# Radle v. Unum Life Insurance Company of America

> District Court, E.D. Missouri · August 15, 2022

URL: https://www.frixlaw.com/law-library/cases/10237428

## Case

- **Court:** District Court, E.D. Missouri
- **Decided:** August 15, 2022
- **Opinion:** 100trialcourt
- **Cited by:** 0 later opinions in the Frix Law Library

## Citator (automated)

- No negative treatment found by the automated citator. That is not the same as a confirmation that the case is good law; read the citing cases.
- Full citator and citing cases: https://www.frixlaw.com/law-library/cases/10237428

## How later opinions describe it (automated extraction)

- affirming denial of motion for discovery to explore conflict of interest because discovery was unnecessary to establish the existence of a conflict

## Opinion text

UNITED STATES DISTRICT COURT
EASTERN DISTRICT OF MISSOURI
EASTERN DIVISION

MICHAEL RADLE, )
)
Plaintiff, )
)
v. )
Case No. 4:21-CV-01039-NAB
)
UNUM LIFE INSURANCE COMPANY OF )
AMERICA, )
)
Defendant.

MEMORANDUM AND ORDER
This matter is before the Court on Plaintiff Michael Radle’s (“Radle”) Motion for
Discovery. (Doc. 16.) Defendant Unum Life Insurance Company of America (“Unum Life”) filed
a response in opposition (Doc. 23), Radle filed a reply (Doc. 27), and the issues are fully briefed.
The parties consented to the jurisdiction of the undersigned pursuant to 28 U.S.C. § 636(c). For
the reasons set forth below, the Court grants Radle’s motion for discovery.
I. Background
This case arises under the Employee Income Security Act (“ERISA”), 29 U.S.C. § 1001,
et seq. Radle filed suit against Unum Life, seeking alternative relief for breach of fiduciary duty
under 29 U.S.C. § 1132(a)(2) (Count I) and for the wrongful denial of disability benefits under 29
U.S.C. § 1132(a)(1)(b) (Count II).
Radle, a former employee of United Skin Specialist, LLC, was a participant in the
employee welfare benefit plan administered by Unum Life. Radle was to be paid long term
disability benefits under the Plan for the 24-month period of November 14, 2017 through
November 13, 2019. (Doc. 22-1, Exh. C.)1 On May 12, 2020, Unum Life informed Radle that his
benefits would be discontinued as of May 13, 2020, based on a finding that he exhausted the 24
months of benefits payable for his mental illness. (Doc. 22-1, Exh. D.) The letter stated, in part:
We cannot pay you Long Term Disability benefits beyond May 13, 2020.
***
You began receiving Long Term Disability benefits effective November 14, 2017
due to the cognitive symptoms and relating impairment resulting from conversion
disorder. On November 9, 2018, we informed you that this condition was limited
to 24 months of benefits. By November 13, 2019, you exhausted benefits the policy
will allow for due to your mental illness.
***
In conclusion, the reviewing physicians have agreed your records support a finding
that you can perform full-time activity at a level that is consistent with the demands
of your occupational duties when excluding your behavioral health condition of
Conversion Disorder. You have exhausted the 24 months of benefits for this
condition. We have found your other conditions, would not preclude your ability to
return to the demands of your regular occupation. Your claim has been closed.

(Exh. D, UA-CL-LTD-002001.)
Radle appealed Unum’s determination letter by letter dated November 6, 2020. (Exh. E,
UA-CL-LTD-002046.) Radle’s appeal letter states three bases for appeal: First, Radle states a
neurosurgery IME confirms the physical origin of post-concussion syndrome. Second, an
independent neuropsychological evaluation rules out conversion order or other psychiatric causes.
Third, Radle’s treating physicians support a physical cause to his disability.
By letter dated February 5, 2021, Unum Life upheld its determination that Radle’s benefits
were limited to a 24-month period and that he had received the maximum benefits allowed under
the Plan:
Our appeal review has concluded, after excluding disabilities due to mental illness,
there remains no medical evidence to support Mr. Radle remains limited from
performing the material and substantial duties of his regular occupation.

1 The Court notes that although the parties repeatedly cite to the administrative record by bates numbers, the
administrative record is not in the Court’s file and neither party attached exhibits to their briefing. The Court’s citations
are to pleadings and any bates stamp references are taken from the exhibits in support of Unum Life’s pending Motion
for Partial Summary Judgment. (Doc. 22-1.)
Accordingly, he is no longer eligible to receive Long Term Disability benefits and
the decision on his claim remains appropriate.

