Mulligan v. Provident Life and Accident Insurance Company

As explained in the “short version, this was not a final court decision in one of our cases.  Rather, this was an important decision earlier in the case, which allowed us to get information about Provident’s bias and internal goals to deny disability claims.  This ruling is important because courts disagree just what discovery someone can get, and what a party must show to be allowed to get the discovery.  This decision is worth reporting, because attorneys rarely seek this kind of discovery, and courts don’t always allow it.

We asked Provident to answer certain written questions, called “interrogatories” and to produce documents in response to our “requests for production.” Mulligan v. Provident Life and Acc. Ins. Co., 271 F.R.D. 584, 587 (E.D. Tenn. Jan. 7, 2011).  The court started by explaining that, “[a]s a general rule, an ERISA claimant may not seek discovery of matters outside the administrative record.”  Id. at 587 (referencing Wilkins v. Baptist Healthcare Sys., Inc., 150 F.3d 609, 618 (6th Cir. 1998)(noting that a district court may not ordinarily consider new evidence)).  However, we argued, and the court agreed with us, that there are limited exceptions to the general rule.  Id. at 593.  Specifically, the court agreed that evidence outside the ERISA record could be considered to show conflict of interest or bias.  Id. at 588 (citing Moore v. LaFayette Life Ins. Co., 458 F.3d 416 at 430 (6th Cir. 2006)).  The court compelled the insurance company to provide monthly trends reports that had the potential to show whether employees were made aware of the effect of their claims decisions on company profitability.  Id. at 593.  These trends reports were limited to the span of time beginning with the month in which the plaintiff filed his disability benefits claim and ending with the month his claim was denied at the final administrative level.  Id.

While the court did not give us all of the discovery we asked for, the court allowed enough to be able to show more about the internal workings of this insurance company.