FILED
United States Court of Appeals
Tenth Circuit
PUBLISH
September 8, 2010
UNITED STATES COURT OF APPEALS
Elisabeth A. Shumaker
Clerk of Court
TENTH CIRCUIT
AILEEN MURPHY,
Plaintiff-Appellant,
v.
No. 09-2028
DELOITTE & TOUCHE GROUP
INSURANCE PLAN; METROPOLITAN
LIFE INSURANCE COMPANY,
Defendants-Appellees.
Appeal from the United States District Court
for the District of New Mexico
(D.C. No. 1:08-CV-00025-RHS-LFG)
Robert J. Rosati, Fresno, California, appearing for Plaintiff-Appellant.
Jack M. Englert, Jr., Holland & Hart, LLP, Greenwood Village, Colorado (Kristina
Martinez, Holland & Hart, LLP, Santa Fe, New Mexico, with him on the brief),
appearing for Defendants-Appellees.
Before KELLY, EBEL, and TYMKOVICH, Circuit Judges.
EBEL, Circuit Judge.
Plaintiff-Appellant Aileen Murphy was a participant in the Deloitte & Touche
Group Insurance Plan (“the Plan”), an insurance plan governed by the Employee
Retirement Income Security Act (“ERISA”). Metropolitan Life Insurance Company
(“MetLife”) both insured and administered the Plan; thus, it operated under an inherent
dual role conflict of interest, see Weber v. GE Group Life Assurance Co., 541 F.3d 1002,
1011 (10th Cir. 2008). While a participant in the Plan, Ms. Murphy filed a claim for
long-term disability benefits, which MetLife ultimately denied.
Ms. Murphy then sought judicial review of MetLife’s decision pursuant to 29
U.S.C. § 1132(a)(1)(B) and all parties agreed to proceed before a magistrate judge. Soon
after filing her action, Ms. Murphy moved for discovery regarding MetLife’s dual role
conflict of interest. The magistrate judge denied Ms. Murphy’s discovery request
because the conflict of interest was apparent on the face of the administrative record,
which rendered discovery on that issue unnecessary. Then, upon receiving motions for
summary judgment from both sides, the magistrate judge granted summary judgment in
favor of the Plan and MetLife.
On appeal, Ms. Murphy challenges the magistrate judge’s denial of her discovery
request and its grant of summary judgment for the defendants. Exercising jurisdiction
pursuant to 28 U.S.C. § 1291, we VACATE the magistrate judge’s discovery and
summary judgment orders and REMAND for further proceedings consistent with this
opinion.
2
BACKGROUND
Ms. Murphy worked as a Tax Firm Director for Deloitte & Touche. Her position
entailed travel, significant interaction and coordination with others, negotiations with the
Internal Revenue Service and clients, advising clients on complex matters, preparation of
proposals, and leading client meetings.
While at Deloitte & Touche, Ms. Murphy participated in the Plan, which was
governed by ERISA and provided long-term disability benefits for plan participants. All
parties agree that to receive long-term disability benefits Ms. Murphy had to satisfy the
Plan’s definition of “Total Disability” or “Totally Disabled”:
[D]ue to an injury or Sickness, you:
1. are completely and continuously unable to perform each of the
material duties of your regular job; and
2. require the regular care and attendance of a Doctor.
However, after the first 24 months of benefit payments, you must also be
completely unable to perform the duties of any gainful work or service for
which you are reasonably qualified taking into consideration your training,
education, experience, and past earnings.
(Aplt. App. v.2 at 152.) The Plan requires that the claimant furnish “[w]ritten proof of a
claim” that “describe[s] the event, the nature, and the extent of the cause for which a
claim is made.” (Id. at 157.) To receive disability benefits, the furnished proof must “be
satisfactory” to the Plan, and the Plan reserves the right to have the claimant examined by
doctors of its choice. (Id.)
In August 2006, Ms. Murphy first submitted a claim for long-term disability
benefits under the Plan. Her primary care physician, Dr. Frances Chavez, provided Ms.
Murphy with two letters supporting her disability claim. In a June 2006 letter, Dr.
3
Chavez diagnosed Ms. Murphy with “ataxic gait” and “blurred vision” and described her
symptoms to include “loss of balance, parasthesias, difficulty with speech, malaise,
memory loss, [and] blurry vision.” (Id. at 344.) Dr. Chavez also described Ms. Murphy
as “unable to communicate clearly” and struggling to recall and focus with numbers.
(Id.)
In a subsequent letter dated August 2006, Dr. Chavez revised her diagnosis, but
explicitly restated her conclusion that Ms. Murphy could not perform any “aspect of [her]
job duties.” (Id. at 393.) Dr. Chavez now diagnosed Ms. Murphy as suffering from
“[l]umbar spinal stenosis” and “[m]emory [d]isturbance.” (Id. at 392.) She described her
symptoms to include “back pain, leg pain, extreme fatigue, balance [and] vision
problems” as well as memory problems, greatly diminished focus and attention, and
adversely affected cognitive disabilities. (Id.) Dr. Chavez noted that she had prescribed
Ms. Murphy Oxycontin and that her “back [and] leg pain [were] currently responding to
[the] painkillers.” (Id. at 392-93.)
