In Feltington v. Hartford Life Insurance Company, No. 14CV6616GRBAKT, 2021 WL 2474213 (E.D.N.Y. June 17, 2021), a dispute involving a denial of long-term disability benefits under a plan governed by the Employee Retirement Income Security Act (“ERISA”), the district court partially granted Plaintiff Lisa Feltington’s request for discovery concerning Hartford’s and its reviewing doctors’ conflict of interest.
Hartford denied Feltington’s claim for long-term disability (“LTD”) benefits after it reviewed her claim under the “Any Occupation” standard of disability and sent her to be evaluated by an independent doctor, Dr. Olugbenga Dawodu. Feltington submitted an appeal to Hartford that included a Functional Capacity Evaluation Summary Report (“FCE Report”) by Best Physical Therapy (“Best”). The FCE was performed by Susan Greenberg, M.S., P.T. (“Greenberg”). After receiving her appeal, Hartford asked its peer review vendor University Disability Consortium (‘UDC’) to retain a board-certified orthopedist to review Feltington’s records and provide an opinion concerning her functional capacity. UDC chose Dr. Neal Small to perform this review. Dr. Small was critical of the FCE Report, claiming it was unsigned and that it was not objective since the exam findings contradicted an examination performed by Dr. Dawodu and Feltington’s activities shown on surveillance videos that Hartford obtained. Dr. Small provided Hartford with a Medical Record Review report (“MRR”), where in claimed that he made multiple attempts to speak with someone at Best and was not able to do so. Dr. Small then concluded that Feltington was capable of working an eight-hour day, five days a week, at a sedentary level with certain restrictions.
Hartford issued a final decision letter upholding its initial decision to terminate Feltington’s LTD benefits. The letter was written by Hartford Appeals Specialist Raichelle Gibbs (“Gibbs”). It explained the basis for Hartford’s decision, including reliance on Dr. Small’s MRR and the IME by Dr. Dawodu. After receiving this letter, Feltington’s attorney contacted Gibbs by letter and challenged the claim that calls to Best were not returned. Counsel stated that he forwarded Hartford’s decision to Best and Greenberg responded with a letter addressing Dr. Small’s criticisms of the FCE report as well as explaining that she did speak to Dr. Small. Specifically, she told Dr. Small she would need to review the file and asked a member of her staff to call him back and ask him to submit a list of written questions he had about the FCE so that she could be prepared for the next phone call. Dr. Small never called back. Greenberg offered to discuss the FCE with Dr. Small at a mutually convenient time.
Based on these events, Feltington brought a motion to seek certain discovery beyond the administrative record, which Hartford opposed. She sought a court order:
(1) directing Hartford to produce a witness under Federal Rule of Civil Procedure 30(b)(6) (“Rule 30(b)(6)”) to testify regarding Hartford’s handling of correspondence it received from Plaintiff after Hartford issued its decision on administrative appeal and closed Plaintiff’s file;
(2) permitting Plaintiff to depose the doctor retained by Hartford to review Plaintiff’s medical documentation on appeal; and
(3) compelling Hartford to answer these three interrogatories: a) State whether Defendant, Hartford Insurance Company, has both discretionary authority and made long term disability payments to Plaintiff pursuant to The Plan under Hartford Group Policy GL6745701; b) State the number of times that Defendant received a medical review of a long term disability claim from Dr. Neal Small of the University Disability Consortium and the number of times that he found the claimant to be disabled; and 3) State the number of times that Defendant received a medical review of a long term disability claim from Dr. Olugbenga Dawodu and the number of times that he found the claimant to be disabled.
Regarding the Rule 30(b)(6) deposition, the court denied this request because Feltington did not show that the deposition has a reasonable chance of helping her meet the good cause requirement to conduct additional discovery outside the administrative record. The post-denial letters are not part of the administrative record because they were created after Hartford made its final decision. However, the court did order Hartford to produce information regarding: “(1) whether Hartford has an internal procedure (written or otherwise) for reopening or reconsidering closed claims; and (2) if such a procedure exists, what that procedure is and whether that procedure was applied or followed with regard to Plaintiff’s claim. The Court is also requiring Hartford to produce the relevant portions of its claims manual or any other documents which memorialize its procedure for reopening closed claims, to the extent such documents exist.”
Regarding the deposition of Dr. Small, the court also denied this request as Feltington did not show that there is a reasonable chance that deposing Dr. Small will lead to evidence of bias that may be imputed to Hartford. Plaintiff can later file a motion to request that the court consider the post-appeal letters in determining the merits of the action.
Regarding the interrogatories, the court denied the first interrogatory as moot since Hartford does not dispute it both evaluates claims and pays benefits such that it operates under a structural conflict of interest. The court granted the other two interrogatories concerning the reviewing doctors. It explained that “[c]onsidering Hartford’s structural conflict of interest in conjunction with Plaintiff’s allegations regarding the financial relationship between Hartford and UDC, the Court finds that there is a reasonable chance that permitting the requested discovery regarding opinions rendered by Dr. Small as to the capability of claimants such as the Plaintiff to perform certain work activities may lead to evidence that will satisfy the good cause requirement.” If Dr. Small often consulted for Hartford and infrequently found claimants unable to perform work, that is relevant to the question as to whether Hartford’s relationship with UDC created a conflict of interest. The same goes for information concerning Dr. Dawodu.
When an LTD claim is subject to abuse of discretion review, conflict of interest information like this is important to determine the proper level of skepticism to apply to an ERISA administrator’s decision.
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