United States District Court, W.D. Virginia, Charlottesville Division
CAROLYN D. SUTER, Plaintiff,
METROPOLITAN LIFE INSURANCE COMPANY, Defendant.
MEMORANDUM OPINION & ORDER
C. HOPPE UNITED STATES MAGISTRATE JUDGE
matter is before the Court for resolution of motions
regarding the permissibility and scope of discovery. On April
11, 2016, Defendant Metropolitan Life Insurance Company
(“MetLife”) moved to modify the Court’s
Pretrial Order, ECF No. 11, and to hold a scheduling
conference. ECF No. 12. In its motion, MetLife notified the
Court that the parties disagreed as to whether the case could
be resolved by review of only the Administrative Record, ECF
No. 8, or whether additional discovery outside of the
Administrative Record should be permitted. Following a
scheduling conference call held on April 13, the Court took
MetLife’s motion under advisement and ordered the
parties to submit briefing on the permissible scope of
discovery. ECF No. 15. The parties each submitted opening and
response briefs, ECF Nos. 16, 18-20, and Plaintiff Carolyn D.
Suter moved to conduct discovery outside of the
Administrative Record, ECF No. 17.
Facts and Procedural History
case concerns Suter’s claim for coverage under an
insurance policy that is governed by the Employment
Retirement Income Security Act of 1974, as amended, 29 U.S.C.
§ 1001, et seq. (“ERISA”). Through
Suter’s employment with the General Electric Company
(“GE”), her husband was insured under GE’s
Dependent Accidental Death & Dismemberment Insurance
(“the Plan”), with Suter the named beneficiary
under her husband’s policy. Compl. ¶¶ 5-6,
ECF No. 1. Benefits payable under the Plan are funded by a
group policy issued by MetLife to GE, and MetLife administers
claims under the Plan in accordance with ERISA. Answer
¶¶ 1, 6. On January 21, 2015, Suter’s husband
died after sustaining injuries in a fall two days earlier.
Compl. ¶ 7. On March 3, 2015, Suter presented MetLife
with a claim for benefits payable to her under the Plan as a
result of her husband’s death. Id. ¶ 8.
MetLife denied Suter’s claim initially and on appeal
after finding that Mr. Suter’s death was not covered
under the terms of the Plan, citing language in the GE
employee benefits handbook (“the Handbook”).
Id. ¶¶ 8, 10-12. Specifically, MetLife
considered two provisions in the Handbook: Section 1.1.5,
which states that “death benefits are paid if you die
from an injury within 180 days of the accident that caused
the injury, or within 3 years of the accident if your death
is solely and directly a result of the accident, ” and
Section 1.1.6, which states that “[b]enefits under [the
Plan] are not paid for losses contributed or caused by: . . .
[d]isease or medical or surgical treatment of such disease .
. . [p]hysical or mental impairment or medical or surgical
treatment of such impairment.” Administrative Record
(“R.”) 112-13. MetLife observed that Mr.
Suter’s death certificate listed cardiac
decompensation, hip fracture, and humerus fracture as the
cause of death and noted that congestive heart failure and
kidney injury contributed to his death. Id. at 113.
MetLife determined that Mr. Suter’s death was not
covered because it “was contributed to by existing
medical conditions and is not considered the direct and sole
result of an accidental injury.” Id.
commenced this action on January 21, 2016, asserting claims
for recovery of Plan benefits and breach of fiduciary duty,
as well as seeking attorney’s fees, costs, and
expenses. Id. ¶¶ 17-32. MetLife
filed its Answer on February 19, asserting nine affirmative
defenses in addition to denying Suter’s
claims. Answer 4-7. The parties had a Rule 26(f) conference
and on March 24 submitted a joint report of their planning
meeting. In their report, the parties acknowledged their
disagreement over the availability of traditional discovery
and, in the event the Court permits discovery, the potential
pre-trial deadlines. ECF No. 9. The Court entered a Pretrial
Order on March 30, setting forth a schedule and provisions
for discovery. ECF No. 11, at 1, 4. On April 7, Suter sent
interrogatories and requests for production to MetLife. Apps.
to Pl. Br., ECF Nos. 18-1 to 18-3. The parties then filed the
instant motions and submitted briefing on the scope and
propriety of discovery. ECF Nos. 12, 16-20.
