Hines v. UNUM Life Insurance Company of America et al, No. 1:2018cv00786 - Document 19 (N.D. Ohio 2018)
Court Description: Opinion & Order signed by Judge James S. Gwin on 7/20/18 granting plaintiff's request to seek discovery specifically on whether plaintiff Hines or plaintiff's healthcare providers forwarded relevant medical evidence to UNUM that is not included in the filed administrative record. (Related Doc. 16 ) (D,MA)
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Hines v. UNUM Life Insurance Company of America et al Doc. 19 UNITED STATES DISTRICT COURT NORTHERN DISTRICT OF OHIO ----------------------------------------------------------------------LINDA M. HINES, Plaintiff, v. UNUM LIFE INSURANCE COMPANY OF AMERICA, Defendant. : : : : : : : : : : : : CASE NO. 1:18-CV-786 OPINION & ORDER [Resolving Doc. 16] ----------------------------------------------------------------------JAMES S. GWIN, UNITED STATES DISTRICT JUDGE: In this ERISA case, Plaintiff Linda M. Hines claims that Defendant UNUM Life Insurance Company of Amer“ca ( UNUM ) wrongfully den“ed her long-term disability benefits.1 On June 7, 2018, Defendant UNUM filed under seal the administrative record it used in its decision.2 Plaintiff argues that the administrative record is missing documents and information that Pla“nt“ff’s healthcare providers gave to UNUM.3 Plaintiff therefore moves the Court for limited discovery about these omissions.4 Defendant UNUM opposes.5 As a general matter, an ERISA claimant cannot seek discovery of evidence outside of the administrative record. 6 In rev“ew“ng a benef“ts cla“m den“al, d“str“ct courts are usually conf“ned to the record that was before the Plan Adm“n“strator. 7 The exception to this rule is for evidence concerning a procedural challenge to the administrator's decision, such as an alleged lack of due process afforded by the administrator or alleged b“as on “ts part. 8 1 Doc. 1-1. Doc. 14. Defendant UNUM cert“f“es that the adm“n“strat“ve record f“le const“tutes a true and accurate copy. 1 at ¶ 5. 3 Doc. 16. 2 4 Id. 5 Doc. 18- Doc. 18. 6 Wilkins v. Baptist Healthcare Sys., Inc. , 150 F.3d 609, 618-19 (6th Cir. 1998). Id. at 615. 8 Id. at 618; Cooper v. Life Ins. Co. of N. Am., 486 F.3d 157, 171 (6th Cir. 2007). 7 Dockets.Justia.com Case No. 1:18-CV-786 Gwin, J. Plaintiff Hines argues that her medical records from Dr. Marc F.G. Estafanous, Dr. Gregory Louis, and Dr. Patricia Grace are relevant to her disability claim and were provided to UNUM, but are not included in the filed administrative record.9 Plaintiff argues that discovery about these absences is relevant to showing that UNUM del“berately ut“l“zed an “ncomplete record to deny Plaintiff benefits.10 Defendant, however, argues that such evidence is inappropriate because Plaintiff fails to make any colorable procedural challenge to warrant discovery.11 Defendant UNUM argues that Plaintiff presents no evidence that the record is incomplete or that UNUM deliberately excluded the relevant records.12 Defendant UNUM argues that Plaintiff cannot now supplement the record when she failed to do so during the administrative process.13 The Court finds that Plaintiff sufficiently makes a procedural challenge to the Adm“n“strator’s decision based on an arguably incomplete administrative record. Further discovery on whether Plaintiff or her healthcare providers forwarded medical records to UNUM that are not included in the administrative record is relevant to her procedural challenge. This discovery can help determine whether there are administrative record gaps that impair the Court’s ab“l“ty to cons“der all ev“dence w“th respect to Defendant UNUM when it made the benefits denial.14 Should that be the case, remand back to Defendant UNUM would be the appropriate remedy.15 This is because Defendant UNUM must be allowed to conduct a rev“ew “n the f“rst “nstance, cons“der“ng the relevant mater“al “t or“g“nally excluded. 9 16 Doc. 16 at 1-2. Id. at 2. 11 Doc. 18 at 3-6. 12 Id. at 3-4. Defendant UNUM also argues that the allegedly missing Dr. Louis records are already included in the filed administrative record. Id. at 4-5 (citing Doc. 14-1 at 168, 346). The Court, however, does not see any indication from the documents that they belong to Dr. Louis. 13 Doc. 18 at 5. 14 See Daft v. Advest, Inc., 658 F.3d 583, 596 (6th Cir. 2011) ( The d“str“ct court lacked cruc“al “nformat“on relevant to the top-hat “ssue, a problem that can be corrected only by remand“ng Pla“nt“ffs' benef“t cla“m. ). 10 15 16 Id. Killian v. Healthsource Provident Admins., Inc., 152 F.3d 514, 522 (6th Cir. 1998). -2- Case No. 1:18-CV-786 Gwin, J. Accordingly, the Court GRANTS Plaintiff’s request to seek discovery specifically on whether Pla“nt“ff H“nes or Pla“nt“ff’s healthcare prov“ders forwarded relevant medical evidence to UNUM that is not included in the filed administrative record. IT IS SO ORDERED. Dated: July 20, 2018 s/ James S. Gwin JAMES S. GWIN UNITED STATES DISTRICT JUDGE -3-
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