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Aliff v. Prudential Insurance Company of America

United States District Court, E.D. Kentucky, Central Division, Lexington

September 4, 2019

TAMMY ALIFF, Plaintiff,
v.
PRUDENTIAL INSURANCE COMPANY OF AMERICA, Defendant.

          MEMORANDUM OPINION AND ORDER

          Danny C. Reeves, Chief Judge United States District Court.

         Plaintiff Tammy Aliff brings this action under the Employee Retirement Income Security Act (“ERISA”), 29 U.S.C. §§ 1001, et seq., challenging Defendant Prudential Insurance Company of America's (“Prudential”) denial of her claim for benefits under a long-term disability plan. The matter is currently pending for consideration of Aliff's motion to compel discovery. [Record No. 22] Because the defendant is both evaluator and payor of Aliff's claim, limited discovery will be allowed.

         I.

         Aliff obtained long-term disability (“LTD”) insurance from Prudential during her employment with Catholic Health Initiatives (“CHI”). [Record No. 1-1, ¶ 10] Aliff was awarded long-term disability (“LTD”) benefits after becoming unable to work in August 2015. Id. at ¶ 14. However, the defendant eventually determined that Aliff was no longer eligible for LTD and terminated those benefits in January 2018. Id. at ¶ 16.

         Aliff also obtained a life insurance policy from Prudential in connection with her employment with CHI. Id. at ¶ 24. The life insurance policy contains a waiver of premium (“WOP”) provision whereby premiums are waived if the defendant is disabled. Aliff submitted a WOP claim, which Prudential denied in December 2016. Id. at ¶¶ 28-32.

         Aliff exhausted her administrative appeals and then filed this action seeking to reverse the defendant's decisions. Id. at ¶ 19-20, 34. Following the entry of a Scheduling Order, Aliff served the defendant with interrogatories and requests for production of documents. However, the defendant only partially responded to the discovery requests, advising Aliff that she was not entitled to all of the information requested. [Record No. 22-3]

         II.

         A district court's review of an ERISA-based claim typically is limited to the administrative record. Wilkins v. Baptist Healthcare Sys., Inc., 150 F.3d 609, 619 (6th Cir. 1998). However, when a claimant makes a procedural challenge to an administrator's decision, such as a challenge based on bias, limited discovery may be appropriate. Bell v. Ameritech Sickness & Acc. Disability Ins. Plan, 399 Fed.Appx. 991, 996-97 (6th Cir. 2010) (citing Wilkins, 150 F.3d at 619). “When the same entity determines eligibility for benefits and also pays those benefits out of its own pocket, an inherent conflict of interest arises.” Cox v. Standard Ins. Co., 585 F.3d 295, 299 (6th Cir. 2009) (citing Metro. Life Insurance Co. v. Glenn, 554 U.S. 105, 108 (2008)). Here, Aliff alleges (and Prudential does not dispute) that Prudential both determined whether Aliff was eligible for benefits and paid those benefits from its own funds.

         Based on this inherent conflict, Aliff may conduct some discovery to enable the Court to determine whether such conflict affected Prudential's benefit decisions. Busch v. Hartford Life & Acc. Ins. Co., No. 5:10-00111-KKC, 2010 WL 38423');">2367 (E.D. Ky. Sept. 27, 2010) (citing Hays v. Provident Life & Acc. Ins. Co., 23');">23 F.Supp.2d 840');">623');">23 F.Supp.2d 840 (E.D. Ky. 2008)). The scope of discovery, however, will be limited to the conflict of interest or any allegations of bias. Id. at *3 (citing McQueen v. Life Ins. Co. of N. Am., 595 F.Supp.2d 752, 755 (E.D. Ky. 2009)).

         III.

         Aliff contends that Prudential has not responded satisfactorily to the following requests:

INTERROGATORY NO. 14
With respect to each entity providing a medical opinion:
a. State the number of medical opinions provided by the entity to the Defendant in the past 10 years;
b. State the total compensation Defendant paid to the entity to date over the past 10 years;
c. State the number of medical opinions that supported Defendant's decision to deny a claim in the past 10 years;
d. State the number of medical opinions that did not support Defendant's decision to deny a claim in the past 10 years; and
e. State the number of times in the past 10 years that the entity provided a medical opinion that a claimant was able to work in at least a sedentary occupation or found that a claimant was not disabled.
INTERROGATORY NO. 15
For each individual providing a medical opinion (“medical reviewer”):
a. Provide the medical reviewer's full name, business address, employer, job title (description), and relationship (if any) with Defendant;
b. State the number of medical opinions the medical reviewer has provided to Defendant in the past 10 years;
c. State the number of medical opinions the medical reviewer has provided to Defendant that supported Defendant's decision to deny a claim in the past 10 years;
d. State the number of medical opinions the medical reviewer has provided to Defendant that did not support Defendant's decision to deny ...

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