Discovery in ERISA Benefit Claims: What Courts in the Ninth Circuit Allow

When courts review ERISA benefit denials, the standard of review makes all the difference in determining whether discovery will be allowed.

Under de novo review, the court asks only one question: Was the denial correct or incorrect? Because the judge makes an independent determination of eligibility, the insurer’s motives usually do not matter. Courts in the Ninth Circuit have therefore been reluctant to allow discovery into insurer conflicts of interest when applying de novo review. For example, in Shaikh v. Aetna Life Ins. Co., No. 18-cv-04394-MMC (TSH), 2019 WL 1571876, at *2–3 (N.D. Cal. Apr. 11, 2019), the court denied discovery into a reviewing doctor’s financial relationship with Aetna, holding that “why the administrator reached a putatively incorrect decision … is supplanted and made irrelevant by the directness and simplicity of the de novo inquiry”. Likewise, in Gonda v. Permanente Med. Grp., Inc., 300 F.R.D. 609, 613–14 (N.D. Cal. 2014), the court explained that conflicts of interest “have little to no bearing” under de novo review, and broad discovery would undercut ERISA’s goal of inexpensive, efficient proceedings.

By contrast, when abuse of discretion review applies, discovery is far more common. Here, courts must evaluate not only whether the denial was reasonable, but also the nature and extent of any conflict of interest that may have influenced the insurer’s decision. In Abatie v. Alta Health & Life Ins. Co., 458 F.3d 955, 970 (9th Cir. 2006) (en banc), the Ninth Circuit held that courts may consider “evidence outside the administrative record to decide the nature, extent, and effect on the decision-making process of any conflict of interest.” In practice, this has opened the door to discovery on issues such as medical reviewer compensation, statistical approval/denial rates, and insurer relationships with outside vendors.

For claimants and their attorneys, this means:

• De novo review: Discovery into insurer bias will rarely be granted, except in exceptional circumstances (such as complex medical issues or credibility disputes not addressed in the administrative record).
• Abuse of discretion review: Courts are much more likely to grant discovery targeted at uncovering conflicts, financial incentives, or procedural irregularities.

This framework sets the stage for the rest of this discussion, which explores the types of discovery courts in the Ninth Circuit have permitted in ERISA benefit cases.

The Legal Framework

• Abatie v. Alta Health & Life Ins. Co., 458 F.3d 955, 968–70 (9th Cir. 2006) (en banc): Courts may consider evidence outside the record when determining how much weight to give an insurer’s conflict of interest.
• Montour v. Hartford Life & Accident Ins. Co., 588 F.3d 623, 634 (9th Cir. 2009): A claimant cannot meet the burden of showing conflict influenced a denial without extrinsic evidence, which may be obtained through discovery.

District courts have built on these principles by authorizing targeted, not unlimited, discovery.

What Types of Discovery Are Allowed?

1. Compensation of Medical Reviewers

Courts often require disclosure of how much insurers pay doctors and consultants.

• Corrigan v. Metropolitan Life Ins. Co., No. 3:17-cv-00207-SLG, 2018 WL 4183241, at *4–5 (D. Alaska June 21, 2018): court compelled responses about Dr. Bailey’s compensation, salary, and how many reviews he performed and denied.
• Zewdu v. Citigroup Long Term Disability Plan, 264 F.R.D. 622, 627–28 (N.D. Cal. 2010): interrogatories into compensation agreements with reviewing doctors and number of claims granted or denied were permitted.

💡 What this means for you: If the doctor reviewing your claim is being paid large sums by the insurance company, that bias should be exposed. Courts will often allow you to ask for this information.

2. Performance Evaluations and Personnel Reviews

Personnel reviews can show whether adjusters or consultants are rewarded for denials.

• Zewdu v. Citigroup LTD Plan, 264 F.R.D. 622, 629 (N.D. Cal. 2010): court allowed performance evaluations of medical professionals involved in claims.
• Stambaugh v. Reliance Standard Life Ins. Co., 708 F. Supp. 3d 1388, 1394 (D. Ariz. 2024): Reliance had to produce evaluations of its nurse and vocational consultant over a five-year period.

💡 What this means for you: If claims staff are being judged (and perhaps rewarded) based on how many claims they deny, that goes directly to fairness. Courts may let you see those evaluations.

3. Statistical Data on Approvals and Denials

Statistical patterns can reveal systemic bias.

