ERISA DISCOVERY VICTORY AGAINST AETNA LIFE INSURANCE COMPANY!

In Williams v. Aetna Life Ins. Co., 13-CV-241-KKC, Doc #: 42 (E.D. Ky. April 16, 2014), our firm was victorious in a motion to conduct discovery in a matter governed by the Employee Retirement Income Security Act of 1974 or “ERISA,” where there is no right to a jury trial, punitive damages are prohibited, and discovery is limited. In her order, Chief Judge Karen Caldwell required Aetna to answer certain of Plaintiff’s discovery inquiries. As noted in our last blog, the merits of the case involved Aetna’s refusal to pay for Plaintiff’s intravenous immunoglobulin treatment for her selective immunodeficiency condition. As we previously explained, Judge Caldwell found Aetna’s behavior to be arbitrary and capricious because Aetna changed its rationale for denying coverage from “experimental or investigational” to “failure to conduct a trial discontinuation of treatment” and Aetna did not meaningfully investigate the claim. Williams v. Aetna Life Ins. Co., 13-CV-241-KKC, 2014 WL 5063660 (E.D. Ky. Oct. 8, 2014). However, our initial discovery victory set stage for our eventual win on the merits.

Victories in ERISA discovery motion practice can be difficult. Discovery inquires outside the ERISA Record are permitted only with respect to conflict of interest issues. See, e.g., Metropolitan Life Ins. Co. v. Glenn, 128 S. Ct. 2343, 2346 (June 19, 2008) (citing Firestone Tire & Rubber Co. v. Bruch, 489 U.S. 101, 115 (1989)); Wilkins v. Baptist Healthcare Systems, Inc., 150 F.3d 609, 618 (6th Cir. 1998); Cerrito v. Liberty Life Assurance Company of Boston, 209 F.R.D. 663, 2002 WL 31060483 (M.D. Fla. 2002). Additionally, the discovery must be limited such that it is “reasonably calculated to lead to the discovery of admissible evidence” under Rule 26(b) of the Federal Rules of Civil Procedure, and “facilitate[s] the prompt and inexpensive resolution of disputes” under ERISA. Mulligan v. Provident Life & Acc. Ins. Co., 271 F.R.D. 584, 588 (E.D. Tenn. 2011).

Fortunately, Chief Caldwell found that Plaintiff’s discovery inquiries – specifically the requests to admit – were “relevant and appropriately tailored to address the conflict of interest and procedural deficiency issues.” The Court decided that “If the administrative record reveals that Aetna violated any of the [articulated] policies or procedures, then the [Plaintiff] may be able to prove that the claims review process was influenced by Aetna’s conflict of interest or that the alleged procedural deficiencies occurred.” This, of course, is what eventually happened and our client garnered a complete victory.

Our victories in the Williams case continue our national commitment to injured and disabled individuals. We have litigated cases on a nation-wide basis and have served prominent, national organizations such as the American Association for Justice (AAJ). As such, our firm is fully involved in helping the injured and disabled community.