UNITED STATES DISTRICT COURT 

SOUTHERN DISTRICT OF OHIO 

EASTERN DIVISION 

SHARON E. GABRENYA, 

 Plaintiff, 

 Civil Action 2:12-cv-1217 

 v. Judge James L. Graham 

 Magistrate Judge Elizabeth P. Deavers 

 

MANAGED DISABILITY PLAN, et. al, 

 

 Defendants. 

 

OPINION AND ORDER 

 This case arises under the Employee Retirement Income Security Act of 1974, 29 U.S.C. 

§ 1001 et seq. (“ERISA”). Plaintiff, Sharon Gabrenya, brings this action against Defendants, 

Managed Disability Plan (“MDP”) and Metropolitan Life Insurance Company (“MetLife”) 

(collectively “Defendants”), to recover full benefits for which Plaintiff is eligible under the 

Managed Disability Plan (the “Plan”) governed by 29 U.S.C. § 1132(a)(1)(B). This matter is 

before the Court for consideration of Plaintiff’s Motion for Discovery (ECF No. 22), 

Defendants’ Opposition to Plaintiff’s Motion (ECF No. 23), and Plaintiff’s Reply (ECF No. 24). 

For the reasons that follow, Plaintiff’s Motion for Discovery is DENIED. 

I. 

 This case involves Plaintiff’s two claims of Short Term Disability (“STD”). Plaintiff 

filed her first STD claim on May 31, 2012, asserting that she could not work due to degenerative 

disc disease, back pain, fatigue, chronic pain, and depression. (Gabrenya Claim File, ECF No. 

22-2.) Defendants denied Plaintiff’s first STD claim due to a lack of supporting medical 

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documentation. Plaintiff appealed the denial on June 21, 2012, and submitted additional 

documentation. Defendants denied this appeal. 

Plaintiff filed her second STD claim on September 10, 2012, following an extensive 

shoulder surgery performed on August 16, 2012. Plaintiff asserts that she could not work until 

October 1, 2012, as a result of the surgery and recovery process. Defendants denied Plaintiff’s 

second STD claim for failure to timely submit her claim. In support of their denial, Defendants 

rely upon a provision in the Plan requiring a claimant to report a STD claim to MetLife “on or 

before the eighth consecutive calendar day beginning with and including [her] first day absent 

from work” and allowing for a “once-per-employee’s-lifetime-8-day extension.” (Summary Plan 

Description 8, ECF No. 22-4.) 

 Plaintiff filed the subject Motion to Compel on October 11, 2013, seeking a Court order 

compelling Defendants to produce the “list of medical procedures causing a presumption of 

disability” as referenced in MetLife’s Summary Plan Description. (Pl.’s Mot. 8, ECF No. 22.) 

Plaintiff refers to the following language from the Summary Plan Description in support of her 

Motion: “[y]ou will automatically be considered unable to perform the Essential Functions of 

Your Occupation for pre-determined durations following certain medical procedures as 

determined and administered by MetLife from time to time.” (Summary Plan Description 8, 

ECF No. 22-4.) Although in her original Motion she asserted MetLife must have referred to the 

document during the administrative process, Plaintiff concedes that MetLife did not rely upon 

the guidelines she seeks in making its decision to deny her claims. Plaintiff nevertheless argues 

that the requested information is relevant and therefore discoverable as part of the administrative 

record pursuant to 29 C.F.R. § 2560.503-1(m)(8) because she repeatedly requested that MetLife 

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consider the information. She further asserts that the information is necessary to demonstrate 

whether Defendants complied with administrative processes. Plaintiff also maintains that the 

information constitutes a statement of policy or guidance with respect to the Plan. In Plaintiff’s 

Reply, she additionally argues that the information at issue constitutes a plan document under 29 

U.S.C. § 1024(b)(4) and is therefore discoverable. More specifically, Plaintiff maintains that the 

list of presumptive disabilities she seeks is an instrument under which the Plan is operated and 

therefore must be produced as a plan document. 