Ms. Murphy also submitted reports, letters, or notes from a psychiatrist, Dr.
Mustafa Ziyalan, a neurologist, Dr. Elizabeth Lakind, and an orthopedic surgeon, Dr.
Claude Gelinas. Dr. Ziyalan noted that Ms. Murphy had been hospitalized in 2005 for
suicidal ideation and diagnosed with Major Depressive Disorder and Panic Disorder, but
describes her depression as “recurrent, in full remission.” Id. at 391. Dr. Lakind
explained that Ms. Murphy suffered from a “lumbar spine disease,” but that Ms. Murphy
was “now on pain medications with good benefit.” Id. at 396. Dr. Lakind also noted that
in June 2006 Ms. Murphy had undergone a cranial MRI, an EEG, and a Brain SPECT
4
and each produced normal results, but a cervical MRI raised some concerns with her
spinal discs. Finally, Dr. Gelinas also diagnosed Ms. Murphy as suffering from
“[j]unctional stenosis and degenerative disc disease” in her spine, and he described her as
suffering from antalgic gait that significantly limited her range of motion. (Id. at 407.)
Despite this information, MetLife denied Ms. Murphy’s claim in September
2006. It “found no clinical evidence to substantiate [the] restrictions and limitations”
described by Dr. Chavez and “no objective clinical evidence or documentation to support
[Ms. Murphy’s] subjective complaints.” (Id. at 349-50.) MetLife noted that Ms. Murphy
informed it over the phone that Oxycontin controlled her pain, she no longer used a
walker, and she had left her job because cognitive problems impaired her performance.
MetLife further noted that Ms. Murphy’s EEG produced normal results, she declined to
have surgery to address her back pain, and she failed to have follow-up tests to rule out
an otologic cause as the source of some of her problems, which an Ear, Nose, and Throat
specialist suggested as a possibility. Therefore, MetLife found “no medical
documentation to substantiate restrictions and limitations or a level of impairment of such
severity” that Ms. Murphy was “preclude[d] . . . from performing [her] sedentary job.”
(Id. at 350.)
Ms. Murphy appealed MetLife’s decision and supplemented the administrative
record with a variety of information. Dr. Chavez provided additional information
confirming Ms. Murphy’s disability, and she expanded her diagnosis to include ataxic
gait, blurred vision, lumbar spinal stenosis, memory disturbance, Major Depressive
Disorder, and Anxiety Disorder. She also submitted documentation that in October 2006
5
she had a suicidal ideation, was admitted to the hospital where she remained for one week
and was diagnosed with Major Depressive Disorder, though she appears not to have
obtained follow-up psychiatric evaluations despite encouragement from Dr. Chavez to do
so.
Additionally, a clinical neuropsychologist, Dr. Stephen Chilulli, provided an
evaluation from September 2006 in which he found Ms. Murphy’s “current intellectual
function . . . significantly above average.” (Id. at 322.) He explained that “[t]here may
be some disruption of [Ms. Murphy’s] attention skills,” but he also noted that, even in the
attention testing, Ms. Murphy performed “some of the more challenging task [sic] . . . .
better than some simple attention tasks,” which he felt “may be related to anxiety”—a
diagnosis consistent with the results of her personality tests. (Id. at 323.) Ultimately,
however, Dr. Chilulli concluded that “[t]he results of neuropsychological testing are
negative for evidence of brain dysfunction, with measures of higher cortical functions
often being in the high average to superior range.” (Id.)
A separate neurologist, Dr. William Weng, also concluded that Ms. Murphy’s
“mental status appears to be fluidly intact,” though he expressed concern that Ms.
Murphy may suffer from depression and anxiety and that her combination of medications
may impact her cognitive function. (Id. at 325.)
Metlife reviewed Ms. Murphy’s additional materials but again denied her claim. It
enlisted two independent physicians to review Ms. Murphy’s claim—a neurologist, Dr.
Bruce LeForce, and a neuropsychologist, Dr. Carol Walker. Both independent physicians
reviewed Ms. Murphy’s file and concluded that her records did not support her claim for
6
disability, though neither personally examined Ms. Murphy. The independent physicians
acknowledged Ms. Murphy’s physical injury to her spine, but noted that her physical pain
was controlled by her medication. As to Ms. Murphy’s claims of cognitive impairment,
the independent physicians concluded that Dr. Chilulli’s and Dr. Weng’s evaluations did
not support Ms. Murphy’s claims of cognitive impairment. Moreover, Dr. Walker spoke
with Dr. Chavez by phone in March 2007, and Dr. Chavez then indicated that Ms.
