More on Murphy

More on Murphy

Murphy v. Deloitte & Touche Group Ins. Plan

An important U.S. Circuit court decision regarding the availability of discovery in ERISA benefit cases where a conflict of interest exists.

According to one U.S. Circuit Court of Appeal, the answer is a resounding "no."  In an important decision today from the Seventh Circuit, Judge Frank Easterbrook writes for a unanimous panel in Krolnik v. The Prudential Ins. Co. of America.  The trial court ruled that Paul Krolnik was prohibited from introducing affidavits in litigation to support his disability claim.  Krolnik also attempted to conduct discovery but the trial court likewise cut him off at the pass.  The trial court ruled that ERISA benefit denial cases, even those conducted under a de novo standard of review, simply involve a review of the insurer's actions rather than consideration of all the facts and arguments presented by both sides in litigation.  After the court granted Prudential summary judgment, Krolnik appealed. 

Judge Easterbrook is known for his concise, direct and unequivocal writing style and this opinion is no exception.  The reference in Firestone Tire & Rubber Co. v. Bruch, 489 U.S. 101 (1989), to "de novo review" is misleading: "[t]he law Latin could be replace by an English word, such as 'independent.'  And the word 'review' simply has to go.  For what Firestone requires is not 'review' of any kind; it is an independent decision rather than 'review' that Firestone contemplates."

Comparing the dispute before the court to non-ERISA insurance litigation, the opinion goes on to state, "[a] judge would not dream of forbidding the parties to take discovery, let alone of rejecting affidavits that did not depend on discovery.  Evidence is essential if the court is to fulfill its fact-finding function.  Just so in ERISA litigation."  Where the evidence is conflicting, the court, rather than an insurer or other ERISA plan administrator, is obligated to weigh the evidence and make a final decision about whether the claimant is entitled to benefits. 

Summing up, Judge Easterbrook takes pains to be clear:

"All in all, it would be best for judges and lawyers to stop thinking about 'de novo review'--with the implication that the judge is 'reviewing' someone else's action--and start thinking about independent decision, which is what Firestone requires."

This is the first Circuit court I'm aware of to explicitly state that there are no restrictions or limitations on the scope of review a trial court carries out when it undertakes de novo review of an ERISA benefit denial case.  There is support for the argument not just in Firestone v. Bruch, as the opinion references, but also in the Court's statements last year in MetLife v. Glenn, 128 S.Ct. 2343 (2008).  In that case the Supreme Court held that there are no special evidentiary or procedural rules trial courts are bound to follow in evaluating how an insurer's inherent conflict of interest affects a court's review. 

As de novo review becomes more common in ERISA benefit denial cases (states are increasingly banning discretionary authority clauses from insurance policies), Krolnik has the potential to significantly shift the basic framework lawyers and judges have taken for granted in litigating ERISA benefit denial cases.  The effect of greater discovery and opportunity to develop and present information in litigation will do two things.  It will result in better, more fully informed and accurate decision making by the federal judiciary.  And it will make litigating ERISA benefit denial cases more costly in time and money for the parties. 

UPDATE: I've place Krolnik in the website library. 

Roy Harmon has a comment on a recent district court decision denying benefits to a claimant under an AD&D policy.  The case, Dove v. The Prudential Life Ins. Co., 2009 U.S. Dist. LEXIS 41896 (D. Kan. 2009), refers to Tenth Circuit precedent to determine how to analyze whether an insurer abuses its discretion in denying ERISA benefits. The precedent the court refers to, Weber v. GE Group Life Ass. Co., 541 F.3d 1002, 1011 (10th Cir. 2008) identifies the four factors a court will typically consider as: "(1) the decision was the result of a reasoned and principled process, (2) is consistent with any prior interpretations by the plan administrator, (3) is reasonable in light of any external standards, and (4) is consistent with the purposes of the plan."  Despite its citation to Weber, the Dove decision doesn't identify or meaningfully analyze these four factors. 

