Source: https://www.lifeanddisabilitylaw.com/erisa-watch-independent-doctor-may-be-deposed-on-de-novo-review/
Timestamp: 2019-04-21 22:26:53+00:00

Document:
The Easter bunny brought more than just candy this year, it delivered a golden egg of a discovery decision in Harding v. Hartford Life & Accident Ins. Co., No. 16-CV-6700, 2017 WL 1316264 (N.D. Ill. Apr. 10, 2017). In Harding, the plaintiff asserted a claim for long term disability benefits and claim for waiver of life insurance premium benefits under ERISA Section 502(a)(1)(B). In is undisputed that de novo review applies. Plaintiff moved to compel seeking two depositions, including one of Dr. Julia Ash, M.D., an independent medical consultant retained by Professional Disability Associates (hired by Hartford) to review Plaintiff’s medical records, and of Mary Roman, a claim manager who rendered the decision denying Plaintiff’s claim on appeal.
This was a light week for ERISA decisions so enjoy an easy read of case recaps below.
Moyle v. Liberty Mut. Ret. Benefit Plan, No. 10CV2179-GPC(MDD), 2017 WL 1331739 (S.D. Cal. Apr. 11, 2017) (Judge Gonzalo P. Curiel). Following remand from the Ninth Circuit, Defendants’ moved for summary judgment on the equitable relief claim under Section 502(a)(3), which the court denied. The court held that there are genuine issues of material fact as to who made the alleged misrepresentation or affirmatively omitted information and whether those persons or entities are “fiduciaries” as defined under 29 U.S.C. § 1002(21)(A). Defendants argued that Gabriel v. Alaska Elect. Pension Fund, 773 F.3d 945 (9th Cir. 2014) precludes reformation where it would be inconsistent with the unambiguous terms of the plan documents, but the court declined to conduct a sua sponte analysis on this issue. The court also denied Defendants’ supplemental motion for summary judgment on the issue of surcharge.
Murphy v. California Physicians Serv., No. 14-CV-2581-PJH, 2017 WL 1330636, at *22 (N.D. Cal. Apr. 11, 2017) (Judge Phyllis J. Hamilton). On de novo review, the court determined that Plaintiff has established that she is disabled from performing the substantial and material acts necessary to pursue her usual occupation of VP of Human Resources at Blue Shield, and that she was in fact not performing the substantial and material acts of her usual occupation in 2013.
Harding v. Hartford Life & Accident Ins. Co., No. 16-CV-6700, 2017 WL 1316264 (N.D. Ill. Apr. 10, 2017) (Judge Robert M. Dow, Jr.). In this lawsuit for long term disability benefits subject to de novo review, the court will permit Plaintiff to depose Dr. Julia Ash, M.D., an independent medical consultant retained by Professional Disability Associates (whom Defendant retained) to review Plaintiff’s medical records. However, the court will not permit Mary Roman’s (claim manager) deposition since her qualifications, her purported biases, and her decision making process are simply irrelevant under a de novo review.
Stevenson v. Aetna Health of California, Inc., No. 3:17-CV-0107-CAB-KSC, 2017 WL 1336776 (S.D. Cal. Apr. 10, 2017) (Judge Cathy Ann Bencivengo). Here, Plaintiff was a subscriber to Defendants’ health care plan and a victim of a preventable medical error at the hands of a Sharp affiliated physician. As a result, he developed Complex Regional Pain Syndrome (“CRPS”). Defendants’ health care plan refused to approve a DRG stimulator so Plaintiff seeks damages for pain, medical expenses, earning losses, along with punitive damages. The court found that Plaintiff’s suit against Sharp Rees Stealy Medical Group and Aetna for “unreasonable denial of benefits” in violation of Civil Code § 3428 is completely preempted by ERISA and fails to state a claim upon which relief can be granted. Dismissed.
Mcculloch v. Board Of Trustees Of The SEIU Affiliates Officers And Employees Pension Plan, et al., No. 16-1374, __F.App’x__, 2017 WL 1314880 (2d Cir. Apr. 10, 2017) (PRESENT: JON O. NEWMAN, DENNIS JACOBS, Circuit Judges, LEWIS A. KAPLAN,* District Judge). Because Plaintiff’s claim for pension benefits is not statutory, and the district court would need to construe specific terms of the pension plan, Plaintiff was required to exhaust internal administrative remedies. Judge of district court is affirmed.
Mclaughlin; J.J.M., v. Board Of Trustees of The National Elevator Industry Health Benefit Plan, No. 16-4108, __F.App’x__, 2017 WL 1325687 (3d Cir. Apr. 11, 2017) (Before: CHAGARES, SCIRICA, and FISHER, Circuit Judges). In this matter where Plaintiffs filed a lawsuit alleging that the Plan breached its fiduciary duty by offsetting benefits otherwise payable to McLaughlin and his family members, but where the act complained of was previously alleged in a counterclaim in a prior lawsuit, the court found that the elements of res judicata are present. The court rejected the argument that the “continuing course of conduct” exception bars application of res judicata.
Griffin v. Focus Brands Inc., No. 16-13485, __F.App’x__, 2017 WL 1359833 (11th Cir. Apr. 13, 2017) (Before MARCUS, JILL PRYOR and FAY, Circuit Judges). A final judgment is on the merits in this narrow circumstance where the district court labeled its dismissal as without prejudice based on its determination that the plaintiff lacked standing, but the Eleventh Circuit clarified on appeal that the relevant issue was not jurisdictional. The court affirmed the district court’s decision to dismiss the claims based on res judicata.
Moyle v. Liberty Mut. Ret. Benefit Plan, No. 10CV2179-GPC(MDD), 2017 WL 1331739 (S.D. Cal. Apr. 11, 2017) (Judge Gonzalo P. Curiel). On remand from the Ninth Circuit, Defendants argued that the claim for breach of fiduciary duty is barred by the statute of repose and the statute of limitations under 29 U.S.C. § 1113. The court held that a statute of repose is not subject to equitable tolling and Plaintiffs have provided sufficient proof that the “fraud or concealment” tolling exception applies to this case. The court found that Plaintiffs Arwood and Rollason’s claims are barred by the six year limitations period for fraud or concealment but that there are genuine issues of material fact as to whether Plaintiff Sanders’ claims are barred by the six year limitations period under the fraud or concealment exception. The court further found that in Plaintiff Moyle’s case equitable tolling should apply while he exhausted his administrative remedies from January 26, 2008 until October 23, 2009. This tolling makes his complaint timely under the six year statute of limitations for fraud or concealment.

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