Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-caed-2_06-cv-01045/USCOURTS-caed-2_06-cv-01045-1/pdf.json

Nature of Suit Code: 791
Nature of Suit: Employee Retirement Income Security Act (ERISA)
Cause of Action: 28:1132 E.R.I.S.A.

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IN THE UNITED STATES DISTRICT COURT

FOR THE EASTERN DISTRICT OF CALIFORNIA

BARBARA STERIO,

Plaintiff,

vs. CIV-S-06-1045 MCE GGH 

HIGHMARK LIFE INSURANCE CO., et al.,

Defendants. ORDER

 /

Previously pending on this court’s law and motion calendar for May 31, 2007,

was plaintiff’s motion to compel production of documents, follow-up interrogatories, and

depositions. The parties filed a joint statement. Jesse Kaplan appeared for plaintiff. Nancy

Potter appeared for defendants.

BACKGROUND

This case concerns plaintiff’s claim that defendants improperly denied long term

disability benefits under an ERISA policy. According to the complaint, filed May 12, 2006,

Highmark Life Insurance Company (“Highmark”) insured the group employee disability benefits

sought by plaintiff. The plan under which plaintiff was covered was the Diabetes Well Long

Term Disability Plan. Plaintiff was employed by Diabetes Well as a receptionist. Although

plaintiff was granted Social Security benefits for hip surgeries, chronic pain, depression, anxiety,

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dizziness, and balance problems, the Highmark insurance coverage was denied. The terms of the

plan are not clear from the complaint.

Plaintiff seeks to compel various forms of discovery. After meeting and

conferring, defendants agreed to produce certain documents. Still other categories of documents

remain at issue.

DISCUSSION

Although not clear from the joint statement, at hearing plaintiff conceded to

application of an abuse of discretion standard of review in this case, despite her lack of

information regarding the terms of the plan. Under the abuse of discretion standard, the court

must base its decision on the administrative record only, not extrinsic evidence. Abatie v. Alta

Health & Life Ins. Co., 458 F.3d 955, 970 (9th Cir. 2006). “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.” Id. Therefore, the court will analyze the discovery at issue in

light of this standard.

3.A. Documents constituting, containing, referring to, or reflecting any agreement

between Highmark and the plan that any discretionary clause, language or basis would be part of

documents responsive to request no. 3 (for such language defendants contend affects the standard

of review to be applied by the court in this action) including any consideration given for

inclusion of such language, and negotiations regarding them

Since plaintiff agreed to the abuse of discretion standard of review, discovery to

determine the standard is no longer necessary. Furthermore, only the actual plan terms are

relevant. The negotiations leading up to the final plan are not relevant as they do not constitute

the contract terms. Therefore, plaintiff’s motion to compel is denied in regard to this request.

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3.B. Documents regarding authorization for such discretionary clause(s), including by the

California Insurance Commissioner, by the Plan, or by any person or entity relating to Highmark

This discovery is not relevant to determine whether any conflict of interest

affected the decision making process. As stated at hearing, the Plan says what it says. Plaintiff

has made no claim in this action to void the Plan or any of its provisions, including any provision

which permits the administrator to determine claims in his or her discretion. Whether the Plan’s

provisions were approved, or not, would shed no light on any purported conflict of interest

maintained by the administrator. Defendants need not respond to this request.

3.C. Names, addresses, and phone numbers of individuals likely to have information

regarding the above subjects

This request is denied as too far afield from the administrative record. The

pertinent issue is whether the plan has a discretionary clause, and the terms of the plan. 

4. All documents regarding the “reserve set, or mandated for, this claim”

Since such discovery may be relevant to a conflict of interest in defendant’s

decision to deny benefits, it will be permitted.

5. All in-house Highmark documents including claim and procedural manuals,

guidelines, bulletins, and memoranda regarding handling of disability claims in general, and

disability claims involving chronic pain, depression, and anxiety

This discovery is permissible to determine whether an administrator has complied

with the procedural requirements of the Plan. The court understands that plaintiff is not seeking

individual case files for persons who made claims because of chronic pain, depression or anxiety,

but rather that plaintiff is seeking only procedures regarding same. 

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CONCLUSION

For the reasons stated on the record at hearing, IT IS ORDERED that plaintiff’s

motion to compel discovery, filed May1, 2007, is granted in part and denied in part in accordance

with the terms of this order.

DATED: 6/5/07 /s/ Gregory G. Hollows

 

GREGORY G. HOLLOWS

 U. S. MAGISTRATE JUDGE

GGH:076/Sterio1045.dsy.wpd

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