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Tretola v. First Unum Life Insurance Co.

United States District Court, S.D. New York

June 23, 2014

MELISSA TRETOLA, Plaintiff,
v.
FIRST UNUM LIFE INSURANCE COMPANY, Defendant.

OPINION & ORDER

PAUL A. ENGELMAYER, District Judge.

In this action, brought pursuant to the Employee Retirement Income Security Act of 1974, 29 U.S.C. ยงยง 1001 et seq. ("ERISA"), plaintiff Melissa Tretola ("Tretola") challenges the decision of defendant First Unum Life Insurance Company ("First Unum") to terminate her longterm disability benefits, effective February 14, 2012. Tretola asserts, inter alia, that First Unum's decision to terminate her benefits was not supported by the evidence, was contrary to the policy's terms, and was tainted by a conflict of interest. Accordingly, Tretola seeks reinstatement of her monthly disability payments, and compensation for all payments missed since February 14, 2012.

The parties have informed the Court that they intend to file cross-motions for summary judgment. As it has previously held, the Court will review First Unum's termination decision de novo. Ordinarily, the de novo review of a benefit denial under ERISA is limited to the record that was before the claims administrator; however, extrinsic evidence may be considered if the court finds "good cause." Tretola has now moved to submit extrinsic evidence in support of her motion for summary judgment. For the reasons that follow, that motion is denied.

I. Background

On January 10, 2013, Tretola filed the Complaint in this case. Dkt. 1 ("Compl."). On June 13, 2013, the Court granted Tretola limited discovery on the extent of First Unum's conflict of interest. Dkt. 9. That period of discovery closed on September 13, 2013, at which point the Court directed briefing as to the level of deference the Court should apply in reviewing First Unum's benefits determination, and whether additional merits discovery was justified. Dkt. 25. On November 14, 2013, the Court held that the appropriate standard of review in this case was de novo, and that "a short period of limited merits discovery" was warranted. Dkt. 32. The Court noted that a court's de novo review of a benefit denial is usually limited to the record before the claims administrator, but that "outside evidence may be considered if the court finds good cause.'" Id. (citing DeFelice v. American Int'l Life Assur. Co., 112 F.3d 61, 67 (2d Cir. 1997)). However, as the Court emphasized, the decision to permit discovery into matters outside of the administrative record did not mean that such evidence would be admissible at trial or on summary judgment. In a phone conference on December 4, 2013, the Court authorized the taking of a Rule 30(b)(6) deposition of a First Unum representative, who would testify concerning the four areas of potential merits discovery sought by Tretola: "1) Unum's inconsistent position on Plaintiff's Social Security Administration award; 2) Unum's slanting the evidence in its favor and for its experts; 3) Unum's failure to identify improvement in plaintiff's medical condition; and 4) Unum's reversal on plaintiff's subjective evidence." Dkt. 33, 36.

The Rule 30(b)(6) deposition was conducted on January 16, 2014; the witness designated by First Unum for that deposition was Cynthia B. Locke. Dkt. 45. For a variety of reasons not relevant here, Tretola objected to the conduct of that deposition and requested that a second deposition be taken. Id. On February 27, 2014, the Court directed that Locke's Rule 30(b)(6) deposition be reopened by March 21, 2014. Id. The reopened deposition was taken on March 14, 2014. Dkt. 50. On April 9, 2014, the Court denied plaintiff's untimely request to depose "a Unum vocational representative" and directed the parties to submit a joint letter, identifying whether they could agree on what, if any, evidence the Court should consider beyond the administrative record. Dkt. 51. On April 23, 2014, the parties submitted their joint letter, stating that they could not agree. Dkt. 52. Accordingly, on May 7, 2014, the Court set a schedule for the parties to brief that limited issue. Dkt. 53.

On May 15, 2014, Tretola filed a motion to consider extrinsic evidence, Dkt. 54, and an accompanying memorandum of law, Dkt. 55 ("Pl. Br."). On May 22, 2014, First Unum filed a memorandum of law in opposition to Tretola's motion to consider extrinsic evidence, Dkt. 60 ("Def. Br."), and two accompanying affidavits, from Steven Del Mauro, Dkt. 61 ("Del Mauro Aff."), and Cynthia B. Locke, Dkt. 62 ("Locke Aff.").

II. Legal Standard

The Court has held that it would review First Unum's decision to deny Tretola's benefits de novo. On de novo review, the Court "stands in the shoes of the original decisionmaker, interprets the terms of the benefits plan, determines the proper diagnostic criteria, reviews the medical evidence, and reaches its own conclusion about whether the plaintiff has shown, by a preponderance of the evidence, that she is entitled to benefits under the plan." McDonnell v. First Unum Life Ins. Co., No. 10 Civ. 8140 (RPP), 2013 WL 3975941, at *12 (S.D.N.Y. Aug. 5, 2013) (citations omitted).

De novo review of a plan administrator's decision "is limited to the record in front of the claims administrator unless the district court finds good cause to consider additional evidence." DeFelice, 112 F.3d at 67 (emphasis added). "The decision whether to admit additional evidence is one which is discretionary with the district court.'" Locher v. Unum Life Ins. Co. of America, 389 F.3d 288, 294 (2d Cir. 2004) (quoting DeFelice, 112 F.3d at 66).

"A demonstrated conflict of interest in the administrative reviewing body is an example of good cause' warranting the introduction of additional evidence"; however, "a conflict of interest does not per se constitute good cause' to consider evidence outside of the administrative record." Id. (quoting DeFelice, 112 F.3d at 67). In both DeFelice and Lochner, the decision to admit extrinsic evidence was based on a demonstrated conflict of interest, coupled with "procedural problems with the plan administrator's appeals process." Id. at 295 (citing DeFelice, 112 F.3d at 66); id. at 296 ("In the case at hand, we hold that the District Court's finding of good cause is bolstered in part by the finding that there were insufficient procedures for internal or appellate review."). As the Second Circuit explained in DeFelice, the admission of extrinsic evidence is appropriate when "the fairness of the ERISA appeals process cannot be established using only the record before the administrator." 112 F.3d at 66.

III. Discussion

Tretola seeks to admit two items of extrinsic evidence: (1) a sworn declaration from Linda Nee, an employee of First Unum between 1994 and 2002, dated February 18, 2003; and (2) a document titled "Fibromyalgia Position Statement and Guidelines, " dated July 29, 2002. See Del Mauro Aff., Exs. A-B. First Unum opposes Tretola's motion on two grounds: that (1) Tretola has failed to establish good cause to introduce these documents; and (2) such ...


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