While a behavioral health underlay is possible based on the available medical
evidence, there are no medical providers indicating Mr. Radle is limited from
working due to a mental illness. The Social Security Administration concluded Mr.
Radle was not disabled and specifically considered his behavioral health
conditions. On appeal, you have specifically denied Mr. Radle has conversion
disorder or any mental limitations. Accordingly, the decision reached on Mr.
Radle's Life Waiver of Premium claim that he is no longer limited from working
when considering mental illness remains appropriate.

(Exh. F, UA-CL-LTD-006291.)
On April 4, 2022, Radle filed a Motion for Discovery indicating that the parties disagree
on the scope of discovery in this matter. (Doc. 16.) Radle asserts that he is entitled to discovery on
both Counts because discovery is necessary in all claims brought under § 1132(a)(3) and because
the procedural irregularities and Unum’s conflict of interest establish good cause for discovery
beyond the administrative record for the § 1132(a)(1)(b) claim. Radle seeks the following
discovery:
1. Written discovery regarding any and all claim handling manuals and procedures
(however so named) that govern the investigation of a claim in order to assess if
Unum followed guidelines for obtaining medical evidence to support its initial
denial of claims as being not medically necessary.
2. Written discovery regarding any and all claim handling manuals and procedures
(however so named) that govern the investigation of a claim in order to assess if
Unum followed guidelines for reviewing and considering medical evidence, and
what weight is to be given to different types of medical evidence.
3. Written discovery into any and all manuals, procedures, and guidelines (however
so named) that govern the retention of third-party reviewers.
4. Deposition of Unum employee Kurt W. Phillips—not to exceed one hour in
time—so as to inquire what medical records and reports were utilized in the
review of Mr. Radle’s claim and what additional evidence undisclosed to Mr. Radle
was used in their benefits determination.
5. Written discovery identifying the Unum appeal vocational expert, Unum appeal
neurologist, and all other reviewers that may have contributed to the additional
evidence alluded to in the 2021 Unum denial letter, along with their curriculum
vitae.
6. Deposition of unidentified Unum appeal vocational expert—not to exceed one
hour in length—so as to inquire what records were utilized in the review of Mr.
Radle’s claims and regarding the application of the Unum manuals and procedures
to those records.
7. Deposition of Unum medical reviewer Dr. Jacqueline Crawford—not to exceed
one hour in length—so as to inquire what records were utilized in the review of Mr.
Radle’s claims and medical records and regarding the application of the Unum
manuals and procedures to those records.
8. Deposition of the Unum appeal neurologist Julie Guay, Psy. D.—not to exceed
one hour in length—so as to inquire what records were utilized in the review of Mr.
Radle’s claims and independent neuropsychological evaluation and regarding the
application of the Unum manuals and procedures to those records.
9. Deposition of any other undisclosed expert—not to exceed one hour in length—
so as to inquire what records were utilized in the review of Mr. Radle’s claims and
regarding the application of the Unum manuals and procedures to those records.
10. All compensation guidelines for medical reviewers, including but not limited
to, the form and computation of any bonuses that may be paid.

(Doc. 17 at 14-15.)
II. Discussion
Under the Employee Retirement Income Security Act of 1974 (“ERISA”), a person who is
denied benefits under an employee benefit plan may challenge that denial in federal court. 29
U.S.C. § 1001 et seq., see § 1132(a)(1)(B). In ERISA cases, review is generally limited to evidence
that was before the administrator, and discovery is not allowed. See Jones v. ReliaStar Life Ins.
Co., 615 F.3d 941, 945 (8th Cir. 2010). This limitation on evidence ensures “expeditious judicial
review of ERISA benefit decisions” and prevents “district courts from becoming substitute plan
administrators.” Donatelli v. Home Ins. Co., 992 F.2d 763, 765 (8th Cir. 1993).
There are some narrow exceptions to this general rule. Radle seeks to apply these
exceptions and obtain discovery on both of his claims. Unum Life objects to conducting any
discovery.
A. Count I: Breach of Fiduciary Duty
In Count I, Radle asserts a breach of fiduciary duty claim pursuant to 29 U.S.C. §
1132(a)(3). He alleges that in terminating benefits, Unum Life, acting as a fiduciary in the
administration of Radle’s claim, failed to adequately consider the facts and circumstances
regarding his claim, failed to adequately investigate the facts supporting his claim, and relied on
biased reviews of Radle’s medical conditions in terminating benefits. Radle seeks the following
relief: “Radle respectfully prays for judgment against [Unum] granting equitable relief including

