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District Court Issues Instructive Opinion Regarding ERISA and Discovery

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Discovery is the pre-trial process that allows the parties to obtain certain evidence for use in a legal case. Indeed, discovery is critically important as it allows parties to get access to evidence that is wholly controlled by the opposing party. However, in ERISA cases, discovery rights are extremely limited. In general, ERISA cases are limited to the information included within the Administrative Record (also known as the claim file held by the insurance company). Recently, in the case of David Robert Aitken v. Aetna Life Insurance Company, the United States District Court for the Southern District of New York issued an instructive decision that shows us when an ERISA plaintiff can go beyond the Administrative Record.

The Background of the Case

David Robert Aitken was formerly employed as an executive officer at a company that carried ERISA regulated retirement and health plans. Mr. Aitken’s own doctors diagnosed him with a disability related to a coronary artery condition. However, the independent consultant that was hired by the insurance company provided a differing opinion. Based on this information, Mr. Aitken’s disability claim was denied. He appealed to the insurance company, and his claim was denied again. Then, he continued to seek his benefits by filing a lawsuit against the company. Within the lawsuit, Mr. Aitken alleged that Aetna had an unlawful conflict of interest with the medical company that had evaluated him. His argument was that the company hired by Aetna had a financial incentive to produce results favorable to the insurance company in order to keep its contract. Through his attorneys, Mr. Aitken sought discovery to obtain evidence related to this issue. Aetna responded by arguing that this type of discovery, which is outside of the claim file, is out of bounds in an ERISA case.

When is Discovery Outside the Claim File Allowed in an ERISA Claim?

For the most part, ERISA lawsuits are limited to the information contained within the insurance company’s claim file. However, in some limited circumstances, courts will allow plaintiffs to conduct discovery that is outside the bounds of the claim file. Here, the Southern District of New York Court clarified its view that discovery outside of the claim file is allowed, but only in limited circumstances. Additionally, the court noted that this discovery must be very narrowly tailored and that it must actually address a legitimate issue. Finally, the court also noted that the plaintiff has the burden of showing that there is good cause for discovery. In this case, the court allowed Mr. Aitken to seek both document requests and interrogatories to address the issue of whether or not Aetna unfairly disregarded the opinions of his doctors in favor of its own chosen doctors.

Do You Need Legal Assistance?

We can help. At Kantor & Kantor LLP, our team has extensive experience handling ERISA claims in California. If you are having any trouble getting the benefits that you deserve, please reach out to our team today. We will review your claim free of charge. From our offices in Alameda, San Jose and San Francisco, we represent clients throughout the Bay Area and Silicon Valley.

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