As attorneys representing claimants whose disability, health or life benefits have been denied, we have grown accustomed to waging a battle over the ability to engage in discovery of information outside of the so called administrative record in cases governed by the Employee Retirement Income Security Act (“ERISA”). Generally, the law in the 10th Circuit as well as most other Circuits in this country limit a judge’s review of a denied long-term disability claim to the ERISA record, a.k.a the insurance company’s claim file. We have often argued that an ERISA claimant is entitled to learn more of the insurance company’s claims handling procedures, the adequacy of those procedures and whether they were adhered to, and information concerning the potential bias of the physician reviewers hired by such insurers to review a claimant’s medical condition and ability to work.
In Murphy v. Deloitte & Touche Group Ins. Plan, 619 F.3d 1151 (10th Cir. 2010), the Tenth Circuit Court of Appeals addressed the scope of discovery permitted when there is a conflict of interest. A conflict of interest is established when the plan administrator who decides the claim also funds the ERISA plan (or, in other words, pays the claim, if approved). A conflict also exists when the disability benefit is provided to the employee by virtue of a policy of insurance issued by an insurance company to the employer, and that insurance company is responsible for paying the disability benefit pursuant to such coverage. In clarifying its prior “admittedly unclear case law as prohibiting any discovery,” the Court ruled that discovery under ERISA is generally limited but that an exception exists allowing the discovery of “extra record” information so as to determine the serousness of the inherent confilct and the likelihood that it jeopardized the decisionmaking process.
Even prior to the recent decision in Murphy this office was successful in obtaining favorable discovery orders on behalf of aggrieved claimants. This office analyzes every case headed toward litigation to determine if pursuing even limited discovery will potentially benefit the client’s case. Please contact the Law Office of Shawn E. McDermott at (303) 964-1800 (or complete our contact form by clicking here) if you have experienced a denial of disability, health or life insurance benefits and require assistance with the internal appeal process or are considering the need to pursue litigation.