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Carol L. Veilleux v. Hartford Life and Accident Insurance Company

December 20, 2012

CAROL L. VEILLEUX,
PLAINTIFF,
v.
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY, DEFENDANT.



The opinion of the court was delivered by: Jeremiah C. Lynch United States Magistrate Judge

Plaintiff Carol Veilleux ("Veilleux") brings this action against Defendant Hartford Life and Accident Insurance Company ("Hartford") seeking reinstatement of long-term disability insurance benefits she claims are due her under an ERISA-governed employee welfare benefit plan. Veilleux has filed a motion for leave to conduct discovery. Veilleux's motion is granted in part and denied in part as set forth below.

ORDER

I. Background

Veilleux was injured in a car accident in 1995. She continued to experience pain from the accident, and was eventually diagnosed with degenerative disc disease. Administrative Record ("A.R.") 795, 868. Veilleux was insured at the time under a long term disability insurance policy ("the Plan") provided through her former employer, Bio-Rad Laboratories, and administered by Hartford. There is no dispute that the Plan is an employee welfare benefit plan governed by the Employee Retirement Income Security Act of 1974 (ERISA), 29 U.S.C. §§ 1001 et seq.

In December 1998, Veilleux applied for long term disability benefits under the Plan. A.R. 958-61. Hartford approved her application in June 1999, and paid her benefits for the next twelve years. A.R. 1120-22. During that period, Hartford corresponded with Veilleux a number of times, requested periodic updates from her medical providers, and conducted surveillance activities on three different occasions.

In May 2011, Hartford conducted a medical assessment of Veilleux's condition and requested that she participate in an orthopedic independent medical examination ("IME"). A.R. 1156-57, 966-78. On October 27, 2011, Hartford advised Veilleux that it had completed its review of her claim and was terminating her benefits. A.R. 1031-35. Hartford advised Veilleux that she had the right to appeal its decision within 180 days. A.R. 1034.

Veilleux, who was by this time represented by counsel, submitted a written appeal on April 23, 2012.*fn1 Several days later, Veilleux provided Hartford with additional medical records in support of her appeal. A.R. 681. On May 9, 2012, Hartford advised Veilleux in writing that it had received her appeal and indicated that it would "make an appeal decision as soon as possible and should make the decision within 45 days of the receipt of the request." A.R. 1027. Hartford's letter also explained if there were special circumstances preventing Hartford "from making the decision in that time, the evaluation period [could] be extended by an additional 45 days."*fn2 Dkt. 1027.

On May 25, 2012 -- 32 days after its receipt of her request for appeal -- Hartford advised Veilleux that it needed more information to evaluate her claim and so asked her to sign an enclosed authorization for medical records. A.R. 1024. Although Hartford did not specifically ask that she do so, Veilleux provided Hartford with additional medical records from her treating physician. Hartford received those records on June 8, 2012. A.R. 1023. By that time, Hartford had also received Veilleux's executed medical release. A.R. 1023.

Just one day earlier, on June 7, 2012, the initial 45-day deadline within which Hartford had indicated it would decide Veilleux's appeal passed. Hartford wrote to Veilleux on June 14, 2012, confirming its receipt of the additional medical records she had provided and indicating that it considered her appeal to have been perfected on June 8, 2012 -- the date on which it had received Veilleux's supplemental medical records. A.R. 1023. Based on that date, Hartford advised Veilleux that "the 45 days for Appeals to render a decision [would] end on July 23, 2012" and explained that it was referring her "file to a medical consultant for an assessment." A.R. 1023. Veilleux received Hartford's letter on June 18, 2012, by which time she had already initiated this litigation with the filing of her complaint on June 15, 2012. Dkt. 1, 27-3. As of the date of this Order, Hartford has not issued a decision on Veilleux's appeal.

Veilleux brings suit under ERISA seeking reinstatement of her long term disability benefits, civil penalties, equitable relief, and a clarification of her right to future benefits. Dkt. 4. Veilleux has moved for leave to conduct a broad range of discovery, including the opportunity to depose her treating and examining physicians. Dkt. 20, at 11. She also hopes to undergo another functional capacity examination, obtain the results of Hartford's surveillance efforts, and inquire into the scope and extent of Hartford's alleged conflict of interest. Dkt. 20, at 11-14. Hartford resists Veilleux's effort to obtain discovery.

II. Discussion

Generally, litigants in a civil action may obtain discovery regarding "any non-privileged matter that is relevant to any party's claim or defense...." Fed. R. Civ. P. 26(b)(1). In an ERISA case like this one, however, discovery plays a far more limited role because the primary purpose of ERISA is "to provide a method for workers and beneficiaries to resolve disputes over benefits inexpensively and expeditiously." Boyd v. Bert Bell/Pete Rozelle NFL Players Retirement Plan, 410 F.3d 1173, 1178 (9th Cir. 2005).

As both parties recognize, the availability and scope of discovery in an ERISA action is directly related to the applicable standard of review. See e.g. Santos v. Quebecor World Long Term Disability Plan, 254 F.R.D. 643, 647 (E.D. Cal. 2009). In order to resolve Veilleux's motion for leave to conduct discovery, then, this Court must first determine whether a de novo or abuse of discretion standard of review applies in this case.

An ERISA plan administrator's decision to deny or terminate benefits is reviewed "under a de novo standard unless the benefit plan gives the administrator or fiduciary discretionary authority to determine eligibility for benefits or to construe the terms of the plan." Firestone Tire & Rubber Co. v. Bruch, 489 U.S. 101, 115 (1989). "When the plan gives the administrator or fiduciary discretionary authority to determine eligibility for benefits, that determination is reviewed for abuse of discretion." Gatti v. Reliance ...


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