Murphy’s “cognition appears clear and there are no signs she is over-medicated.” (Id. at
234). As to Ms. Murphy’s depression and anxiety, Dr. Walker explained that Dr. Ziyalan
had previously diagnosed Ms. Murphy’s depression as in full remission and that while
Ms. Murphy had been subsequently hospitalized for suicidal ideation, her failure to
follow-up with a psychiatrist left uncertainties as to the ongoing seriousness of the
depression and anxiety Ms. Murphy suffered. (Id.)
Ms. Murphy subsequently filed this action in federal court seeking a review of
MetLife’s decision and both parties consented to proceed before a magistrate judge. Ms.
Murphy initially sought discovery, which it describes as limited to MetLife’s dual role
conflict as administrator and payor of the Plan, but the magistrate judge denied the
discovery request. The magistrate judge then granted MetLife and the Plan’s motion for
summary judgment. Ms. Murphy now appeals those orders.
DISCUSSION
I. Discovery
We first address Ms. Murphy’s claim that the district court erred in denying her
request for discovery related to MetLife’s dual role conflict of interest. She argues that
7
the Supreme Court’s recent decision in Metropolitan Life Insurance Co. v. Glenn, 554
U.S. 105, 128 S.Ct. 2343 (2008), changed the legal landscape for discovery in ERISA
cases involving dual role conflicts of interest, and the district court failed to apply this
new approach. We review de novo whether the district court employed the correct legal
standard for discovery. See Neiberger v. Fed Ex Ground Package Sys., Inc., 566 F.3d
1184, 1189 (10th Cir. 2009) (reiterating the general proposition that we review de novo
whether the district court applied the proper legal standard at issue). Although we
disagree with Ms. Murphy’s proposition that Glenn changed our standard for discovery,
we believe the lack of clarity in our case law on this issue and the Glenn decision suggest
we should clarify the appropriate standard for discovery related to a dual role conflict of
interest.
A. Supplementation of the Administrative Record Generally
In an ERISA case where, as here, the plan “‘gives the administrator or fiduciary
discretionary authority to determine eligibility for benefits or to construe the terms of the
plan,’” we review the administrator’s decision for an abuse of discretion. Holcomb v.
Unum Life Ins. Co. of Am., 578 F.3d 1187, 1192 (10th Cir. 2009) (quoting Fought v.
Unum Life Ins. Co. of Am., 379 F.3d 997, 1002-03 (10th Cir. 2004), abrogated on other
grounds by Glenn 128 S.Ct. at 2351); see also Weber, 541 F.3d at 1010 n.10 (describing
terms “arbitrary and capricious” and “abuse of discretion” as interchangeable in this
context). Our cases, however, have failed to provide clear guidance to the district court
regarding the appropriate standard for resolving discovery requests in these types of
cases. See Kohut v. Hartford Life and Accident Ins. Co., --- F. Supp. 2d. ---, 2008 WL
8
5246163, *12 (D. Colo. Dec. 16, 2008) (describing our case law as exhibiting “judicial
schizophrenia”).
As a starting point, we have frequently, consistently, and unequivocally reiterated
that, “‘in reviewing a plan administrator’s decision under the arbitrary and capricious
standard, the federal courts are limited to the administrative record.’” Weber, 541 F.3d at
1011 (quoting Fought, 379 F.3d at 1003); see also, e.g., Holcomb, 578 F.3d at 1192 (10th
Cir. 2009) (citing Fought, 379 F.3d at 1003); Fought, 379 F.3d at 1003 (citing Hall v.
Unum Life Ins. Co. of Am., 300 F.3d 1197, 1201 (10th Cir. 2002)); Hall, 300 F.3d at
1201 (citing Sandoval v. Aetna Life & Cas. Ins. Co., 967 F.2d 377, 380-81 (10th Cir.
1992), and Woolsey v. Marion Labs., 934 F.2d 1452, 1460 (10th Cir. 1991)); Sandoval,
967 F.2d at 380 (citing out-of-circuit cases); Woolsey, 934 F.2d at 1460 (citing out-of-
circuit cases). Because we generally restrict district courts’ review of an administrator’s
decision to the administrative record and because Federal Rule of Civil Procedure
26(b)(1) permits discovery only where it “appears reasonably calculated to lead to the
discovery of admissible evidence,” extra-record discovery would generally seem
inappropriate.