Improper Denial of Benefits
claim for review of an ERISA plan administrator’s
coverage determination, a court applies an abuse of
discretion standard of review if “the benefit plan at
issue vests the administrator with discretionary
authority.” Helton v. AT&T Inc., 709 F.3d
343, 351 (4th Cir. 2013). Here, the parties agree that an
abuse of discretion standard is appropriate. Pl. Br. 5, ECF
No. 18. Under this standard of review, a court generally will
not consider evidence outside of the administrative record
prepared by the plan administrator. Helton, 709 F.3d
at 352. This is not an absolute bar, however. In
Helton, the Fourth Circuit determined that evidence
extrinsic to the administrative record may be considered by
the reviewing court if that evidence (1) is necessary to
assess the factors that are relevant to whether a plan
administrator abused its discretion, as set out in Booth
v. Wal-Mart Stores, Inc. Associates Health & Welfare
Plan, 201 F.3d 335 (4th Cir. 2000), and (2) was known to
the plan administrator at the time it rendered its benefits
determination. Helton, 709 F.3d at 352-56.
Booth, the Fourth Circuit stated that a
court’s review of an ERISA coverage determination for
abuse of discretion requires evaluation of the following
(1) the language of the plan; (2) the purposes and goals of
the plan; (3) the adequacy of the materials considered to
make the decision and the degree to which they support it;
(4) whether the fiduciary’s interpretation was
consistent with other provisions in the plan and with earlier
interpretations of the plan; (5) whether the decisionmaking
process was reasoned and principled; (6) whether the decision
was consistent with the procedural and substantive
requirements of ERISA; (7) any external standard relevant to
the exercise of discretion; and (8) the fiduciary’s
motives and any conflict of interest it may have.
201 F.3d at 342-43. As the Helton court observed,
extrinsic evidence may be necessary to evaluate these
factors, particularly the third, fourth, and eighth factors.
709 F.3d at 354. Courts should consider “whether a
review of that evidence is required in order to ‘fill
in gaps in the administrative record’” as to a
particular Booth factor. Lockard v. Unum Life
Ins. Co. of Am., No. 3:15cv21, 2015 WL 4730089, at *3
(N.D. W.Va. Aug. 10, 2015) (quoting Yelton v.
ScanSource, Inc., 983 F.Supp.2d 683, 698
Suter contends that her discovery requests are related to the
third, fourth, and fifth Booth factors.
Specifically, she seeks documents relating to previous claims
that MetLife has received for Dependent Accidental Death and
Dismemberment Insurance coverage or for claims in which
MetLife relied on the relevant provisions of the Handbook, as
well as all documents relating to the training of MetLife
personnel with regard to such claims. Suter argues that these
documents are necessary to assess whether MetLife has applied
the relevant provisions consistently in previous claims,
whether there are discrepancies between the training of
claims evaluators and their decisionmaking in practice, and
whether MetLife’s decision in her case was reasonable.
Pl. Br. 7.
argument is insufficient as to her discovery requests
regarding the training of MetLife employees. She has not
explained how the requested information is necessary for the
Court to evaluate any of the Booth factors or
identified any gap in the record that this information would
fill. Instead, Suter appears to seek “carte
blanche to conduct discovery” on the question of
employee training, which would “convert the emphasis
of this litigation from the reasonableness of an
administrator’s claim decision to an ‘exhaustive
scrutiny of . . . the administrator’s business
practices.’” Lockard, 2015 WL 4730089,
at *4 (quoting Clark v. Unum Life Ins. Co. of Am.,
799 F.Supp.2d 527, 533 (D. Md. 2011)). Discovery should not
be permitted where, as here, the information is speculative
and, in any event, does not appear to be necessary to
resolution of the issues in the case.
has, however, shown that discovery may be necessary to fill
gaps in the record as to previous interpretations of the
relevant Plan provisions. As is evident from her Complaint,
Suter’s primary argument in this matter focuses on a
contested interpretation of language in the Handbook.
See Compl. ¶¶ 8-14 (disputing
MetLife’s use of a “sole and direct”
causation standard in finding that the injuries Suter’s
husband sustained in his accident were not the cause of
death). The Administrative Record prepared by MetLife
provides little explanation of how it interpreted Sections
1.1.5 and 1.1.6 and why it applied the standard it used in
Suter’s benefits determination. See R. 112-13,
235-36. Information regarding MetLife’s application of
this standard in prior cases would ...