payment of the amount of unpaid past and future benefits, interest on past due sums, attorney fees
and costs and for any other such relief as the Court deems just and proper.” (Doc. 1 at 13.) He also
asks the Court to “Declare Plaintiff’s rights under the terms of the Plan, and clarify his rights to
future benefits under the terms of the Plan;” “Enjoin Defendants [sic] to provide a procedure for a
full and fair review of adverse determinations under the Plan in accordance with 29 U.S.C. §
1133;” and “Enjoin Defendants [sic] to discharge their fiduciary duties in accordance with 29
U.S.C. § 1104.” (Doc. 1 at 15.) As is more fully discussed below, Radle seeks discovery on this
claim to explore the nature and extent of the conflict of interest and/or procedural irregularity that
forms the basis of Unum Life’s fiduciary duties.
Although a review of the denial of benefits is generally limited to evidence that was before

the administrator, district courts have held “this limitation on discovery does not apply to claims
involving ERISA plans when the claims are for equitable relief under § 1132(a)(3) or for equitable
estoppel.” Kostecki v. Prudential Ins. Co. of Am., No. 4:14-CV-695 JCH, 2014 WL 5094004, at
*1 (E.D. Mo. Oct. 10, 2014) (collecting cases). “This is so because these types of actions ‘do not
benefit from the administrative process.’” Id. (quoting Jensen v. Solvay Chems., Inc., 520
F.Supp.2d 1349, 1355 (D. Wyo. Oct. 18, 2007) (“Case law does not constrain discovery under
ERISA § [1132](a)(3) actions.”).
Because the principles of limiting discovery in wrongful denial cases do not apply to claims
of fiduciary duty claims, the Court finds that discovery on Count I is appropriate. Radle alleges
that Unum Life has breached its fiduciary duty and violated ERISA and Radle seeks equitable
relief to enforce ERISA provisions or the terms of the plan. At this stage and upon consideration
of the precedent of this Court, it seems that this claim would benefit from consideration of facts
likely outside the administrative record.2 See, e.g., Friemon v. Nat'l Carriers' Conf. Comm., No.

4:18CV702 JCH, 2018 WL 6171439, at *2 (E.D. Mo. Nov. 26, 2018); Dapron v. Spire Missouri,
Inc., No. 4:17 CV 2671 JMB, 2018 WL 3609446, at *6 (E.D. Mo. July 27, 2018); Kostecki v.
Prudential Ins. Co. of Am., No. 4:14-CV-695 JCH, 2014 WL 5094004, at *2 (E.D. Mo. Oct. 10,
2014). Therefore, the Court will grant Radle’s motion for discovery to the extent it seeks discovery
related to Radle’s breach of fiduciary duty claim. Radle is not granted leave to seek discovery of
information that is already apparent from the administrative record. Without having reviewed the
administrative record, the Court is not in a position to determine whether the ten categories of
requests sought, including five depositions on overlapping topics, are sufficiently limited in scope.
The parties should diligently meet and confer and attempt to agree on the appropriate scope of
discovery.

B. Count II: Wrongful Denial of Benefits
In Count II, Radle claims he was wrongfully denied disability benefits under 29 U.S.C. §
1132(a)(1)(b). Radle argues discovery is necessary to determine the effect of Unum’s palpable
conflict of interest and/or procedural irregularities in the record.
In a wrongful denial of benefits case, a district court may permit the admission of additional
evidence if the plaintiff shows “good cause” for the court to do so. Brown v. Seitz Foods, Inc.,

2 Unum Life does not dispute that a breach of fiduciary duty claim is not subject to the typical discovery limitations
imposed on a denial of benefits claim. Instead, Unum Life briefly argues that Radle’s breach of fiduciary duty claim
fails as a matter of law and points to its pending motion for summary judgment. Although Unum Life may be correct
in its assertion that Radle cannot prevail on his breach of fiduciary duty claim, the Court is not addressing the merits
of the summary judgment motion at this time.
Disability Ben. Plan, 140 F.3d 1198, 1200 (8th Cir. 1998). Discovery may be permitted to establish
either a palpable conflict of interest or serious procedural irregularity. See Farley v. Arkansas Blue
Cross & Blue Shield, 147 F.3d 774, 776 n.4 (8th Cir. 1998). Conflicts of interest exists whenever
the same entity both determines benefits eligibility under an ERISA plan and pays the benefits out