I've blogged on a number of previous occasions about the scope of discovery in ERISA benefit denial cases, especially in light of Met Life v. Glenn, 128 S.Ct. 2342 (2008).  Another aspect of the discussion about the availability of discovery, at least in the Tenth Circuit, are these four factors identified in Weber and other Tenth Circuit precedent.   The first three factors seem to clearly contemplate the need for either the willingness of an insurer to provide information relating to these issues in the mandatory pre-litigation appeal process or discovery once in litigation.  Does a claimant need to request information relating to these factors before llitigation begins?  If not, can a claimant request that information for the first time in litigation?  

It seems quite evident that if a claimant does request that information in the pre-litigation appeal process and is stonewalled (which is likely to occur), the claimant can conduct discovery on those issues in litigation.  Otherwise, how could a court competently consider the identified factors?  In light of the fiduciary duty obligations outlined in ERISA that apply to insurers who both administer and pay claims, a good argument can be made that the insurer has an obligation as part of its claims procedure obligations to provide information relating to these factors in its claims file regardless of whether the claimant specifically asks about these factors or not.  At least, a fiduciary in the Tenth Circuit would be well advised to follow that practice. 

Yesterday the U.S. Court of Appeals for the First Circuit issued its long awaited decision in Denmark v. Liberty Life Ass. Co.  The case involves Diane Denmark's assertion that Liberty Life wrongly denied her disability claim.  The procedural history is long and torturous.  The First Circuit ended up delaying a ruling in the case until MetLife v. Glenn, 128 S.Ct. 2343 (2008), was decided to get the Supreme Court's guidance on how an insurer's conflict of interest affects the standard of review a trial court should utilize in ERISA benefit denial cases. 

The First Circuit reversed the trial court's ruling in Liberty Life's favor and remanded the case for additional consideration based on "refinements" Glenn required to First Circuit precedent on the appropriate standard of review for conflicted ERISA plan administrators.  The court makes clear that Glenn requires a trial court to take the particular facts of an insurer's structural conflict of interest into account on a case by case basis.  "[C]ourts are duty-bound to inquire into what steps a plan administrator has taken to insulate the decisionmaking process against the potentially pernicious effects of structural conflicts."  In addition, depending on the facts of the case, the conflict may be so signicant that it justifies a ruling by the court that a claim denial was arbitrary and capricious.  

But the most interesting aspect of the decision is its language about what discovery is available to claimants in ERISA benefit denial cases.  The opinion acknowledges that discovery may be necessary to gather the information the Supreme Court identifies as relevant in Glenn.  But, curiously, the majority opinion makes clear its hostility to the idea that the same scope of discovery ordinarily carried out in other types of civil litigation would be proper to flesh out the conflict of interest issues identified by the Supreme Court.  Any discovery directed to conflict of interest in an ERISA benefits case ". . . must be allowed sparingly and, if allowed at all, must be narrowly tailored so as to leave the substantive record essentially undisturbed."  This, despite the Supreme Court's statement in Glenn that it contemplates no "special procedural or evidentiary rules" different from other litigation as to how evidence of conflict of interest will be presented.  Glenn, 128 S.Ct. at 2351.  

The majority opinion then goes on to foretell what district courts in the First Circuit can expect the pre-litigation appeal record to contain by way of information that will make discovery as to conflict unnecessary in future cases.  Quite honestly, the penultimate paragraph in Section III of Denmark is simply bizarre.  Such soothsaying simply has no place in a judicial opinion.  This paragraph is a badly concealed attempt to instruct insurance companies and other conflicted ERISA fiduciaries how they can curtail discovery into facts they would rather not have come to light and that could demonstrate they are ignoring their fiduciary duty of loyalty to ERISA plan participants and beneficiaries.  

A concurring opinion from Judge Lipez shares some of my heartburn.  That concurrence criticizes the majority opinion for its hasty and unwarranted discussion of complex legal issues that neither party to the litigation briefed or raised on their own.  Courts are ". . . far more likely . . . to fashon defective rules, and to assert misguided propositions, which have not been fully thought through . . ." when they stray into territory based on their predilections.  The majority opinion's language that discovery must be allowed sparingly is an "unwarranted signal that discovery into the existence of an actual conflict is disfavored."  In future cases, First Circuit district courts "should not feel bound by the hostile attitude towards discovery that is improvidently reflected in dicta in the majority opinion."