However, even as we have told district courts to limit their analysis to the
administrative record, we have also instructed the district courts to assess the effect of a
dual role conflict of interest in a manner that seems incompatible with a flat prohibition
on extra-record discovery and supplementation. If an administrator operates under a dual
role conflict of interest, the district court must always weigh the conflict of interest in its
abuse of discretion analysis, but it must allocate the conflict more or less weight
9
depending on its seriousness.1 See Weber, 541 F.3d at 1010. But, without discovery, a
claimant may not have access to the information necessary to establish the seriousness of
the conflict. Similarly, the administrator may not be fully able to rebut a claim of conflict
by showing that it “has taken active steps to reduce potential bias and to promote
accuracy, for example, by walling off claims administrators from those interested in firm
finances.” Glenn, 128 S.Ct. at 2351. And, if the district court cannot consider material
beyond the administrative record, it may not be able to fulfill its judicial task of allocating
the proper weight to the conflict of interest. If the administrative record does not
specifically address these issues and if we flatly prohibited the consideration and
1
In 2008, the Supreme Court clarified that the presence of a dual role conflict does not
alter the level of deference accorded an administrator’s decision, and instead we must
weigh the conflict “as a factor in determining whether there is an abuse of discretion,”
according it more or less weight depending on its seriousness. Glenn, 128 S.Ct. 2350-52
(quotation omitted). Prior to Glenn, we described our approach to dual role conflicts as
“‘a sliding scale approach where the reviewing court will always apply an arbitrary and
capricious standard, but [will] decrease the level of deference given . . . in proportion to
the seriousness of the conflict.’” Weber, 541 F.3d at 1010 (quoting Flinders v.
Workforce Stabilization Plan of Phillips Petroleum Co., 491 F.3d 1180, 1190 (10th Cir.
2007), abrogated on other grounds by Glenn, 128 S.Ct. at 2351) (further quotation
omitted). Because we emphasized that we “will always apply an arbitrary and capricious
standard” of review even where dual role conflicts exist, we have interpreted our pre-
Glenn approach as consistent with Glenn. Weber, 541 F.3d at 1010-11 (quotation
omitted) (describing the two approaches as mirroring each other). However, because we
have occasionally used the phrase “dial back our deference” to describe our analysis in
cases of dual role conflicts, see id. at 1010, we pause to emphasize that this language
means only that we will weigh the conflict of interest as a factor in our abuse of
discretion analysis, and we will weigh it more or less heavily depending on the
seriousness of the conflict, see id. at 1011 (“[W]e still employ the arbitrary and capricious
standard, but we will weigh [an administrator’s] conflict of interest as a factor in
determining the lawfulness of the benefits denial.”).
10
discovery of information outside the administrative record, the district court may not be
able to make a fully informed analysis that properly weighs the conflict of interest. 2
This seeming tension in our case law, however, naturally resolves itself if we
recall the origins of our language that speaks in terms of a flat rule against a district
court’s consideration of extra-record information. Our first two cases to adopt this
restriction from other circuits were Woolsey v. Marion Laboratories, 934 F.2d 1452,
1460 (10th Cir. 1991) (citing Perry v. Simplicity Engineering, 900 F.2d 963, 966 (6th Cir.
1990), and Voliva v. Seafarers Pension Plan, 858 F.2d 195, 196 (4th Cir. 1988)), and
Sandoval v. Aetna Life & Casualty Insurance Co., 967 F.2d 377, 380-81 (10th Cir. 1992)
(citing Perry, 900 F.2d at 967, and Voliva, 858 F.2d at 196). In both Sandoval and
Woolsey, we articulated the rule against extra-record supplementation in the context of
rejecting a claimant’s efforts to supplement the record with substantive evidence of his
eligibility for benefits, such as additional evidence of disability. See Sandoval, 967 F.2d.
at 380-81 (rejecting district court’s consideration of psychological evaluations not
submitted to the plan administrator and explaining that “[i]n effect a curtain falls when
the fiduciary completes its review, and for purposes of determining if substantial
evidence supported the decision, the district court must evaluate the record as it was at
the time of the decision.”) (emphasis added); Woolsey, 934 F.2d at 1460 (stating in the
2
To the extent these materials are not contained in the record, both the administrator and
the plan participant will suffer an inability to present evidence related to the conflict.
However, the administrator has better access to information regarding the steps it has
taken and could include these materials in the administrative record if it so chooses. So
the greater prejudice of prohibiting extra-record discovery falls on the claimant.
11
context of discussing the substantive evidence that supported an administrator’s decision
concerning the disbursement of benefits that, “[i]n determining whether the decision was
supported by substantial evidence, we consider only the facts before the Administrators at
the time of their decision”) .
In this context, a general prohibition on extra-record supplementation makes
sense. Both a plan participant and an administrator have a fair opportunity to include in
the record materials related to the participant’s eligibility for benefits. Because the
administrator must base its decision on the materials included in the administrative
record, a district court would have no justification for concluding that an administrator
abused its discretion by failing to consider materials never submitted to it for inclusion in
the administrative record.3 See Sandoval, 967 F.2d at 381 (“If a plan participant fails to
bring evidence to the attention of the administrator, the participant cannot complain of the
administrator’s failure to consider this evidence.”). As we explained in Sandoval, a plan
participant “is not entitled to a second chance to prove his disability.”4 Id.
3
An administrator, however, may be found to have abused its discretion where it refuses
to consider materials submitted for its review by the plan participant. Cf. Nance v. Sun
Life Assurance Co. of Canada, 294 F.3d 1263, 1269 (10th Cir. 2002) (rejecting
claimant’s argument that a district court should consider substantive evidence of his
disability submitted after administrator had issued its final denial of benefits because
claimant had not shown the administrator acted in arbitrary and capricious manner by
declining to reopen the claim based on claimant’s additional submissions).
