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Benjamin v. Oxford Health Ins., Inc.

United States District Court, D. Connecticut

February 28, 2017




         On December 22, 2016, plaintiff Amy Benjamin (“plaintiff”) filed a Motion to Compel Further Responses to Plaintiff's First Set of Requests for Production. [Doc. #44]. Plaintiff's motion seeks an Order compelling defendant Oxford Health Insurance, Inc. (“defendant”) to provide further responses to plaintiff's discovery requests that were served on defendant on November 4, 2016. See Id. at 2. Defendant has filed a Memorandum of Law in Opposition to Plaintiff's Motion to Compel, [Doc. #47] and plaintiff has filed a Reply. [Doc. #48]. Defendant has also filed a motion to strike a portion of plaintiff's reply, and plaintiff has filed a response. [Docs. ##49, 52]. For the reasons set forth below, plaintiff's motion to compel is GRANTED, in part, and DENIED, in part. Defendant's motion to strike is GRANTED.

         I. Background

         Plaintiff filed this action on March 10, 2016, pursuant to 29 U.S.C. §§1132(a), (e), (f), and (g) of the Employee Retirement Income Security Act of 1974, (hereinafter “ERISA”) seeking, inter alia, benefits under the terms of an employee benefit plan. See Doc. #1. On August 10, 2016, Judge Alvin W. Thompson referred this case to the undersigned to conduct an early settlement conference. See Docs. ##24, 25. On August 22, 2016, the undersigned entered a settlement conference Order, setting deadlines and requirements for a settlement conference scheduled for October 21, 2016. [Doc. #29]. On October 19, 2016, after extensive ex parte discussions regarding settlement with counsel for both parties, the undersigned concluded that the record was not sufficiently developed for a settlement conference to be productive in this matter. The Court therefore canceled the settlement conference, and entered an amended Scheduling Order requiring all discovery requests to be propounded on or before November 4, 2016, and responses to be served within 30 days of the date of service of the requests. See Docs. ##37, 38.

         During a telephonic status conference on December 9, 2016, before the undersigned, counsel for plaintiff indicated that she was unsatisfied with defendant's responses to plaintiff's discovery requests. See Doc. #43. The Court thus encouraged the parties to meet and confer, and entered a Scheduling Order, setting deadlines for the filing of any discovery-related motions. See Doc. #43. On December 22, 2016, counsel for plaintiff filed the instant Motion to Compel. [Doc. #44]. On January 3, 2017, the motion was referred to the undersigned. [Doc. #45]. On January 13, 2017, counsel for defendant filed a memorandum in opposition to plaintiff's motion. [Doc. #47]. On January 27, 2017, plaintiff filed a reply. [Doc. #48]. On February 6, 2017, defendant filed a Motion to Strike certain portions of plaintiff's reply papers. [Doc. #49]. Plaintiff filed a response to defendant's motion to strike on February 17, 2017. [Doc. #52].

         II. Legal Standard

         In an action challenging the denial of benefits under ERISA, “the presumption is that judicial review is limited to the record in front of the claims administrator unless the district court finds good cause to consider additional evidence.” Muller v. First Unum Life Ins. Co., 341 F.3d 119, 125 (2d Cir. 2003) (quotation marks and citation omitted).[1] See also Krauss, 517 F.3d at 631 (“[A] district court's decision to admit evidence outside the administrative record is discretionary, but which discretion ought not to be exercised in the absence of good cause.” (quotation marks and citation omitted)).

         “It follows that if a court has the discretion to admit materials outside the administrative record upon a showing of good cause, then the court must also have the discretion to permit discovery of such materials.” Puri v. Hartford Life & Acc. Ins. Co., 784 F.Supp.2d 103, 105 (D. Conn. 2011) (quotation marks omitted). However, “in order to justify discovery beyond the administrative record, Plaintiff need not make a full good cause showing, but must show a reasonable chance that the requested discovery will satisfy the good cause requirement.” Burgio v. Prudential Life Ins. Co. of Am., 253 F.R.D. 219, 230 (E.D.N.Y. 2008) (quotation marks and citation omitted); see also Schrom v. Guardian Life Ins. Co. of Am., No. 11CV1680(BSJ)(JCF), 2012 WL 28138, at *3 (S.D.N.Y. Jan. 5, 2012)(“[D]iscovery is only permitted where it is reasonably likely that the requested information will satisfy the good cause requirement.” (citations omitted)). Accordingly, in an ERISA case, “a plaintiff is entitled to seek discovery ... if she can demonstrate a good reason why evidence thus obtained might later provide good cause for a court to admit evidence beyond the administrative record.” Puri, 784 F.Supp.2d at 105 (quotation marks omitted). “The good cause standard required to obtain evidence beyond the administrative record through discovery is therefore less stringent than when requesting that the court consider such evidence in its final determination.” Burgio, 253 F.R.D. at 230 (quotation marks and citation omitted); see also Laakso v. Xerox Corp., No. 08CV6376(CJS), 2011 WL 3360033, at *3 (W.D.N.Y. Aug. 3, 2011) (“[I]n an ERISA action, the standard for obtaining discovery of matters beyond the administrative record is less stringent than the standard for admissibility.” (citation omitted)).

