Structural Conflict of Interest Warrants Discovery of Statistical Information on Claims
Walker v. Metropolitan Life Ins. Co., 585 F. Supp. 2d 1167 (N.D. Cal. 2008.)
Plaintiff sued MetLife and Kaiser Permanente Benefits Plan for denying his claim for long-term disability benefits. The court denied cross motions for summary judgment on the grounds that the Administrative Record did not contain sufficient information regarding MetLife’ relationship with a company, NMR, retained to conduct independent medical reviews such that the court could assess the impact of MetLife’s undisputed structural conflict of interest. In order to obtain this information, the court ordered MetLife to provide the number of claims that were approved and denied after a review was conducted by an NMR-retained physician.
The court articulated three reasons for allowing the discovery of the statistical data. First, that Administrative Record did not fully address the possible influence of the structural conflict of interest. Second, discovery of this information was consistent with the Ninth Circuit’s suggestion in Abatie that conflicted administrators “bring forth affirmative evidence that any conflict did not influence its decision making process.” Finally, in light of recent decisions in Glenn and Abatie, the demand for this information will only grow and the cost to MetLife’s in terms of production and litigation costs will decrease over time. Even though the court acknowledged the large expense involved in compiling the requested data, MetLife was ordered to produce the documents within 30 days.
Judicial Opinion Available Here