4
Even in ERISA cases where we review the administrator’s decision de novo, as for
example where the plan does not vest discretion in the administrator to interpret the plan,
we have “emphasize[d] that ERISA policy strongly disfavors expanding the record
beyond that which was available to the plan administrator” and “[s]upplemental evidence
should not be used to take a second bite at the apple, but only when necessary to enable
the court to understand and evaluate the decision under review.” Jewell v. Life Ins. Co.
12
Other policy concerns also support a general rule against supplementation of the
record on the merits issue of disability. In particular, Congress designed ERISA “to
provide a method for workers and beneficiaries to resolve disputes over benefits
inexpensively and expeditiously.” Id. at 380 (quotation omitted). Allowing the district
court to go beyond its limited scope of review and consider extra-record materials would
undermine this goal, and both prolong the decisionmaking process and inject greater
uncertainty into that process. See id.
Although we have frequently used broad language to describe our restriction on
extra-record discovery and supplementation, the breadth of that language can be
misleading, at least to some degree. In fact, in Sandoval we did not use the absolutist
language that we have shifted towards in some later cases. See id. (stating that “the
district court generally may consider” only materials contained in the administrative
record) (emphasis added). While Woolsey used more absolute language, as stated
previously, it used that language in the context of addressing a district court’s
consideration of substantive evidence of eligibility not included in the record. 934 F.2d
at 1460. And like both Woolsey and Sandoval, most of our subsequent cases have
employed this restriction with respect to substantive evidence of eligibility, or simply
reiterated the restriction in rote form without substantive discussion of its scope. See,
of N. Am., 508 F.3d 1303,1309 (10th Cir. 2007). Thus, even under de novo review, a
party still cannot supplement the record with substantive evidence of disability absent a
showing that the evidence (1) is necessary, (2) could not have been presented to the
administrator at the time it made its decision, (3) is not cumulative or repetitive, and (4) is
not “‘simply better evidence than the claimant mustered for the claim review.’” Id.
(quoting Hall, 300 F.3d at 1203) (further quotation omitted).
13
e.g., Holcomb, 578 F.3d at 1192 (reciting general proposition that a court’s review is
limited to the administrative record without further comment); Weber, 541 F.3d at 1008
n.7, 1011 (refusing to consider extra-record materials offered to prove substantive
eligibility for benefits); Flinders, 491 F.3d at 1190-91 (explaining that district court could
review reasonableness only of rationale for denying claim that is asserted in the
administrative record because the restriction on review of extra-record materials also
prevents an administrator from submitting extra-record materials or theories); Adamson
v. Unum Life Ins. Co. of Am., 455 F.3d 1209, 1212-14 (10th Cir. 2006) (noting court’s
limitation to the record under abuse of discretion review without further comment);
Gaither v. Aetna Life Ins. Co., 388 F.3d 759, 767-68 (10th Cir. 2004) (same); Allison v.
Unum Life Ins. Co. of Am., 381 F.3d 1015, 1021 (10th Cir. 2004) (same); Finley v.
Hewlett-Packard Co. Employee Benefits Org. Income Prot. Plan, 379 F.3d 1168, 1176
(10th Cir. 2004) (same); Nance, 294 F.3d at 1269 (rejecting claimant’s argument that
district court should consider substantive evidence of his disability submitted after
administrator had issued its final decision); Hall, 300 F.3d at 1201 (same); Kimber v.
Thiokol Corp., 196 F.3d 1092, 1098 (10th Cir. 1999) (same); Chambers v. Family Health
Plan Corp., 100 F.3d 818, 824 (10th Cir. 1996) (holding that Sandoval prevents review of
substantive extra-record evidence regarding claimant’s eligibility for benefits and
declining to address whether procedural irregularities affect a district court’s scope of
review).
Specifically, the broad language prohibiting extra-record discovery is potentially
misleading in cases involving a dual role conflict of interests or procedural irregularities.
14
In fact, some of our cases contemplate the possibility that a district court may permit
extra-record discovery related to a dual role conflict of interest. In Wolberg v. AT&T
Broadband Pension Plan, 123 Fed. App. 840 (10th Cir. 2005) (unpublished),5 the plan
participant argued that the plan administrator had a standard conflict of interest, which
meant that the plan participant bore the burden to prove the conflict existed and
jeopardized the administrator’s decisionmaking process. Id. at 845. Although we
reiterated the general principle that “[i]n ERISA cases [our] review is confined to the
administrative record,” id. at 844-45, we explicitly criticized the plan participant for
failing to seek discovery that could have proven the seriousness of the conflict of interest.
Id. at 846 n.3. Because we would not have criticized the plan participant for failing to
seek discovery on the conflict of interest if discovery and supplementation of the record
on that issue were never available, we necessarily implied that, at least in some
circumstances, discovery related to a conflict of interest may be available.6 Cf. Weber,
5
Of course, unpublished orders and judgments do not establish binding precedent in our
circuit, but they may occasionally be referenced for illustrative purposes.
