary suggestion (ECF No. 30 at 5) is inaccurate.

Logically, too, there is no decisive link from one party‟s self-interest to another‟s credibility. 

That is to say, from Sun Life‟s structural incentive to minimize benefit payments it does not follow 

that its outside consultants distorted their assessments to favor the insurer. The two phenomena are 

distinct. The Gonda court thus rightly observed that an insurer‟s “purported conflict of interest has 

little or no bearing on whether [a] Plaintiff can introduce extra-record evidence concerning the 

credibility of” third-party “physicians . . . retained . . . to review [the] Plaintiff‟s claims.” Gonda, 

300 F.R.D. at 616 n. 3.

Obviously, there may be “exceptional” cases in which these things are tied; for example, where 

an insurer, driven by a virulent self-regard, so distorts its obligation to rightly handle benefits 

claims that it hires only those consultants who knowingly warp their own conclusions to protect 

their paymaster‟s treasury. But this cannot be deemed the ordinary case — particularly in view of 

the “restrictive” Opeta standard that bounds this whole inquiry. A case cannot fall into Opeta’s

“exceptional” class of “credibility” cases simply because there exists a garden-variety “structural 

conflict of interest.”

Case 3:14-cv-05295-JST Document 48 Filed 10/27/15 Page 12 of 21
13

ORDER (No. 3:14-cv-05295-JST (LB))

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

United States District Court

Northern District of California

Sun Life‟s “structural conflict” alone does not suggest — much less “clearly establish” — that 

its outside consultants were “biased” or otherwise lacked “credibility” so as to warrant 

“exceptional” discovery beyond the administrative record.

* * *

4.2 Third-Party Medical Reviewers’ Credibility and Bias

We now reach the point on which the plaintiff puts the most weight: the notion that, because 

the insurer paid them and perhaps had hired them in other cases, the third-party physicians whom 

Sun Life hired to review the plaintiff‟s medical records were “biased” in Sun Life‟s favor. The 

plaintiff writes that the conclusion that Sun Life‟s four outside consultants reached (in sum, that he 

was not disabled) is contrary to the weight of the administrative record — meaning the records, 

reports, and opinions of the plaintiff‟s “dozens” of treating physicians. The consultants‟ 

“incredible” opinions provide “clear evidence of [their] bias and lack of credibility,” in the 

plaintiff‟s view, and so justify additional discovery under Opeta. (ECF No. 30 at 5-7.)

The court disagrees. That these reviewers reached conclusions different from those reached by 

the plaintiff‟s treating physicians does not stand as evidence that the outside physicians were 

biased in Sun Life‟s favor, much less that they “clear[ly]” lack credibility. This is true even if, as 

the plaintiff suggests, the reviewers‟ reasoning and opinions cut against the overwhelming weight 

of the administrative record. That would not mean that they distorted their work to serve Sun 

Life‟s financial interests. It would not mean that they “summarily ignored” (ECF No. 30 at 6) the 

plaintiff‟s existing medical records. That their opinions do not jibe with the opinions of “dozens” 

of the plaintiff‟s own physicians means only that they took a minority view. A view, perhaps, with 

little support in the wider administrative record. These last points might in turn suggest, at most, 

that Sun Life‟s reviewers are incorrect. Not biased, or lacking credibility, but wrong. A de novo

review can account for all this without imagining that the reviewers were shills who warped their 

analyses to serve Sun Life‟s pecuniary interests. All the items that the plaintiff cites as indicating 

“bias” and “lack of credibility” (ECF No. 30 at 6) really just take issue with the soundness of the 

medical reviewers‟ reasoning or the rightness of their conclusions.

The plaintiff ‟s argument at the hearing on this matter confirmed this last point. The plaintiff 

Case 3:14-cv-05295-JST Document 48 Filed 10/27/15 Page 13 of 21
14

ORDER (No. 3:14-cv-05295-JST (LB))

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

United States District Court

Northern District of California

there urged that what was “exceptional” about this case, and what demonstrated the medical 

reviewers‟ bias, was that they had summarily dismissed or just “ignored” what the plaintiff 

considers to be “gold standard” support demonstrating that he has thoracic outlet syndrome. The 

proposed deposition could inquire into that bias — or, more precisely, into why the reviewers had 

“ignored” decisive material. Which is to say that the plaintiff would not inquire into the reviewers‟ 

“bias,” so much as invoke that putative bias to justify a further inquiry into the soundness of their

reasoning and conclusions. But, judging again from the plaintiff‟s own statements, the existing 

record should provide enough information from which the district court may assess the reviewers‟ 

substantive work and reach its own de novo decision on whether the plaintiff is disabled. 

