Good morning, ERISA Watchers! There were no notable circuit court decisions this past week, so we have chosen to highlight two published district court decisions from matters involving disability claims. The first is favorable to plan participants and the second is not. Is it any surprise that the former is from within the Ninth Circuit? 

Enjoy the long read of the summaries below. Until next week. Stay safe and be well.

The first case:  Jones v. Life Ins. Co. of N. Am., No. CV-19-04669-PHX-DLR, __ F. Supp. 3d __, 2020 WL 2126498 (D. Ariz. May 5, 2020). The almost Sisyphean topic of discovery in ERISA benefits cases added a new page when, on de novo review, the court required LINA “to respond to discovery that delves into the number of times it retained and the amount of money it paid to third-party vendors in disability and LWOP claims and medical reviewers utilized here, LINA-generated performance evaluations of the vendors and medical reviewers, the number of times they concluded that a claimant could perform work, LINA-generated performance evaluations for LINA employee Mary Faltaous, and any guidelines and manuals used by LINA in evaluating this claim, including the ‘DMS Expert Resource Professional conduct Statement’ and any guidelines and manuals.” 
Continue Reading District Court Permits Vast Conflict Discovery in Life Waiver of Premium Dispute Subject to De Novo Review

Good morning, ERISA Watchers! There were no notable circuit court decisions from this past week, so exercising some editorial discretion, this week’s notable decision is a firm victory in a discovery dispute involving a self-funded long-term disability plan, Chacko v. AT&T Umbrella Benefit Plan No. 3, No. 2:19-CV-01837-JAM-DB, 2020 WL 1984171 (E.D. Cal. Apr. 27, 2020). 

Before going into the decision, I want to take a step back to discuss the Ninth Circuit’s decision in Demer v. IBM Corporation LTD Plan, 835 F.3d 893 (9th Cir. 2016). Demer alleged that there was (1) a structural conflict of interest since MetLife both decided claims for the disability plan and was responsible for paying those claims; and (2) at least two of the doctors that MetLife hired to review the medical records “have performed a significant number of reviews for MetLife and have received significant compensation for their services.” Demer, 835 F.3d at 900. The court then analyzed these two areas of conflict separately: the structural conflict of interest and the financial conflict of independent physician consultants. Id. at 900-903.
Continue Reading Courts Find Discovery of Independent Physician Consultants’ Financial Conflict Permissible in Absence of Structural Conflict

In this week’s notable decision, Advanced Physicians, S.C. v. Connecticut General Life Insurance Company, et al., No. 3:16-CV-2355-G, 2020 WL 58698 (N.D. Tex. Jan. 3, 2020), a district court in Texas held that the fiduciary exception to the attorney-client privilege prohibits Cigna from withholding privileged documents from a medical service provider related to Cigna’s alleged wrongful denial of insurance claims under the NFL Player Insurance Plan (“Plan”).

By way of background, Advanced Physicians (“AP”) alleged that Defendant Great-West Healthcare-Cigna (“Cigna”), which has discretionary authority to make coverage decisions under the Plan, began wrongfully refusing to pay any of AP’s claims for services that it provided to retired NFL players.  Advanced Physicians, S.C. v. Connecticut Gen. Life Ins. Co., 2017 WL 4868180 (N.D. Tex. Oct. 27, 2017).  The court previously dismissed AP’s claim for relief under ERISA Section 502(a)(3) but permitted its claim for benefits under ERISA Section 502(a)(1)(B) to proceed.  Advanced Physicians S.C. v. Connecticut Gen. Life Ins. Co., No., 2018 WL 1509120, at *3 (N.D. Tex. Mar. 27, 2018).
Continue Reading In NFL ERISA Suit, Court Finds Fiduciary Exception to Attorney-Client Privilege Applies to Cigna’s Privileged Documents