 Defendants counter that discovery is not warranted in this case under § 2560.503-1(m)(8) 

because MetLife did not consider or rely upon the list of medical procedures causing 

presumptive disability during their review and determination of Plaintiff’s claims. Defendants 

explain that Plaintiff’s first claim for STD did not involve a medical procedure and that MetLife 

denied her second claim because it was filed out of time. Defendants further assert that the 

requested information is also not necessary to demonstrate compliance with administrative 

processes, nor is it a statement of policy with respect to the Plan. Finally, Defendants maintain 

that the information solicited by Plaintiff constitutes an internal guideline rather than a plan 

document and is therefore not discoverable under § 1024(b)(4). 

II. 

 The Federal Rules of Civil Procedure generously permit discovery “regarding any 

nonprivileged matter that is relevant to any party’s claim or defense . . . .” Fed. R. Civ. P. 

26(b)(1). In adjudicating the merits of an ERISA denial of benefits claim, a district court cannot, 

however, consider evidence outside of the administrative record. Wilkins v. Baptist Healthcare 

Sys. Inc., 150 F.3d 609, 619 (6th Cir. 1998). Consequently, matters outside the record are 

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generally not relevant or discoverable. See id.; Fed. R. Civ. P. 26(b)(1). “An exception is 

recognized, however, when evidence outside the record ‘is offered in support of a procedural 

challenge to the administrator’s decision, such as an alleged lack of due process afforded by the 

administrator or alleged bias on its part.’” Johnson v. Conn. Gen. Life Ins. Co., 324 F. App’x 

459, 466 (6th Cir. 2009) (quoting Wilkins, 150 F.3d at 619). In instances involving such 

challenges, evidence outside the record may be relevant and discoverable. Id.; Fed. R. Civ. P. 

26(b)(1). 

Every employee benefit plan must provide claimants with a “reasonable opportunity for a 

full and fair review of a claim and adverse benefit determination.” 29 C.F.R. § 2560.503-

1(h)(2). As part of the full and fair review, the plan administrator must provide the claimant with 

the administrative record upon the claimant’s appeal of an adverse benefit determination. 29 

C.F.R. § 2560.503-1(h)(2)(iii). The administrative record includes all “documents, records, and 

other information relevant to the claimant’s claim for benefits.” Id. Relevant documents include 

any “document, record, or other information . . . relied upon . . . submitted, considered, or 

generated in the course of making a benefit determination . . . [or that] [d]emonstrates 

compliance with the administrative processes or safeguards required . . . .” 29 C.F.R. § 

2560.503–1(h)(2)(iii) and (m)(8). 

 In addition, under ERISA’s disclosure provisions, the plan administrator “shall, upon 

written request of any participant or beneficiary, furnish a copy of the latest updated summary 

plan description, plan description and the latest annual report, any terminal report, the bargaining 

agreement, trust agreement, contract, or other instruments under which the plan is established or 

operated.” 29 U.S.C. § 1024; see also Cultrona v. Nationwide Life Ins. Co., 936 F. Supp. 2d 

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832, 853 (N.D. Ohio 2013) (noting that the administrator does not have a duty to provide the 

claimant with all documents relevant to her claim, but does have a duty to provide the claimant 

with plan documents upon his or her written request.). Congress enacted this disclosure 

provision to ensure that “the individual participant knows exactly where he [or she] stands with 

respect to the plan.” Firestone Tire & Rubber Co. v. Bruch, 489 U.S. 101, 118 (1989) (quoting 

H.R. Rep. No. 93-533, p. 11 (1973)). 

Plan documents include “instruments under which the plan is established or operated.” 

29 U.S.C. §1024. The Sixth Circuit has advised that the scope of the ERISA disclosure 

provision is “limited to those class of documents which provide a plan participant with 

information concerning how the plan is operated.” Allinder v. Inter–City Prods. Corp., 152 F.3d 

544, 549 (6th Cir. 1998); see also Cultrona, 936 F. Supp. 2d at 853 (noting that the scope of § 

1024(b)(4) is not a “broad ‘catch all’”); Ames v. Am. Nat’l Can Co., 170 F.3d 751, 758 (7th Cir. 