Furthermore, consider the plaintiff‟s likely position if he were allowed to depose Sun Life‟s 

consultants — and these consultants elaborated defenses of their work. Would the plaintiff 

consider that material as outside the administrative record and thus beyond consideration? At all 

lengths, the plaintiff‟s “bias” argument seems a dispute with the quality of the reviewers‟ work.

The plaintiff sees the bias as stemming from the fact that Sun Life paid these outside 

reviewers. (See ECF No. 30 at 5-7.) These “paid consultants,” the plaintiff writes, were “hired to 

render opinions that support Sun Life‟s terminations. Accordingly, additional discovery is 

necessary to investigate and expose the extent of this bias and its effect on the credibility, 

objectivity, and thus reliability of their opinions . . . .” (ECF No. 30 at 7) (emphasis in original).

The court again disagrees. The court sees better reasoning in those decisions holding that mere 

compensation does not itself justify extrinsic discovery under Opeta’s “credibility of medical 

experts” head. See Polnicky, 2014 U.S. Dist. LEXIS 29123 at *7 (“mere fact that a physician 

receives compensation from a plan administrator for performing medical reviews is insufficient by 

itself to be probative of bias”) (citing Lavino v. Metro. Life Ins. Co., 779 F. Supp. 2d 1095, 1104 

(C.D. Cal. 2011), Nolan, 745 F. Supp. 2d at 923, Kludka v. Qwest Disability Plan, No. CV-08-

1806, 2010 U.S. Dist. LEXIS 34572, *2 (D. Ariz. Apr. 7, 2010), and Brice, 2011 U.S. Dist. LEXIS 

77525, at *3. The plaintiff does not challenge the reviewers‟ qualifications; nor does he point to 

misrepresentations or similar problems in their work. See Polnicky, 2014 U.S. Dist. LEXIS, at *7-

*8; Brice, 2011 U.S. Dist. LEXIS 77525, at *3. He does not show that they were biased, or 

Case 3:14-cv-05295-JST Document 48 Filed 10/27/15 Page 14 of 21
15

ORDER (No. 3:14-cv-05295-JST (LB))

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

United States District Court

Northern District of California

otherwise lack credibility, to warrant additional discovery under Opeta.

Some cases have reached a different conclusion. Facing essentially the same “bias” and 

“credibility” arguments that the plaintiff makes here, these cases have held that Opeta sanctions 

additional discovery into the relationship between a plan administrator and its outside medical 

reviewers, “because it goes to the weight the court will assign those [reviewers‟] opinions in its de 

novo review.” Rowell, 2012 U.S. Dist. LEXIS 16957, at *11; accord Gonda, 300 F.R.D. at 614-15;

Bourland, 2014 U.S. Dist. LEXIS 134813, at *7; Reynolds v. UNUM Life Ins. Co. of Am., No. 

2:10cv2383, 2011 U.S. Dist. LEXIS, *3 (D. Ariz. Aug. 12, 2011); see also Eisner, 2013 U.S. Dist. 

LEXIS 65090 at *4-*9 (analyzing outside Opeta). But Opeta’s mandate to limit additional 

discovery to “exceptional circumstances,” including on the issue of medical-reviewer credibility, 

leads the undersigned to a different view. This points to a more general consideration of Opeta’s 

rule and the way in which it has guided this decision. That consideration occupies the last part of 

this analysis.

* * *

5. Key Analytical Points

Two operative points have guided the conclusions reached above, especially on the issues of 

Sun Life‟s “structural conflict of interest” and the possible “bias” of its outside medical reviewers. 

The first point is that Opeta must be taken at its “restrictive” word. “Exceptional circumstances” 

cannot too readily be found without nullifying Opeta. The second is that the directness of a de 

novo review obviates most extra-record discovery into the motives and putative shortcomings of 

those who assessed the plaintiff‟s benefits claims. In circumstances like the present, at least, 

further inquiry into such matters is not “clearly . . . necessary” to a de novo review.

