Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-cand-5_05-cv-03790/USCOURTS-cand-5_05-cv-03790-1/pdf.json

Nature of Suit Code: 791
Nature of Suit: Employee Retirement Income Security Act (ERISA)
Cause of Action: 28:1001 E.R.I.S.A.

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United States District Court

For the Northern District of California

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 Fisher elected not to file a reply brief.

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*E-FILED 6/9/06*

IN THE UNITED STATES DISTRICT COURT

FOR THE NORTHERN DISTRICT OF CALIFORNIA

SAN JOSE DIVISION

GINA FISHER, 

Plaintiff,

 v.

THE ANDERSON BEHEL STEVENS CREEK

PORSCHE AUDI EMPLOYMENT BENEFIT PLAN,

Defendant. /

BLUE SHIELD OF CALIFORNIA,

 Real Party in Interest.

_____________________________________________/

NO. 05-03790 RMW (RS)

ORDER DENYING MOTION FOR

LEAVE TO CONDUCT

DISCOVERY

I. INTRODUCTION

Plaintiff Gina Fisher seeks review under ERISA of her health plan administrator’s

determinations regarding the benefits payable to her. By this motion, Fisher requests leave to

propound interrogatories and to take depositions with respect to certain subjects as to which she

contends the administrative record is incomplete. The motions were fully briefed1

 and heard by the

Court on May 24, 2006. Based on all papers filed to date, as well as on the oral argument of

counsel, the Court denies the motion, for the reasons explained below.

Case 5:05-cv-03790-RMW Document 27 Filed 06/09/06 Page 1 of 4
United States District Court

For the Northern District of California

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 II. BACKGROUND

Fisher was a participant in The Anderson Behel Stevens Creek Porsche Audi Employee

Benefit Plan (“the Plan”), which was provided through her husband’s former employer. The Plan is

subject to ERISA, the Employee Retirement Security Act of 1974, 29 U.S.C. §1001 et seq. Real

party in interest, Blue Shield of California, administers the plan and makes determinations as to what

benefits are payable.

Fisher apparently incurred medical bills with “non-preferred providers.” Blue Shield

determined that some of the services rendered were not “medically necessary” and disallowed

payment for those services. As to other services, Blue Shield contends it paid the percentage called

for by the terms of the Plan.

III. DISCUSSION

When courts are called upon to review an administrator’s determination regarding the

payment of benefits under ERISA, “the record that was before the administrator furnishes the

primary basis for review.” Kearney v. Standard Insurance Co., 175 F.3d 1084, 1090 (9th Cir. 1999). 

That is true regardless of whether in the particular case the standard of review is de novo or abuse of

discretion. Id. Because review is primarily limited to the administrative record, and because, “‘[a]

primary goal of ERISA was to provide a method for workers and beneficiaries to resolve disputes

over benefits inexpensively and expeditiously,’” permitting discovery is rarely appropriate in cases

such as this. Newman v. Standard Insurance Co., 997 F.Supp. 1276, 1281 (C.D. Cal. 1998).

Here, the primary thrust of Fisher’s motion is her contention that there are “anomalies” in the

administrative record that she should be allowed to explore through ordinary discovery mechanisms. 

In opposition, however, Blue Shield has demonstrated that in most cases the information that Fisher

contends is missing from the administrative record in fact appears therein.

To the extent Fisher is also contending that she should be permitted to inquire into matters

not reflected in what Blue Shield has shown is the complete administrative record, she has not

established that such discovery is necessary or appropriate in this case. Fisher’s central concern

seems to arise from her contention that she obtained “preauthorization” for a certain surgical

procedure, but that the administrative record “contains no information regarding this

Case 5:05-cv-03790-RMW Document 27 Filed 06/09/06 Page 2 of 4
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For the Northern District of California

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28 ORDER DENYING MOTION FOR LEAVE TO CONDUCT DISCOVERY 

05-03790 RMW (RS) 

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preauthorization.” Blue Shield has explained, however, that its benefits determinations with respect

to the procedures in question were not made on the basis of whether or not there was a

“preauthorization,” rather the claims were either paid or denied as not “medically necessary.” Since

the claims were not denied based on a lack of a “preauthorization,” there is no relevance to why

more information regarding the purported preauthorization does not appear in the administrative

record. Furthermore, Fisher remains free to make such arguments on the merits as may be

appropriate with respect to the fact that she contends certain procedures were “preauthorized” but

the records of Blue Shield apparently fail to reflect such preauthorization.

Notwithstanding all of this, Blue Shield has expressed a willingness to provide Fisher with

certain additional information she is seeking, including information regarding the board

certifications of doctors who reviewed her file. Blue Shield is hereby directed to provide that

information. 

IV. CONCLUSION

The motion is DENIED, except insofar as Blue Shield is directed to provide the additional

information it offered to provide in its briefing and at the hearing..

IT IS SO ORDERED.

Dated: June 9, 2006 

RICHARD SEEBORG

United States Magistrate Judge

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United States District Court

For the Northern District of California

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28 ORDER DENYING MOTION FOR LEAVE TO CONDUCT DISCOVERY 

05-03790 RMW (RS) 

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THIS IS TO CERTIFY THAT NOTICE OF THIS ORDER HAS BEEN GIVEN TO:

Jordan S. Altura jaltura@barwol.com, cpinell-gentry@barwol.com

Ned A. Fine nfine@employerlawyers.com, emiller@employerlawyers.com;

cbrown@employerlawyers.com; jdare@employerlawyers.com; dhosilyk@employerlawyers.com

John M. LeBlanc jleblanc@barwol.com, nne@barwol.com

Laurence F. Padway lp@padway.com, fp@padway.com; ncahill@padway.com

Counsel are responsible for distributing copies of this document to co-counsel who have not

registered for e-filing under the Court's CM/ECF program. 

Dated: June 9, 2006 Chambers of Judge Richard Seeborg

By: /s/ BAK 

Case 5:05-cv-03790-RMW Document 27 Filed 06/09/06 Page 4 of 4