         Good cause may exist to permit discovery beyond the administrative record where there is an allegation of a structural conflict of interest; however, courts have generally determined that the party seeking the discovery must show more than the existence of a conflict to satisfy its burden. See Feltington v. Hartford Life Ins. Co., No. 14CV6616(ADS)(AKT), 2016 WL 1056568, at *9 (E.D.N.Y. Mar. 15, 2016) (“[A] structural conflict of interest is not sufficient by itself to permit extra-record discovery and a party seeking to conduct discovery outside the administrative record must allege more than a mere conflict of interest.” (quotation marks and citation omitted) (collecting cases)); cf. Locher v. Unum Life Ins. Co. of America, 389 F.3d 288, 296 (2d Cir. 2004) (holding that “a conflicted administrator does not per se constitute good cause, and caution[ing] district courts that a finding of a conflicted administrator alone should not be translated necessarily into a finding of good cause” but that “it may be possible, in unforeseen circumstances, for good cause to rest entirely on the existence of a conflicted administrator”). Discovery beyond the administrative record has also been “permitted to test the adequacy of the administrative record, ” Gill v. Bausch & Lomb Supplemental Ret. Income Plan I, No. 09CV6043(CJS), 2011 WL 2413411, at *5 (W.D.N.Y. June 10, 2011), and thus to provide “meaningful judicial review[.]” Nagele, 193 F.R.D. at 106. Ultimately, however, “[t]o obtain discovery outside the administrative record, [] a plaintiff must do more than make conclusory allegations, claim discovery is needed to determine whether he or she received a fair review, or allege a structural conflict of interest.” Shelton, 2016 WL 3198312, at *3 (citation omitted); see also Lane v. The Hartford, No. 06CV3931(DC), 2006 WL 3292463, at *2 (S.D.N.Y. Nov. 14, 2006) (denying plaintiff's request for discovery beyond the administrative record because “[p]laintiff does not allege that there was a conflict of interest, nor does plaintiff sufficiently explain why discovery is needed - except for her repeated assertion that it is needed to determine whether she received a ‘full and fair review'”).

         III. Discussion

         Plaintiff's Motion to Compel concerns defendant's failure to provide responses to plaintiff's Requests for Production served on defendant on November 4, 2016. Specifically, plaintiff seeks additional responses to Requests for Production 1, 2, 7, 8, 9, 10, and 11. See Doc. #44-1 at 3. Plaintiff groups her requests into two categories: Those seeking discovery and information regarding defendant's interpretation of the subject insurance plan's preauthorization requirement (Requests for Production 1, 2, 7, 8, and 9); and those requesting discovery on the issue of whether an in-network facility was available to treat plaintiff at the time of her admission to an out-of-network facility (Requests for Production 10 and 11). See generally Doc. #44-1. Defendant argues that plaintiff has not shown that she is entitled to any of the discovery she seeks, and has asserted substantially the same objections, with minor variations, in response to each of plaintiff's requests. See generally Doc. #47. The Court will address the challenged requests as grouped by plaintiff, but will first address defendant's pending motion to strike portions of plaintiff's reply papers. [Doc. #49].

         A. Defendant's Motion to Strike Plaintiff's Reply

         As an initial matter, defendant has moved to strike portions of plaintiff's reply papers, arguing that plaintiff improperly raised new arguments in support of her motion to compel for the first time in reply. See generally Doc. #49. Specifically, defendant moves to strike references in plaintiff's reply to two new arguments as to why the requested discovery is necessary: (1) to explore defendant's conflict of interest; and (2) to determine an appropriate amount of potential damages. See Id. at 2, see also Doc. #48 at 2-4. Plaintiff has submitted a response to defendant's motion. [Doc. #52].

         “Arguments may not be made for the first time in a reply brief.” Knipe v. Skinner,999 F.2d 708, 711 (2d Cir. 1993); see also Corpes v. Walsh Constr. Co., 130 F.Supp.3d 638, 644 (D. Conn. 2015)(“Because raising new arguments for the first time in a reply brief is improper, the Court will not consider these issues[.]” (citations omitted)). Plaintiff's motion does not allege a structural conflict of ...

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