Searching over 5,500,000 cases.


searching
Buy This Entire Record For $7.95

Download the entire decision to receive the complete text, official citation,
docket number, dissents and concurrences, and footnotes for this case.

Learn more about what you receive with purchase of this case.

Yasinoski v. Connecticut General Life Insurance Co.

September 30, 2009

DENNIS YASINOSKI, PLAINTIFF,
v.
CONNECTICUT GENERAL LIFE INSURANCE COMPANY AND TRANSPORT WORKERS UNION OF AMERICA, AFL-CIO, EMPLOYEES OF AMERICAN AIRLINES, DEFENDANTS.



The opinion of the court was delivered by: A. Kathleen Tomlinson, Magistrate Judge

ORDER

I. PRELIMINARY STATEMENT

Plaintiff Dennis Yasinoski ("Plaintiff" or "Yasinoski") brings this action pursuant to the Employee Retirement Income Security Act of 1974 ("ERISA"), 29 U.S.C. § 1001 et seq., against Defendants Connecticut General Life Insurance Company ("CGLIC")*fn1 and the Transport Workers Union of America, AFL-CIO, Employees of American Airlines (the "Union") (together, "Defendants"), to recover long-term disability and Supplemental Pension Benefits under a group long-term disability plan (the "Plan"). This insurance coverage was secured by the Union through CGLIC under group policy number 0501640. See Compl. [DE 1] ¶¶ 2, 3, 4. Plaintiff alleges that CGLIC wrongfully terminated his benefits under the Plan in violation of ERISA.

Although the underlying documents which have been provided to the Court thus far are somewhat sparse, it appears that Plaintiff claims he became totally disabled from work on July 20, 2004 as the result of an incident involving an altercation with a co-worker. See DE 16 (Def.'s Opp'n to Pltf.'s Mot. to Compel). Plaintiff's claim for long-term disability ("LTD") benefits was initially approved on April 6, 2005 and he received benefits retroactively from January 21, 2005. Compl. ¶¶ 6, 7; DE 16. Plaintiff received LTD benefits until January 21, 2007, after which CGLIC terminated his benefits, citing lack of disability within the meaning of the policy.*fn2 Compl. ¶¶ 6, 8; DE 16. Plaintiff filed an appeal of CGLIC's decision, which was denied. DE 15, Ex. A (Feb. 5, 2007 letter from Medha Bharadwaj, Appeals Claim Manager, to Plaintiff, denying appeal); DE 16.

The instant dispute involves the scope of discovery in this case. In the majority of ERISA cases, discovery is limited to the administrative record of the agency proceedings below. Before the Court is Plaintiff's Motion [DE 15] to take limited discovery outside the administrative record. For the reasons stated in this Order, Plaintiff's Motion to Compel is DENIED.

II. THE PARTIES'CONTENTIONS

A. Plaintiff's Motion To Compel

Plaintiff seeks to obtain two categories of discovery: (1) "[a]ll documents with reference to defendants' internal written policies, procedures and guidelines, relating to its or their claim handling and claims evaluation by defendants of LTD and Supplemental Pension Benefits, including plaintiff's claim[;]" and (2) to depose "Medha Bharadwaj and defendants' claim manager, responsible for denial of plaintiff's claim for LTD Benefits and Supplemental Pension Benefits."*fn3 DE 15. Plaintiff moves to compel discovery outside the administrative record on two grounds: (1) alleged "material discrepancies" between the information contained in the administrative record and the conclusions reached by Defendants in denying Plaintiff's claim; and (2) "CGLIC is the claims administrator and claim payer, by reason of which there are factual issues regarding whether CGLIC is not disinterested and a conflict of interest exists herein." Id.

1. Alleged Material Discrepancies In The Administrative Record

With respect to Plaintiff's claim that there are material discrepancies between the information contained in the administrative record and the conclusions reached by Defendants in denying Plaintiff's claim, Plaintiff argues that CGLIC relied upon the opinion of Dr. Goodman, a prior treating orthopedist, who stated that "plaintiff was medically capable of performing certain specific 'sedentary occupations[,]'" but added that Plaintiff's medical condition "limited plaintiff's ability to sit in any capacity, for 2.5 hours during an eight (8) hour work day[.]"