1999) (holding that the “other instruments” provision should be limited to “formal legal 

documents governing a plan” and explaining that “[i]f it had meant to require production of all 

documents relevant to a plan, Congress could have said so”); Faircloth v. Lundy Packing Co., 91 

F.3d 648, 653 (4th Cir. 1996) (holding that the “other instruments” provision “encompasses 

formal or legal documents under which a plan is set up or managed”). 

III. 

The Court first considers whether the information at issue is discoverable as a plan 

document under 29 U.S.C. § 1024(b)(4) before considering Plaintiff’s alternative argument that 

the information is discoverable due to its relevance under 29 C.F.R. § 2560.503-1(m)(8). 

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Plaintiff is correct that, upon her request, MetLife was obligated to produce all Plan 

documents, including all instruments under which the Plan is operated. See 29 U.S.C. § 

1024(b)(4). The Court, however, must interpret whether such instruments are plan documents 

narrowly and will not include documents “used in the ministerial day-to-day processing of 

individual claims.” Allinder, 152 F.3d at 549. A number of courts have limited this provision to 

encompass only “formal legal documents that underpin the plan.” See Doe v. Travelers Ins. Co., 

167 F.3d 53, 60 (1st Cir. 1999); Faircloth, 91 F.3d at 653; Ames, 170 F.3d at 759. “While it may 

prove informative for Plaintiff to obtain all documents requested, ERISA does not mandate 

disclosure of all documents that might be useful to a plan participant. Rather, it requires 

disclosure only of that ‘class of documents which provide a plan participant with information 

concerning how the plan is operated.’” Hollowell v. Cincinnati Ventilating Co., Inc., 711 F. 

Supp. 2d 751, 764 (E.D. Ky. 2010) (quoting Allinder, 152 F.3d at 549) (emphasis in original). 

The Court concludes that the information Plaintiff seeks is not a Plan document under § 

1024(b)(4). Although the language in in the Summary Plan Description provides that claimants 

will “automatically” be considered disabled following certain procedures, the Description further 

delineates that those procedures and the duration of disability are “as determined and 

administered by MetLife from time to time.” (Summ. Plan Descrip., ECF No. 22-4.) Given that 

MetLife has explicitly reserved the right to determine and administer the medical procedures that 

qualify, the Court determines that this provision does not legally obligate MetLife with respect to 

the referenced-medical procedures and is merely an interpretive tool. See Mondry v. Am. Family 

Mut. Ins. Co., 557 F.3d 781, 797 (7th Cir. 2009) (acknowledging that “a number of courts have 

concluded that internal guidelines or memoranda that a claims administrator uses in deciding 

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whether or not a claim for benefits falls within the coverage of a plan do not constitute ‘other 

instruments under which the plan is established or operated’” because while those documents 

may be relevant to a plan beneficiary’s entitlement to benefits, “as internal interpretive tools they 

are not binding on the claims administrator and therefore do not formally govern the operation of 

the plan”). The information Plaintiff seeks is therefore not discoverable under § 1024(b)(4). 

Plaintiff’s reliance upon the Department of Labor Advisory Opinion 96-14A and BioMedical Applications of Kentucky, Inc. v. Coal Exclusive Company, L.L.C., 782 F.Supp. 2d 438 

(E.D. Ky. 2011), is misplaced. Both the Advisory Opinion and Bio-Medical, which relied upon 

the Advisory Opinion, involved the schedules of “usual and customary fees.” D.O.L. Advisory 

Op. 96-14A at 1; Bio-Med., 782 F.Supp. 2d at 443. In these instances, claims administrators 

applied these specified schedules to determine the dollar amounts they would pay for claims. 

Advisory Op. 96-14A at 2; Bio-Med., 782 F.Supp. 2d at 443. In contrast, here, the guidelines 

Plaintiff seeks constitute interpretive tools to be “determined and administered by MetLife from 

time to time.” (Summary Plan Description 8, ECF No. 22-4). Regardless, as set forth above, the 

Sixth Circuit has construed § 1024(b)(4) to require production of only “those class of documents 

which provide the participant with information concerning how the plan is operated. Allinder, 

152 F. 3d at 549. Cf. Ferree v. Life Ins. Co. of N. Am., No.1:05CV2266, 2006 WL 205012, *5 

(M.D. Fla. Oct. 14, 2011) (rejecting Advisory Opinion 96-14A as “contrary to the outcome 

required by rules of statutory construction.”); Castro v. Hartford Life & Acc. Ins. Co., No. 5:11-

CV-466-OC-34TBS, 2011 WL 4889174, *5 (M.D. Fla. Oct. 14, 2011) (rejecting Advisory 

Opinion 96-14A and holding that the claimant’s request for claims manuals and guidelines fell 

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outside the scope of § 1024(b)(4)). The interpretive guidelines Plaintiff seeks certainly do not 

speak to and cannot inform her as to how the Plan operates. 