6
In Fought v. Unum Life Insurance Co. of America, the magistrate judge denied a
claimant’s request for discovery “into the extent of [the administrator’s dual-role] conflict
of interest.” 379 F.3d at 1001. Although we noted the general restriction on extra-record
discovery and supplementation, see id. at1003, and also noted that the plan administrator
had “persistently resisted discovery as to the extent of that conflict,” id. at 1007, we never
explicitly addressed whether the denial of the claimant’s discovery request was
appropriate or the standard for addressing such a discovery request, see id. at 1014
(concluding only that the district court erred in upholding the administrator’s decision as
reasonable).
Similarly, other cases relied on by MetLife and the Plan, e.g., Spencer v. Arkansas
Blue Cross & Blue Shield, 205 Fed. App. 652, 654 (10th Cir. 2006) (unpublished);
Geddes v. United Staffing Alliance Employee Medical Plan, 469 F.3d 919, 927-28 (10th
15
541 F.3d at 1011 (noting, in a case involving an administrator with an inherent dual role
conflict of interest, that the court was left to its “own analytic devices” in assessing the
administrator’s reasonableness in lights of its conflict, in part, because “the record
reveal[ed] little about [the administrator’s] claims assessment process”). And district
courts within our circuit have recognized that “limited discovery for the purpose of
determining the scope of a conflict of interest” may be appropriate. Paul v. Hartford Life
and Accident Ins. Co., No. 08-cv-00890, 2008 WL 2945607, *2 (D. Colo. July 28, 2008)
(unreported) (compiling cases and concluding that “while it would not be proper to allow
Plaintiff to conduct discovery directed to the factual merits of his claim, this Court will
permit limited discovery related to the alleged conflict of interest in this case and to the
policies and procedures used by [the administrator] to make its decision”); see also, e.g.,
Kohut, 2008 WL 5246163, *10-*13 (interpreting Tenth Circuit law to permit discovery
related to the seriousness of a conflict of interest).
More to the point, the Supreme Court’s decision in Glenn contemplates the
possibility of extra-record discovery related to a dual role conflict of interest. In Glenn,
the Supreme Court explained that a conflict of interest weighs more heavily against an
administrator where it has a history of biased claims administration. 128 S.Ct. at 2351.
As an example of this situation, Glenn cited to a law review article by John Langbein that
Cir. 2006); DeGrado v. Jefferson Pilot Financial Insurance Co., 451 F.3d 1161, 1166,
1169 (10th Cir. 2006); Roach v. Prudential Life Insurance Brokerage, 62 Fed. App. 294,
298-99 (10th Cir. 2003) (unpublished); Kaus v. Standard Insurance Co., 162 F.3d 1173,
1998 WL 778055, *2-*4 (10th Cir. 1998) (unpublished), are also not determinative of the
issue of when discovery related to a conflict of interest is appropriate.
16
detailed the history of one company’s biased administration of claims. See id. (citing
John H. Langbein, Trust Law as Regulatory Law: The Unum/Provident Scandal and
Judicial Review of Benefit Denials Under ERISA, 101 Nw. U. L. Rev. 1315, 1317-21
(2007). That article details how various investigations and lawsuits unrelated to benefit
denial claims (e.g., wrongful termination claims by former employees) revealed that an
insurer pressured its employees and physicians to deny claims without proper analysis yet
instructed them to use language that a court would find adequate to support the denial.
Langbein, supra, 101 Nw. U. L. Rev. at 1317-21. This type of pressure was most
apparent in cases of “subjective illnesses” that did not show up on x-rays, MRIs, and
other objective medical tests (e.g., “mental illness, chronic pain, migraines, or even
Parkinsons”). Id. at 1319 (quotation omitted). Although the Supreme Court did not
explicitly state that the district court could consider extra-record materials or that a
claimant could discover extra-record materials, it must have contemplated that, at least in
some cases, discovery and consideration of extra-record materials may be necessary and
appropriate as an administrative record is not likely to contain the details of a history of
biased administration of claims as discussed in Langbein’s article. See Denmark v.
Liberty Life Assurance Co. of Boston, 566 F.3d 1, 10 (1st Cir. 2009) (“The majority
opinion in Glenn fairly can be read as contemplating some discovery on the issue of
whether a structural conflict has morphed into an actual conflict.”) (dicta); see also id. at
11 (Lipez, J., concurring) (agreeing with majority that Glenn contemplates discovery
related to a dual role conflict of interest but criticizing the majority for reaching that
question unnecessarily and taking an unnecessarily limited view on the availability of
17
discovery); Johnson v. Conn. Gen. Life Ins. Co., 324 Fed. App. 459, 466-67 (6th Cir.
2009) (unpublished) (indicating that Glenn is consistent with the Sixth Circuit’s prior
case law that permits discovery related to a dual role conflict of interest and procedural
irregularities); Wilcox v. Wells Fargo & Co. Long Term Disability Plan, 287 Fed. App.
