Source: https://www.debofsky.com/Past-Case-Notes-Of-The-Month/Anderson-v-Sun-Life-Assur-Co-of-Canada.shtml
Timestamp: 2019-04-23 04:27:17+00:00

Document:
Claims that require consideration of complex medical questions or issues regarding the creditability 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 record.
Plaintiff further alleges that Sun Life has a structural conflict of interest because it is responsible for evaluating benefit claims and paying them. (Doc. 29-1). A conflict of interest exists where the same party evaluates claims for benefits and pays benefits claims. Metropolitan Life Ins. Co. v. Glenn, 554 U.S. 105, 112, 128 S.Ct. 2343, 2348, 171 L. Ed. 2d 299 (2008). An ERISA plaintiff may be permitted to supplement the administrative record with evidence of the Defendant's conflict of interest. Welch v. Metropolitan Life Ins. Co., 480 F.3d 942, 949-950 (9th Cir. 2007) (citing Tremain v. Bell Industries, Inc., 196 F.3d 970, 976-977 (9th Cir. 1999)). As such, discovery into Defendant Sun Life's alleged conflict of interest and how that conflict may have affected the handling of Plaintiff's claim is appropriate.
Finally, the court ruled that discovery into the interpretation of plan terms was also appropriate.
Discussion: This is a significant ruling. Although the court acknowledged its role is to determine whether the insurer correctly or incorrectly denied benefits, the approval of discovery (although the court was clear to point out that admissibility is yet to be determined) implies that the process under which the insurer made its determination remains a relevant area of inquiry. Other cases that have also found it appropriate to take some discovery under the de novo standard into areas involving potential bias include Shepherd v. Life Ins.Co. of North Amer., 2012 U.S.Dist.LEXIS 13453 (N.D.Ill. February 3, 2012)(February 2012), Wise v. Life Ins.Co. of North America, 2012 U.S.Dist.LEXIS 50231 (C.D.Ill. April 10, 2012)(April 2012), Marantz v. Permanent Medical Group Inc. Long Term Disability Plan, 2006 U.S.Dist.LEXIS 87258 (N.D.Ill. 11/29/2006); Wojno v. CIGNA Group Insur., 2011 U.S.Dis.LEXIS 86339 (C.D.Cal. July 21, 2011)(August 2011); Bailey v. American Heritage Life Ins.Co., 2011 U.S.Dist.LEXIS 127211 (E.D.Mo. November 3, 2011)(November 2011); and Sallavanti v. Unum Life Ins.Co. of America, 2012 U.S.Dist.LEXIS 105409 (M.D.Pa. July 26, 2012)(August 2012), where the court permitted discovery of other reports authored by Unum's consultants in an effort to examine potential bias.

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