DE 15. According to Plaintiff, the material discrepancy is that the "sedentary occupations" which CGLIC concluded Plaintiff could perform actually required Plaintiff to sit for an eight-hour work day. Id., Ex B. at CGLIC 0223-0231.

In addition, Plaintiff maintains that at least two documents in the administrative record reflect limitations on his ability to walk. First, the Social Security Administration's disability determination contains a finding of "total incapacity," and second, Plaintiff's application for a handicap permit contains a medical certification by Dr. Goodman stating that Plaintiff "is severely limited in ability to walk." Id., Ex. C at CGLIC 0142. According to Plaintiff, the material discrepancy here is that the "sedentary occupations" which CGLIC concluded Plaintiff could perform required "walking." Id. at CGLIC 0223-0231.

2. Purported Conflict Of Interest

Regarding Plaintiff's claim that a conflict of interest may exist, Plaintiff asserts that "CGLIC is the claims administrator and claim payer, by reason of which there are factual issues regarding whether CGLIC is not disinterested...." Thus, according to Plaintiff, he is entitled to discovery outside the administrative record (1) "to evaluate the exact nature of the information considered by CGLIC in making its decision;" (2) to determine "whether CGLIC was competent to evaluate the information in the [a]dministrative record;" (3) to establish "how CGLIC reached its decision" since no independent medical examinations ("IMEs") were conducted; and (4) to answer "whether, given the nature of the medical information in the record[,] it was incumbent upon CGLIC to seek outside technical assistance in reaching a 'fair and full review' of the claim." DE 15.

Moreover, Plaintiff argues that the requested documents and depositions are warranted because they "will uncover evidence of conflict of interest herein and determine the criteria used by defendants in making their decision and determination of plaintiff's appeal, as well as the completeness of the [a]dministrative record." Id. Thus, according to Plaintiff, he has "shown a reasonable chance that the requested discovery will satisfy a good cause requirement." Id. Finally, Plaintiff argues that a conflict of interest is evident from Defendant's discovery responses, in which Defendants purportedly admitted "that its denial of Plaintiff's LTD benefits was made without any independent medical examinations performed of plaintiff by physicians; nor, have defendants had any vocational rehabilitation consultant evaluation performed of plaintiff." Id.

B. Defendants' Opposition

Defendants argue that the requested discovery is not relevant and will not shed light on the "sole issue" to be decided upon review, namely, whether Plaintiff was entitled to LTD benefits when he sought them. DE 16. Regarding Plaintiff's claim that there exist material discrepancies in the administrative record, Defendant maintains that the documents in the claim file show that Plaintiff is capable of performing the sedentary occupations considered by CGLIC's Vocational Department. Id. In particular, Defendants assert that Dr. Goodman*fn4 stated in his Physical Statement of Disability "that plaintiff may be able to do any occupation, other than his own, pending limitations." Id. Additionally, according to Defendants, CGLIC's Vocational Department conducted a study, as a result of which it determined that "Plaintiff could perform several occupations based on the requirements and descriptions of each, which included an identification clerk, a call-out operator, a dispatcher, maintenance service, an assignment clerk and a routing clerk." Id. Furthermore, according to Defendants, Dr. Goodman "admitted that Plaintiff could perform any of the above listed jobs without restrictions." Id.

With respect to Plaintiff's claims regarding a conflict of interest on the part of CGLIC, Defendants state "that there is no investigation herein whether CGLIC was in a conflict of interest since the standard of review is de novo and not arbitrary and capricious." Id. Moreover, Defendants oppose Plaintiff's request for production of their claims handling policies and procedures on the grounds that such documents are "confidential, proprietary material and/or trade secrets and are not contained in a written ...


Buy This Entire Record For $7.95

Download the entire decision to receive the complete text, official citation,
docket number, dissents and concurrences, and footnotes for this case.

Learn more about what you receive with purchase of this case.