• Corrigan, 2018 WL 4183241, at *2–3: MetLife ordered to produce denial statistics for accidental death claims from 2014–2016.
• Stambaugh, 708 F. Supp. 3d at 1393–94: Reliance compelled to disclose approval/termination rates for LTD claims, and vendor MCN’s review statistics.
• Doe v. AT&T W. Disability Benefits Program, No. 17-cv-07077-JCS, 2019 WL 2436789, at *7 (N.D. Cal. June 11, 2019): court permitted discovery into statistical approval/denial rates for LTD claims.

💡 What this means for you: If an insurer (or one of its doctors) almost never approves claims, that’s powerful evidence of bias. Courts may allow you to get those statistics.

4. Relationships With Third-Party Vendors

Insurers rely heavily on outside vendors to supply medical reviewers. Courts scrutinize those ties.

• Stout v. Hartford Life & Accident Ins. Co., No. 2:19-cv-04620, 2021 WL 2555630, at *5 (C.D. Cal. June 21, 2021): Hartford ordered to produce vendor contracts, compensation agreements, and audits.
• Stambaugh, 708 F. Supp. 3d at 1393–94: Reliance required to disclose how often MCN and specific doctors were hired, and the amounts paid to them.

💡 What this means for you: If the insurer always turns to the same outside vendor who regularly sides with them, you may be able to uncover that relationship in court.

5. Policies, Procedures, and Training Manuals

Guidelines and manuals often shape claim outcomes.

• Zewdu, 264 F.R.D. at 628–29: compelled production of training documents, claims manuals, and evaluation procedures.
• Stambaugh, 708 F. Supp. 3d at 1394: ordered Reliance to turn over policies for LTD/STD transitions and claims manuals used in 2020.

💡 What this means for you: If an insurer’s manuals or training materials show a focus on cost-cutting over fairness, you can request them in discovery.

6. Evidence of Doctor Shopping or Bias

Courts allow probing where insurers repeatedly seek favorable opinions.

• Villanueva v. Life Ins. Co. of N. Am., No. CV 17-4652 PA (GJSx), 2019 WL 4747909, at *6–7 (C.D. Cal. June 7, 2019): discovery permitted into independence, neutrality, and financial ties of medical reviewers after allegations of “doctor shopping.”

💡 What this means for you: If the insurer rejects your doctors’ opinions and keeps looking until they find someone to deny your claim, courts may let you investigate.

7. Conflict Mitigation Measures

Insurers sometimes argue they’ve walled off claims from financial pressures. Courts want proof.

• Stambaugh, 708 F. Supp. 3d at 1394–95: court ordered discovery into steps Reliance had taken to mitigate conflict and bias.

💡 What this means for you: If an insurer says it has safeguards in place, you may be entitled to test whether those safeguards actually exist or work.

What Courts Have Rejected

Courts typically reject overbroad or irrelevant requests:

• Underwriting files (Zewdu, 264 F.R.D. at 627–28).
• Premiums and benefits paid (Corrigan, 2018 WL 4183241, at 2; Zewdu, 264 F.R.D. at 629).
• All claim files (Duran v. Cisco Sys., Inc. Grp. Long Term Disability Plan, No. 12-cv-05755-WHO, 2014 WL 1685936, at *5 (N.D. Cal. Apr. 28, 2014)).
• Unrelated depositions (Corrigan, 2018 WL 4183241, at *5–6).

Practical Tips for Claimants and Attorneys

1. Be Specific: Tie every request to conflicts or bias, not medical merits.
2. Scope and Timeframe: Courts favor 3–5 year lookbacks.
3. Think Aggregates: Ask for approval/denial rates, not individual claim files.
4. Cite Case Law: Use Stambaugh, Corrigan, Zewdu, and Doe as persuasive authority.
5. Address Objections Early: Offer protective orders or in camera review for sensitive information if appropriate. However, resist attempts by the insurers to have conflict information sealed where there is no basis to do so.

Conclusion

Discovery in ERISA benefit claims is narrow but powerful. Courts in the Ninth Circuit recognize that claimants need tools to uncover conflicts, financial incentives, and biased procedures. By targeting requests to these areas—and citing strong precedents—attorneys can give their clients a fair chance to expose the forces driving unfair denials.

💡 Bottom line for claimants: Even though insurers argue the record is closed, you may still have a right to dig deeper when conflicts of interest are at play.