602, 603-04 (9th Cir. 2008) (unpublished) (explaining that Glenn permits “consideration
of evidence outside of the administrative record to determine the appropriate weight to
accord the conflict of interest factor”).
For the reasons we have discussed above, then, we conclude that our case law
prohibits courts from considering materials outside the administrative record where the
extra-record materials sought to be introduced relate to a claimant’s eligibility for
benefits. See Sandoval, 967 F.3d at 380. Our cases and the Supreme Court’s decision in
Glenn, however, contemplate that this general restriction does not conclusively prohibit a
district court from considering extra-record materials related to an administrator’s dual
role conflict of interest. Therefore, discovery related to the scope and impact of a dual
role conflict of interest may, at times, be appropriate, and we now turn to elucidating the
standard for addressing discovery requests related to a dual role conflict of interest.
B. Standard for discovery related to a dual role conflict of interest
Just as our cases have not clearly delineated between supplementation of the
record with evidence of a claimant’s eligibility for benefits and supplementation with
evidence of the seriousness of a conflict of interest, our cases have also failed to articulate
in plain terms the standard for discovery beyond the administrative record related to a
dual role conflict of interest of an ERISA plan administrator. The Supreme Court in
18
Glenn counseled against special procedural and evidentiary rules in this context. 128
S.Ct. at 2351. We take that counsel to apply also to discovery rules, which in this case
will then be governed by the familiar standards of Federal Rule of Civil Procedure 26(b).
As stated previously, in Glenn, the Supreme Court held that the district court
weighs a dual role conflict as one factor in its abuse of discretion analysis, allocating it
more or less weight depending on its seriousness. 128 S.Ct. at 2350-51. In reaching this
conclusion, the Supreme Court rejected other approaches to handling a dual role conflict,
such as shifting to the administrator the burden of proving its decision was reasonable.
See Holcomb 578 F.3d at 1192-93 (explaining that Glenn abrogated our burden-shifting
scheme). Glenn explained that it was not “necessary or desirable for courts to create
special burden-of-proof rules, or other special procedural or evidentiary rules, focused
narrowly upon the evaluator/payor conflict.” 128 S.Ct. at 2351.
We take Glenn’s admonition against special rules to apply beyond the particular
issue addressed in Glenn. We think it also commands that we not create any special rules
for discovery related to a dual role conflict of interest. Instead, we must apply Federal
Rule of Civil Procedure 26(b) to discovery requests seeking information related to a dual
role conflict of interest, just as we would apply that rule to other discovery requests.
Although Rule 26(b) will govern these (and other) discovery requests in ERISA
cases, we emphasize that neither a claimant nor an administrator should be allowed to use
discovery to engage in unnecessarily broad discovery that slows the efficient resolution
of an ERISA claim. In fact, for the reasons that follow, discovery related to a conflict of
interest may often prove inappropriate.
19
Rule 26(b) will not permit unlimited discovery. Rule 26(b)(1) permits discovery
only of “[r]elevant information” and the discovery must “appear[] reasonably calculated
to lead to the discovery of admissible evidence.” Moreover, all discovery is limited by
Rule 26(b)(2), which protects against, inter alia, overly burdensome discovery requests,
discovery of cumulative materials, and overly costly discovery requests. See Fed. R. Civ.
P. 26.2(b)(2)(C)(i) & (ii); cf. Hall, 300 F.3d at 1203 (explaining that even in de novo
review “[c]umulative or repetitive evidence . . . should not be admitted”).
In exercising its discretion over discovery matters under Rule 26(b), district courts
will often need to account for several factors that will militate against broad discovery.
First, while a district court must always bear in mind that ERISA seeks a fair and
informed resolution of claims, ERISA also seeks to ensure a speedy, inexpensive, and
efficient resolution of those claims. See Jewell, 508 F.3d at 1308 (noting ERISA’s “goal
of prompt resolution of claims by the fiduciary”) (quotation omitted). And while
discovery may, at times, be necessary to allow a claimant to ascertain and argue the
seriousness of an administrator’s conflict, Rule 26(b), although broad, has never been a
license to engage in an unwieldy, burdensome, and speculative fishing expedition. See
Fed. R. Civ. P. 26(b) & (b)(2); see also Crawford-El v. Britton, 523 U.S. 574, 598 (1998)
(“Rule 26 vests the trial judge with broad discretion to tailor discovery narrowly.”). The
party moving to supplement the record or engage in extra-record discovery bears the
burden of showing its propriety. Cf. Hall, 300 F.3d at 1203 (explaining that, where
district court reviews an administrator’s decision de novo, “[t]he party seeking to
supplement the record bears the burden of establishing why the district court should
20
exercise its discretion to admit particular evidence by showing how that evidence is
necessary to the district court’s de novo review”).