The Court next turns to Plaintiff’s argument that the information is relevant to her claim 

and must be produced under 29 C.F.R. § 2560.503-1(m)(8). As set forth above, the Department 

of Labor’s regulations require only the production of guidelines actually “relied upon” or 

“submitted, considered, or generated” in reviewing a claimant’s claim for benefits. See Byrd v. 

Metro. Life Ins. Co., No. 3:07-CV-206, 2008 WL 974787, at *2 (E.D. Tenn. Apr. 9, 2008) (citing

29 C.F.R. § 2560.503-1(m)(8)) (declining to compel production of the administrator’s guidelines 

where the claimant offered no evidence suggesting that the guidelines were considered and 

where the administrator submitted a declaration from its representative stating that based upon 

his review of the administrative record and discussions with the individual reviewers, the 

guidelines were not used to adjudicate the claimant’s claim); McQueen v. Life Ins. Co. of North 

Am., 595 F.Supp. 2d 752, 755 (E.D. Ky. Jan. 27, 2009) (declining to compel production of 

claims-handling guidelines, procedures, and a reference copy of the company plan for any 

purpose other than to provide details of defendant’s conflict of interest and stating, “it is not 

necessary that the plaintiff have copy of the guidelines that were not used” in order to make the 

argument that defendant’s failure to consider the guidelines is a factor that may weigh in favor of 

a finding that defendant’s decision was arbitrary); Thies v. Life Ins. Co. of N.A., 768 F.Supp. 2d 

908, 914 (W.D. Ky. Feb. 4, 2011) (declining to compel production of an “Accidental Death and 

Disability Resource” upon the defendant’s sworn affidavit that these items were not used or 

considered in the review of the plaintiff’s claim). 

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Plaintiff concedes that MetLife did not rely upon the guidelines at issue in making its 

benefit decision. Instead, she contends that “by repeatedly asking for the [guidelines] during the 

administrative processing of her claim,” the information was necessarily “considered” by 

Defendants, making the guidelines relevant. (Pl.’s Mot. 10, ECF No. 22.) Defendants counter 

that, under Plaintiff’s interpretation, a claimant could render guidelines or other internal 

memoranda relevant and discoverable simply by asking for them, even if an administrator never 

used the documents in making the benefits determination. 

Defendants’ point is well taken. Plaintiff’s suggested interpretation would contravene 

ERISA’s goal of expeditious claim review and the general prohibition of discovery outside the 

administrative record. See Perry v. Simplicity Eng’g, a Div. of Lukens Gen. Indus., Inc., 900 

F.2d 963, 967 (6th Cir. 1990) (“A primary goal of ERISA was to provide a method for workers 

and beneficiaries to resolve disputes over benefits inexpensively and expeditiously. Permitting 

or requiring district courts to consider evidence from both parties that was not presented to the 

plan administrator would seriously impair the achievement of that goal.”) (internal citations 

omitted); Wilkins, 150 F.3d at 619 (holding that a district court cannot generally rely on evidence 

other than what is contained in the administrative record). 

Because Defendants did not rely upon, submit, consider, or generate the guidelines at 

issue in making their determination to deny Plaintiff’s claims, she is not entitled to discovery of 

the guidelines under 29 C.F.R. § 2560.503-1(m)(8). 

IV. 

For the reasons set forth above, Plaintiff’s Motion for Discovery is DENIED. (ECF No. 

22.) 

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IT IS SO ORDERED. 

Date: November 20, 2013 /s/ Elizabeth A. Preston Deavers 

 Elizabeth A. Preston Deavers 

 United States Magistrate Judge 

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