of its own pocket. Metro Life Ins. Co. v. Glenn, 554 U.S. 105, 114 (2008). A procedural irregularity
is said to exist where the plan administrator, in the exercise of its power, acted dishonestly, from
improper motive, or failed to use sound judgment in reaching its decision. Menz v. Procter &
Gamble Health Care Plan, 520 F.3d 865, 869 (8th Cir. 2008).
1. Conflict of Interest
Unum Life is both the decider of benefits eligibility and the payer of benefits under the
Plan. This is the definition of a conflict of interest. Radle argues that “[d]iscovery into what [e]ffect
that conflict [had] on the determination reached by Unum is necessary,” and from the face of the
claim file Unum Life ignored substantial objective medical evidence that the initial diagnosis of
conversion disorder was no longer appropriate or supported by the evidence. (Doc. 17 at 7.)

District courts utilize discretion regarding whether to allow discovery, and in the face of
an undisputed structural conflict of interest, courts vary on whether discovery should be allowed.
Compare Jones v. ReliaStar Life Ins. Co., 615 F.3d 941, 945 (8th Cir. 2010) (affirming denial of
motion for discovery to explore conflict of interest because discovery was unnecessary to establish
the existence of a conflict); and Dapron v. Spire Missouri, Inc., No. 4:17 CV 2671 JMB, 2018 WL
3609446, at *5 (E.D. Mo. July 27, 2018) (“The existence of a possible or actual conflict of interest
does not automatically justify additional discovery.”); with Stallings v. Procter & Gamble
Disability, Comm., No. 1:20-CV-270-MTS, 2021 WL 4902328, at *2 (E.D. Mo. Oct. 21, 2021)
(“Plaintiff should be allowed to conduct limited discovery to determine whether such policies,
procedures, and practices [to ensure any conflict does not impact the benefit determination
process] do actually exist and, if so, to what extent, if any, they interfered with the fair review of
Plaintiff’s claim for benefits.”); Sampson v. Prudential Ins. Co. of Am., No. 4:08CV1290 CDP,
2009 WL 882407, at *2 (E.D. Mo. Mar. 26, 2009) (“[A] conflict or procedural irregularity cannot

be considered in a vacuum. Discovery is required to explore the nature and extent of the purported
conflict or irregularity at issue.”); and Sanders v. Unum Life Ins. Co. of Am., No. 4:08 CV 00421
JLH, 2008 WL 4493043, at *4 (E.D. Ark. Oct. 2, 2008) (“Sanders is entitled to know whether the
review conducted by Unum in his case complied with Unum’s internal guidelines and policies, if
such guidelines and policies exist.”). Here, Radle has shown a conflict of interest because the
parties agree that Unum Life acts as both a plan administrator and the payer of benefits. The
undersigned concludes that limited discovery may be conducted to allow for Radle to determine
how Unum Life’s conflict affected the evaluation of Radle’s claim, if at all.
2. Procedural Irregularities
Radle contends that two procedural irregularities support the need for discovery. First,

Radle asserts that Unum Life relied on evidence it did not submit to Radle for review. Second,
Radle asserts that Unum Life failed to consider up-to-date objective medical evidence in favor of
the outdated reports of Unum Life’s reviewers.
Even assuming that these constitute procedural irregularities, the mere existence of a
procedural irregularity does not establish good cause for discovery. Because “[a] palpable conflict
of interest or serious procedural irregularity will ordinarily be apparent on the face of the
administrative record or will be stipulated to by the parties,” Farley, 147 F.3d at 776 n.4, “[a]
plaintiff must show good cause for such discovery by establishing that the administrative record is
insufficient to establish a ... serious procedural irregularity,” Moore v. Sedgwick Claims Mgmt.
Servs., Inc., No. 4:19 CV 2513 CDP, 2020 WL 2494590, at *2 (emphasis added and internal
quotation marks omitted). This limited-discovery regime “ensure[s] expeditious judicial review ...
and [ ] keep[s] district courts from becoming substitute plan administrators.” Brown v. Seitz Foods,
Inc. Disability Benefit Plan, 140 F.3d 1198, 1200 (8th Cir. 1998).