Second, in determining whether a discovery request is overly costly or
burdensome in light of its benefits, the district court will need to consider the necessity of
discovery. Cf. Hancock v. Metro. Life Ins. Co., 590 F.3d 1141, 1155 (10th Cir. 2009)
(explaining that “a conflict of interest affects the outcome at the margin, when we waver
between affirmance and reversal”). For example, the benefit of allowing detailed
discovery related to the administrator’s financial interest in the claim will often be
outweighed by its burdens and costs because the inherent dual role conflict makes that
financial interest obvious or the substantive evidence supporting denial of a claim is so
one-sided that the result would not change even giving full weight to the alleged
conflict.7 Similarly, a district court may be able to evaluate the effect of a conflict of
interest on an administrator by examining the thoroughness of the administrator’s review,
which can be evaluated based on the administrative record. And, without further
discovery, a district court may allocate significant weight to a conflict of interest where
the record reveals a lack of thoroughness.
7
To be clear, the administrator’s financial interest in the claim might be apparent and
discovery related to that interest will often be unwarranted. However, the extent to which
the administrator has insulated its decisionmaking process from its financial interest may
not be obvious. For example, discovery related to how an administrator structures its
compensation for the independent physicians that reviewed a plan participant’s claim
might be appropriate to determine if the administrator took steps to insulate the
independent reviewers from the administrator’s obvious financial interest.
21
The above considerations are simply some factors a district court may include in
its calculus when addressing a discovery request in an ERISA case. A district court has
substantial discretion in handling discovery requests under Rule 26(b). See Motley v.
Marathon Oil Co., 71 F.3d 1547, 1550 (10th Cir. 1995) (“Generally, control of discovery
is entrusted to the sound discretion of the trial courts[.]”) (quotation, alteration omitted).
Although in exercising that discretion the district court must bear in mind both the need
for a fair and informed resolution of the claim and the need for a speedy, inexpensive,
and efficient resolution of the claim, we will not disturb a district court’s exercise of
discretion unless it has abused that discretion. See Ridenour v. Kaiser-Hill Co., 397 F.3d
925, 938 (10th Cir. 2005) (“We review discovery rulings for an abuse of discretion.”).
C. Resolution of Ms. Murphy’s discovery request
As stated previously, we review de novo whether the district court employed the
correct legal standard in resolving a discovery request. See Neiberger, 566 F.3d at 1189.
And, if it has employed the correct legal standard, we review its exercise of discretion for
an abuse of discretion. See Ridenour, 397 F.3d at 938.
Here, we do not think the magistrate judge resolved Ms. Murphy’s discovery
request under the correct legal standard. The magistrate judge began his analysis by
acknowledging that “[d]iscovery may be permitted in ERISA cases to ascertain whether a
conflict of interest exists.” (Aplt. App. v.1 at 85.) But after some discussion that
discovery may be permitted in some circumstances, the magistrate judge concluded that
because MetLife conceded it served as both the administrator and insurer of the Plan, its
conflict of interest was “now ‘apparent’ [and] further discovery into the conflict [was] not
22
required.” (Id. at 87.) He appears to have read our admittedly unclear case law as
prohibiting any discovery related to the seriousness of an inherent dual role conflict of
interest or efforts to mitigate any conflict of interest. The magistrate judge’s conclusion,
however, paints with too broad a brush. Ms. Murphy might be able to argue that
discovery, appropriately circumscribed, is appropriate to allow her to determine, and
present evidence on, the seriousness of the inherent conflict and the likelihood that it
jeopardized MetLife’s decisionmaking process in her case.8 Therefore, we think it is
appropriate to vacate the district court’s denial of Ms. Murphy’s request for discovery so
that it may reconsider that request in light this opinion.9
II. The denial of Ms. Murphy’s claim
Because we have vacated the district court’s order denying Ms. Murphy’s
discovery request, we need not resolve Ms. Murphy’s argument that the magistrate judge
erred in upholding MetLife’s denial of her claim for long-term disability benefits.
Instead, we vacate the magistrate judge’s order granting summary judgment in favor of
8
Of course, MetLife will have an opportunity to respond with its own evidence that the
conflict did not jeopardize its decisionmaking process.
9
The magistrate judge was understandably concerned by the breadth of Ms. Murphy’s
discovery request, which sought extensive evidence of how the administrator and
independent physicians had resolved other cases. (Aplt. App. v.1 at 82-83.) We
appreciate the magistrate judge’s concern that this discovery could create a morass of
secondary and remote arguments going to which other cases are comparable and relevant
to showing prejudice or bias in this case. The utility of such expansive discovery is likely
in all but the most unusual cases to be outweighed by the burdensomeness and costs
involved. In any event, the balancing of these concerns will be vested in the sound
discretion of the magistrate judge upon remand.
23
MetLife and the Plan because the magistrate judge’s resolution of the discovery issue
may affect its analysis of the merits.
CONCLUSION
For the foregoing reasons, we VACATE the district court’s orders denying Ms.
Murphy’s discovery request and granting summary judgment in favor of MetLife and the
Plan. We REMAND for further proceedings consistent with this opinion.
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