In Choi v. Unum Life Insurance Company of America; et al., No. CV 24-06338-JKS-AME, 2025 WL 2234903 (D.N.J. Aug. 6, 2025), the District of New Jersey denied a plaintiff’s motion to compel discovery beyond the administrative record in her ERISA long-term disability (LTD) case. The court held that the plaintiff, K. Choi, failed to establish a reasonable suspicion of misconduct by Unum to justify discovery into its internal claims handling procedures, performance metrics, and physician consultants.
This decision underscores the high bar claimants must meet to obtain conflict-of-interest discovery in ERISA actions—particularly under the arbitrary and capricious standard of review in certain jurisdictions.
Katie Choi, a former pharmacist for CVS, filed suit under ERISA § 502(a) after Unum terminated her LTD benefits. Choi initially received benefits under a Unum-administered plan after ceasing work in December 2020 due to physical impairments. However, Unum terminated her benefits in June 2023, asserting that she could perform “gainful occupations” despite her conditions.
Choi appealed internally and submitted additional medical evidence. Unum upheld the termination after a paper review by Dr. Neal Greenstein, an internal medicine physician retained by Unum. Dr. Greenstein opined that Choi had no functional limitations—a conclusion Choi alleged was based on a boilerplate report, similar to those he had written for other claimants. Unum stood by his opinion and upheld the denial in February 2024.
Choi then filed suit, alleging Unum’s decision was arbitrary and capricious. She also asserted that Unum operated under a structural conflict of interest—as both the payor and decision-maker under the Plan—and that it had a pattern and practice of incentivizing claim denials through financial targets and reliance on biased medical reviewers.
Plaintiff’s Discovery Motion
Choi sought to compel responses to broad discovery requests directed at Unum’s claims handling practices. These included interrogatories and document requests related to:
Choi argued this discovery was necessary to determine the extent of Unum’s conflict of interest and its impact on her specific claim decision. She relied heavily on the 2004 Regulatory Settlement Agreement (RSA) Unum entered with state regulators over past claims-handling abuses, and on internal practices like “recovery plans” and “target reports.”
The Court’s Analysis
The court reiterated that judicial review of an ERISA claim denial under the arbitrary and capricious standard is confined to the administrative record—except in limited circumstances where the plaintiff shows a “reasonable suspicion of misconduct” by the fiduciary. This exception permits extra-record discovery only to probe conflicts of interest or bias—not to supplement the merits.
The court found that Choi failed to meet this standard.
The court rejected Choi’s reliance on the 2004 RSA and related deposition testimony from a former Unum employee who had left the company well before her claim arose. The court noted that these allegations were speculative and temporally remote, with no connection to Choi’s specific claim.
The court acknowledged that Unum tracked claims closure data and expected reserves to be released from terminated claims but emphasized that such tracking alone was insufficient to suggest bad faith. The court found no evidence that Choi’s claim denial was linked to these financial goals, and pointed to a declaration from a Unum director stating that the specialists involved were unaware of any financial metrics or quotas.
Choi alleged that Unum systematically disregarded treating physicians in favor of biased consultants like Dr. Greenstein. She argued that his reports were boilerplate and used across multiple claims. However, the court determined that this was essentially a merits argument—that Unum relied on flawed evidence—and not one that raised a reasonable suspicion of misconduct or bias.
Moreover, the court rejected Choi’s request for “batting average” discovery—data showing how often Dr. Greenstein found in favor of claimants—as irrelevant and disproportionate under Rule 26(b)(1), citing Third Circuit precedent, Reichard v. United of Omaha, 805 F. App’x 111, 116–17 (3d Cir. 2020).
Conclusion
The court concluded that Choi’s discovery requests failed to establish a factual basis for misconduct specific to her claim and would improperly expand the scope of ERISA review beyond the administrative record. Accordingly, it denied her motion to compel.
This decision reaffirms the narrow scope of ERISA discovery and the evidentiary threshold required to explore alleged conflicts of interest in the Third Circuit. Some courts remain reluctant to open the door to wide-ranging discovery absent clear, case-specific indications of bias or irregularities.
*Please note that this blog is a summary of a reported legal decision and does not constitute legal advice. This blog has not been updated to note any subsequent change in status, including whether a decision is reconsidered or vacated. The case above was handled by other law firms, but if you have questions about how the developing law impacts your ERISA benefit claim, the attorneys at Roberts Disability Law, P.C. may be able to advise you so please contact us.
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