* * *

5.1 Opeta Must be Applied “Restrictively”

There is tension in the heart of Opeta. On the one hand, to advance ERISA‟s goals of keeping 

claims procedures prompt and inexpensive, Opeta expressly describes a “restrictive” standard, 

under which discovery beyond an administrative record may be allowed “only” in “limited” and 

“exceptional circumstances.” Opeta, 484 F.3d at 1217. The de novo plaintiff who seeks such 

Case 3:14-cv-05295-JST Document 48 Filed 10/27/15 Page 15 of 21
16

ORDER (No. 3:14-cv-05295-JST (LB))

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

United States District Court

Northern District of California

discovery must “clearly establish[]” that extrinsic evidence is “necessary to conduct an adequate 

de novo review of the benefit decision.” Id. (emphasis in original). Even then, a court may 

conclude that further discovery is not “required.” Quesinberry, 987 F.2d at 1027. “In most cases,” 

the Ninth Circuit has “emphasized,” “only the evidence that was before the plan administrator at 

the time of determination should be considered.” Opeta, 484 F.3d at 1217 (quotation omitted).

On the other hand, Opeta counts among the “exceptional circumstances” that “could” warrant 

extrinsic discovery situations that arise frequently. As we have already noticed, defendants in 

ERISA benefits-denial suits have often served as both plan administrator and plan funder, setting 

up the “structural conflict of interest” that might cause a court to question the insurer‟s 

“impartiality” in denying benefits. See id. Furthermore, judging from the case law, ERISA plan 

administrators often hire third-party physicians to assess claimants‟ cases. No one would expect 

such consultants to work for free, and the fact that they are paid, and are perhaps employed 

repeatedly by the same administrator, will reliably prompt ERISA plaintiffs to challenge their 

opinions as “biased” and lacking “credibility.” See id.

This tension between Opeta’s ostensibly “restrictive” rule and the common situations that it 

describes has led district courts to contradictory decisions. Thus, some cases have agreed that an 

insurer‟s structural conflict justifies extrinsic discovery (see Knopp), while others have held that 

conflict irrelevant to de novo review (Gonda). Decisions have split more numerously over whether 

to permit additional discovery into the “bias” and “credibility” of paid outside medical reviewers. 

Some cases have swiftly concluded that such evidence would help the de novo court to weigh the 

reviewers‟ opinions (e.g., Rowell); while others — correctly, in the undersigned‟s view — hold 

that the mere fact of compensation does not alone raise sufficient “credibility” issues under Opeta, 

and that the directness of the de novo inquiry makes such considerations irrelevant (e.g., Polnicky).

The undersigned thinks that Opeta must be taken at its “restrictive” word. If it justified 

extrinsic discovery merely to note the existence of a structural conflict of interest, or to observe 

that consultants were paid, then the situations in which Opeta authorizes such discovery would be 

routine rather than “exceptional.” Opeta would erase its own rule. The undersigned thus 

respectfully concludes that decisions permitting such discovery — once a claimant points to a 

Case 3:14-cv-05295-JST Document 48 Filed 10/27/15 Page 16 of 21
17

ORDER (No. 3:14-cv-05295-JST (LB))

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

United States District Court

Northern District of California

“structural conflict of interest,” or wonders if an outside reviewer is “biased” and lacks

“credibility” because the plan administrator paid for her opinion — drift away from Opeta’s 

explicitly “limited” rule. A plaintiff who wants discovery beyond the existing administrative 

record in a de novo case must point to something more than a mere structural conflict of interest or 

the fact of compensation to third-party medical reviewers. That is more in keeping with the letter 

and substance of Opeta.

* * *

5.2 De novo review obviates most discovery into “conflict” and “bias”

Adhering closely to Opeta’s “significant restrictions,” Gonda, 300 F.R.D. at 613, is also 

consistent with the (perhaps more basic) insight that a de novo review, by its nature, need not 

concern itself with the motives of plan administrators or their paid third-party medical reviewers. 

The only question on de novo review, as we have repeatedly said, is “simply . . . whether the plan 

administrator correctly or incorrectly denied benefits.” Abatie, 458 F.3d at 963. Why the 

administrator reached a putatively incorrect decision — whether because its self-interest inclined it 

to hold on to funds; or because it relied on the “biased” opinions of lackey consultants — that 

question is supplanted and made “irrelevant” by the directness and simplicity of the de novo 

inquiry.

