United States District Court, W.D. New York
June 6, 2005.
SHEILA NAPORA, Plaintiff,
VERIZON COMMUNICATIONS INC., f/k/a NYNEX, THE PRUDENTIAL INSURANCE COMPANY OF AMERICA, Defendants.
The opinion of the court was delivered by: HUGH SCOTT, Magistrate Judge
Before the Court are the parties' crossing motions to compel
(Docket Nos. 38 (defendant Verizon Communications' ("Verizon")),
40 (plaintiff's)). In the Order in part granting relief sought
(Docket No. 51), the Court further ordered the parties to brief
the applicable standard for this action and the scope of
discovery available in this action. By unopposed motion for
extending the time to respond, these briefs were due on May 13,
2005 (Docket No. 54). Plaintiff (Docket No. 55) and defendants
Verizon and Prudential Insurance (Docket No. 56) each submitted
timely briefs on these issues.
This action arose under the Employee Retirement Income Security
Act, 29 U.S.C. §§ 1001, 1132(a)(1)(B) ("ERISA"). Plaintiff's
claims arise from the denial of her claim for benefits under
NYNEX's sickness and accident benefit plan, now maintained by
corporate successor Verizon. She alleges an onset date of
September 1995 (Docket No. 55, Pl. Memo. at 2), with her benefits
terminated on or about October 1995 (Docket No. 1, Compl. ¶ IX). According to the denial letter from the plan administrator
(Docket No. 55, Ex. B, at 2), plaintiff initially was denied on
April 24, 1996. She appealed that decision and it was upheld on
May 7, 2001 (id.). She then requested an additional review of
the decision, which was again upheld on June 12, 2002 (id.).
Plaintiff sued under ERISA, 29 U.S.C. § 1132(a)(1)(B), to
recover benefits due to her under the terms of the plan, to
enforce rights under the plan, or to clarify her rights to future
benefits under the plan.
Defendants produced the administrative record of plaintiff's
claim under the Verizon plan. During argument of the motions to
compel, Verizon argued that this Court's review is limited to the
administrative record and the denial of plaintiff's claim is
reviewed here under an arbitrary and capricious standard (Docket
No. 56, Defs. Supp'al Br. at 2), hence plaintiff is only entitled
to the already produced administrative record.
Plaintiff contends that this Court's review is a de novo
standard (Docket No. 55, Pl. Memo. at 1). She argues that Verizon
cannot amend its plan to obtain a less stringent standard of
review (id. at 2).
I. Standard for Judicial Review of Denial of Benefits under
Plaintiff argues that this Court has de novo review of a
denial of benefits under ERISA, citing Firestone Tire & Rubber
Co. v. Bruch, 489 U.S. 101, 115 (1989), holding that the denial
of benefits under a plan "is to be reviewed under a de novo
standard unless the benefit plan gives the administrator or
fiduciary discretionary authority to determine eligibility for
benefits or to construe the terms of the plan." If the plan gives
such discretion to the administrator or fiduciary, then review would be under an abuse of discretion/arbitrary and
capricious standard, unless there is an inherent conflict of
interest. Id. at 115. (Docket No. 55, Pl. Memo. at 1-2.)
Plaintiff contends that the plan did not give the administrator
or fiduciary authority to determine eligibility or to construe
its terms. She points to an inherent conflict of interest since
Verizon denied the claim of benefits (Docket No. 55, Pl. Memo. at
2). Plaintiff argues that the plan in effect was in 1991 (id.
Ex. A, summary plan description), but her claim was reviewed and
denied in June 2002 (id. Ex. B). She also indicates that the
Verizon plan was subsequently amended in 2001 to grant the
administering committee full discretionary authority (id. at 2,
Ex. C,*fn1 Verizon 2001 Plan, at 4).
Verizon, however, contends that the applicable plan when
plaintiff submitted her claim was the 2001 plan and that plan
gave the administrator full discretion (Docket No. 56, Defs.
Supp'al Brief at 3-4, Ex. A, 2001 Verizon summary plan
description, at 23, 24, 1; see id. Ex. B). But, even under
the 1991 plan, determinations by the appeal committee were final
under that plan (Docket No. 56, Defs. Supp'al Br. at 4; Docket
No. 55, Pl. Memo. Ex. A, at 11; see also id. at 18 (1991 plan
description, "in any event, the decision of the appeals committee
is final")). Verizon cites to a 1990 plan document which made the
administrator's decisions regarding benefits final (Docket No.
