Our Client v. Metropolitan Life Insurance Company

This case was significant because we were successful in a pre-trial discovery ruling by the court into the bias of the doctors MetLife relied on to help MetLife deny our client’s claim.  Usually, discovery in ERISA cases is limited to the administrative record.

However, here, the court recognized a limited exception involving procedural challenges, such as bias, conflict of interest, or denial of due process.  Id. (quoting Wilkins v. Baptist Healthcare System, Inc., 150 F.3d at 619; Bennett v. Unum Life Ins. Co., 321 F.Supp.2d 925, 932 (E.D. Tenn. 2004)).  The court held that such discovery is not available in every case, but should be permitted when the plaintiff first identifies a “specific procedural challenges concerning the decision to deny or terminate ERISA benefits. “Second, the plaintiff must make an initial showing to the Court that she has a reasonable basis to make such procedural challenges.” Id.

The court found we made a threshold showing of a reasonable basis by bias because we found information from other cases, including one from the Southern District of Texas and another from the Court of Appeals for the Seventh Circuit.  This information showed that Dr. Porter, the doctor hired by MetLife to review our client’s file, was the president and CEO of a company called Network Medical Review Company (“NMR”). Id.  The information showed NMR performed 850 file reviews for MetLife in 2003, receiving over $550,000 in compensation.  Id.  The court agreed that these facts met a threshold showing of bias such that our client was entitled to discovery regarding Dr. Porter.  Id. at *5.

 

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