Going further, one can say that de novo review can account for (and not merely avoid) some 

issues that often lead ERISA plaintiffs to seek additional discovery. Consider Tarasovsky, supra, 

which both parties cite. There, too, a plan administrator‟s outside reviewers concluded that the 

plaintiff was not disabled. See Tarasovsky, 2012 U.S. Dist. LEXIS 69921 at *1-*2, *6-*9. The 

Tarasovsky court denied summary judgment (to both parties) partly because the administrative 

record left “unanswered questions” about the relationship between the insurer and its outside 

reviewers. Id. at *15-*19. “The unknown connection” between the defendant and its consultants, 

Tarasovsky reasoned, was “especially concerning . . . where so many other physicians concluded 

that [the] plaintiff was disabled.” Id. at *16. The plaintiff here draws a parallel to Tarasovsky; he 

argues that Sun Life‟s outside reviewers found no disability despite an “avalanche” of proof from 

his treating physicians. (ECF No. 30 at 6.) This impugns the reviewers‟ bona fides, in the 

Case 3:14-cv-05295-JST Document 48 Filed 10/27/15 Page 17 of 21
18

ORDER (No. 3:14-cv-05295-JST (LB))

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

United States District Court

Northern District of California

plaintiff‟s view, so that further discovery should be allowed into the “connection” between Sun 

Life and its consultants. (See id.)

That is the wrong conclusion. First, Tarasovsky used a different legal standard. Though it 

declined to decide which standard applied to its merits review, Tarasovsky effectively used the 

“more complex” variant of the abuse-of-discretion standard. See Tarasovsky, 2012 U.S. Dist. 

LEXIS 69921 at *11-*15. That review is conceptually wider-ranging than de novo review. See id. 

(discussing Montour, 588 F.3d at 629-31). Under the “more complex” inquiry, “all the facts and 

circumstances” surrounding a benefits decision “must be considered”; unlike de novo review, this 

innately admits of inquiry into how the administrator‟s or its consultants‟ motives affected that 

decision. See id. at *13-*15. Thus, a court conducting a “complex” abuse-of-discretion analysis 

“may consider evidence beyond that contained in the administrative record.” Id. at *15 (quoting 

Abatie, 458 F.3d at 970). But that is not our case. Second, the de novo standard that applies here

can substantively account for the fact that paid consultants reach decisions that go against the 

weight of the administrative record. As we observed earlier, in deciding whether a benefit decision 

was correct, a de novo court can consider the facts that Sun Life‟s outside medical reviewers took 

a minority position, and that (according to the plaintiff) their opinions find little or no support in 

an “avalanche” of record material. The de novo review can, in this way, account directly for the 

contrarian position of Sun Life‟s consultants without imagining that they or Sun Life acted from 

improper motives, and without launching additional discovery into those essentially ancillary 

questions.

Consider too the case of Barteau, supra. The plaintiff writes that Barteau “found evidence 

regarding claims[-]reviewer bias necessary to its de novo review.” (ECF No. 30 at 7 (citing 

Barteau, 2009 U.S. Dist. LEXIS at *52). (The word “necessary” is a bit of an overstatement; 

Barteau did not mention Opeta’s “necessary” limitation but instead wrote that “when the evidence 

in question pertains to the bias of the reviewing physician, such evidence is permitted under a de 

novo standard of review.” Id.) The Barteau court did consider extrinsic evidence into whether the 

insurer-administrator‟s outside consultant “was an advocate for” the insurer. Id. The present point 

is to notice that Barteau need not have done so to carry out its de novo review; or, more to the 

Case 3:14-cv-05295-JST Document 48 Filed 10/27/15 Page 18 of 21
19

ORDER (No. 3:14-cv-05295-JST (LB))