56, Defs. Supp'al Br. at 4, Ex. C, 1990 NYNEX Plan, § 3.4). That
language from other plans have held to convey sufficient
discretion upon the administrators. (Id. at 4-5, citing
Johnson v. Eaton Corp., 970 F.2d 1569, 1572 (6th Cir. 1992).)
Even if the summary plan description was silent as to discretion,
the plan which grants discretionary authority triggers the arbitrary and capricious standard. (Id. at 5, citing Atwood v.
Newmont Gold Co., 45 F.3d 1317, 1321 (9th Cir. 1995).) Even the
alleged conflict of interest only determines whether there was an
abuse of discretion rather than change the applicable standard of
review. Pagan v. NYNEX Pension Plan, 52 F.3d 438, 442 (2d Cir.
1995). Defendants note that the fact that an internal employee
benefits committee reviewed plaintiff's claim alone does not
constitute a conflict of interest. Id. (Docket No. 56, Defs.
Supp'al Br. at 5-6.)
Thus, the first issue appears to be which version of the plan
was applicable when plaintiff applied and was denied benefits.
Plaintiff points to the onset date in 1995, while Verizon relies
upon the date when plaintiff submitted her application (although
no one has alleged when that was, but plaintiff was initially
denied in 1996, see Docket No. 55, Ex. B, at 2). Neither party,
however, points to authority or a plan provision that supports
their respective positions on which version of the plan was
applicable. Plaintiff here sought review of the denial of her
claim while Verizon was changing the plan. The 2001 plan by its
terms updated and replaced all previous plans (id. Ex. A, at
2), while the 1991 plan description notes that Verizon reserved
the right to amend the program, subject to collective bargaining
(Docket No. 55, Ex. A, at 18; see also Docket No. 56, Ex. C, at
35 (1990 NYNEX Plan Section 8); cf. Docket No. 56, Ex. A at 3
(2001 plan description)). The denial of benefits cited to the
2001 version of the plan (Docket No. 55, Pl. Memo. Ex. B).
But the plan is essentially the same on the issue of the
discretion vested in the plan administrator and, in particular,
the finality of its decisions. Verizon alternatively argues that
even the 1991 plan vested discretion in the administrator.
(Docket No. 56, Defs. Supp'al Brief at 4.) Plaintiff points to
the summary plan description, but the underlying plan itself
provides for administrator finality that indicates discretionary authority.
Thus, under either version of the plan, the administrator had the
discretion that would make judicial review that of an arbitrary
and capricious standard.
II. Scope of Discovery
The parties' arguments on the standard of judicial review
implicates the scope of discovery available to plaintiff.
Plaintiff believes that, since this case is subject to this
Court's de novo review, she is entitled to broad discovery
beyond the administrative record. Defendants, however, contend
that all production has been made with the production of that
administrative record, since this Court's review is limited to an
arbitrary and capricious standard based upon the administrative
record before the plan administrator and the plan's appellate
process. (Docket No. 56, Defs. Supp'al Br. at 6-7.) See Miller
v. United Welfare Fund, 72 F.3d 1066, 1071-72 (2d Cir. 1995).
The administrative record includes documents which the
administrator reviewed or relied upon in deciding a claim. Id.
at 1071. The Court may consider evidence beyond this record only
in exceptional circumstances where the plaintiff demonstrates
"good cause." Locher v. Unum Life Ins. Co., 389 F.3d 288, 294
(2d Cir. 2004); Snyder v. First Unum Life Ins. Co., No.
02CV889, 2004 U.S. Dist. LEXIS 16258, at *10 n. 3 (W.D.N.Y. Aug.
6, 2004) (Skretny, J.). Thus, discovery beyond the administrative
record is only available upon a showing of good cause. (See
Docket No. 56, Defs. Supp'al Br. at 8-9.)
Plaintiff here has not shown good cause to go beyond the
administrative record. She only argues that a conflict of
interest existed because Verizon issued the decision denying her
benefits application. The Second Circuit has held that "a
conflicted administrator does not per se constitute good cause"
and "the finding of a conflicted administrator alone should not
be translated necessarily into a finding of good cause." Locher,
supra, 389 F.3d at 296 (emphasis in original).
Therefore, plaintiff's discovery is limited to the
administrative record before the plan administrator, absent proof
of good cause to go beyond this record.
For the reasons stated above, the Court finds that defendants
state the correct standard of judicial review in this case, that
of an arbitrary and capricious standard. As a result, the scope
of discovery is limited to the administrative record, absent a
showing of good cause to explore beyond that record.