First, Radle asserts that Unum Life failed to follow ERISA regulations that require an
administrator to give a claimant a clear explanation of why the claim was denied and the
opportunity to review and respond to new information that the administrator relied upon to make
the denial. (Doc. 17 at 8 citing 29 C.F.R. § 2560.503-1.) Unum Life responds that there is no
procedural irregularity because Unum Life did not violate an applicable ERISA regulation. Unum
Life contends that the regulation Radle points to is an amended regulation that was not in effect at
the time Radle filed his claim, and Unum Life has filed a motion for partial summary judgment
with respect to the issue. Radle replies that regardless of when the amendment went into effect,
Unum Life presumably adopted claims policies and procedures that are consistent with the
amendment’s requirements. If Unum Life changed its internal guidelines prior to deciding Radle’s

appeal and declined to implement the guidelines for Radle’s appeal, then a procedural irregularity
may exist regardless of whether the amended ERISA regulation applied at the time Radle filed his
claim.
The undersigned finds that Radle has shown good cause for limited discovery to determine
whether Unum Life’s decision not to provide the additional information generated on appeal prior
to reaching a final appeal decision was in compliance with its policies and procedures. (See Doc.
22-1, Exh. H.) Radle should be allowed to determine whether such policies, procedures, or
guidelines exist and, if so, to what extent they affected a fair review of Radle’s claim for benefits,
if at all.
As to second alleged irregularity, Radle argues that Unum disregarded evidence related to
three Independent Medical Exams and/or Opinions: the August 9, 2020 IME performed by
neurosurgeon Dr. Yazdi, the June 2020 Independent Neuropsychological Evaluation performed by
Dr. Leonberger, and the October 16, 2020 Independent Vocational Assessment performed by

Delores Gonzalez. However, Radle admits that Unum Life considered and at least “cherry-picked”
from the evaluations (see, e.g., Doc. 17 at 10, 12, Doc. 27 at 6), and his real grievance is that Unum
Life favored different evaluations over these three evaluations. These arguments seemingly can be
addressed by consulting the administrative record, as they go to a merits review of the denial
decision. See, e.g., J.W. by & through Williams v. Cigna Health & Life Ins. Co., No. 4:21-CV-
00324-SRC, 2022 WL 1185196, at *3 (E.D. Mo. Apr. 21, 2022) (“[B]ecause the administrative
record contains the information on which Cigna relied in making its coverage determinations,
when the Court turns to the merits, it need only consult the administrative record to determine
whether Cigna failed properly to investigate [plaintiff’s] claims and whether Cigna abused its
discretion in denying coverage.”); Tucker v. Express Scripts Health & Welfare Benefits Plan, No.

4:20-CV-00987-NCC, 2021 WL 1857109, at *6 (E.D. Mo. May 10, 2021) (“The different medical
opinions regarding the extent and nature of [plaintiff’s] disability lies at the heart of a merits-based
ERISA determination and does not establish a conflict of interest or procedural irregularity.”)
The Court will grant Radle’s motion to the extent it seeks discovery consistent with the
above discussion. The grant of leave to conduct discovery does not mean that Radle is entitled to
wholesale access to the ten categories of information and depositions he identifies in his motion.
Instead, the parties will meet and confer regarding the appropriate scope of discovery and make
every effort to agree on reasonable requests. Additionally, to the extent the administrative record
does not contain “all documents, records, and other information relevant to the claimant’s claim
for benefits” including documents, records, or other information “submitted, considered, or
generated in the course of making the benefit determination, without regard to whether such
document, record, or other information was relied upon in making the benefit determination,”
Unum Life shall supplement the administrative record pursuant to 29 C.F.R. § 2560.503-1(h)(2)
and 29 C.F.R. § 2560.503-1(m)(8). See Woodrome v. Ascension Health, No. 4:19-CV-02638 JCH,
2020 WL 1479149, at *2 (E.D. Mo. Mar. 26, 2020) (“[A] plaintiff is entitled to the administrative
record and should not have to engage in discovery to obtain a complete record as defined by the
Regulations.”)
Accordingly,
IT IS HEREBY ORDERED that Plaintiff's Motion for Discovery is GRANTED. (Doc.
16.)

□□ [Sa__
NANNETTE A. BAKER
UNITED STATES MAGISTRATE JUDGE
Dated this 15th day of August, 2022.

1]

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Source: Frix Law Library, https://www.frixlaw.com/law-library/cases/10237428. Public record. Not legal advice.