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

United States District Court

Northern District of California

point, that the present plaintiff need not obtain additional discovery to address the similar 

problems he perceives in the work of Sun Life‟s third-party consultants. The Barteau court was 

concerned that the insurer‟s medical reviewer had reached conclusions contrary to the plaintiff‟s 

historical medical records, that his analysis was internally inconsistent, and that he proffered 

statements that were flatly incorrect. See id. at *26-*28. The plaintiff here makes similar 

complaints about the work of Sun Life‟s consultants. (ECF No. 30 at 5-6.) But these challenges do 

not justify a new investigation into the motives of Sun Life‟s reviewers. Assume that the plaintiff 

is correct in all that he says about the outside reviewers‟ reasoning and conclusions. The de novo 

inquiry can account for all this directly. If a medical reviewer seems to have “summarily 

ignore[d]” a wealth of existing information; if his analysis is internally inconsistent; if he proceeds 

under factual statements that are demonstrably incorrect — all this can weigh into whether, on de 

novo review, the district court concludes that the reviewer, and the insurer who relied on his 

opinions, “correctly or incorrectly denied benefits.” Invoking such concerns, in other words, does 

not “clearly establish” that additional discovery is “necessary” to an “adequate” de novo review.

* * *

The undersigned thinks that, in light of Opeta’s “restrictive” standard, and ERISA‟s concern 

that claims be resolved inexpensively and expeditiously, it cannot be too quick to perceive 

“exceptional circumstances” that permit discovery beyond the administrative record. Particularly 

where de novo review, being direct, negates or accounts in its own way for many such problems. 

This “restrictive” approach is more than consistent with Opeta; it ensures the basic integrity of 

Opeta‟s framework and rule, which otherwise threatens to swallow itself.

The plaintiff has pointed only to the existence of a structural conflict and the fact that Sun Life 

paid its outside medical reviewers. From those facts he then offers his suspicion and suggestion 

that Sun Life and the outside reviewers may have reached their conclusions from inappropriate 

motives. He has not “clearly established” that discovery into these matters is “necessary” to an 

adequate de novo review.

* * *

Case 3:14-cv-05295-JST Document 48 Filed 10/27/15 Page 19 of 21
20

ORDER (No. 3:14-cv-05295-JST (LB))

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

United States District Court

Northern District of California

CONCLUSION

The decision whether additional discovery is warranted in an ERISA benefits-denial case is 

discretionary and contextual. If Opeta means what it says, then it applies to only “exceptional 

circumstances,” where further discovery is “clearly . . . necessary” to an adequate de novo review, 

and not to “most cases.” But the pertinent circumstances here are not exceptional. They are 

ordinary. The ultimate question is whether the administrative record gives the district court enough 

information to decide de novo whether the plaintiff is entitled to benefits. For the reasons 

discussed throughout this order, the existing record here does provide enough information to make 

that decision.

The court thus partly grants and partly denies the plaintiff‟s requested discovery. Sun Life is 

ordered to produce the material described in the foregoing order and summarized as follows:

Sun Life must produce any parts of the administrative record, defined as “relevant” under the 

applicable ERISA regulations, that have not yet been given to the plaintiff. See supra, Analysis, 

Part 1.

Insofar as ERISA regulations require Sun Life to produce the policies and guidelines that 

applied to the plaintiff‟s claims, and to the extent that those have not yet been produced, Sun Life 

is ordered to produce them. Beyond the policy documents, the plaintiff cannot obtain further 

discovery into whether Sun Life followed its policies and guidelines in handling his claims. If Sun 

Life has any material that “demonstrates [its] compliance with the administrative processes and 

safeguards” required for the specific purposes of 29 C.F.R. § 2560.503-1(b)(5), it must produce 

that material. See supra, Analysis, Part 2.

The plaintiff is not entitled to additional discovery into Sun Life‟s relationship with the thirdparty medical reviewers that it hired to assess the plaintiff‟s claims. See supra, Analysis, Part 4.

The plaintiff will not be permitted to conduct depositions on any of this material. Cf. Johnson 

Leung v. Cigna Life Ins. Co. of N. Am., 2011 U.S. Dist. LEXIS 9109, *7 (N.D. Cal. Jan. 24, 2011) 

(“Depositions are generally not warranted or approved.”) (abuse-of-discretion case).

Case 3:14-cv-05295-JST Document 48 Filed 10/27/15 Page 20 of 21
21

ORDER (No. 3:14-cv-05295-JST (LB))

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

United States District Court

Northern District of California

IT IS SO ORDERED.

Dated: October 27, 2015 ______________________________________

LAUREL BEELER

United States Magistrate Judge

Case 3:14-cv-05295-JST Document 48 Filed 10/27/15 Page 21 of 21