Tomlinson v. United Behavioral Health

Background

Sandra Tomlinson brought the action on behalf of her minor child concerning United Behavioral Health’s denial of coverage for residential treatment under UBH’s 2017 Level of Care Guidelines. The opinion states that related classes in earlier proceedings had a June 1, 2017 cutoff date and that this action concerns individuals whose requests for benefits were denied under the 2017 Guidelines after that cutoff.

The parties submitted a joint discovery letter about two disputes. First, UBH argued that a provision in the health-benefit plan limited the evidence in the case to the administrative record and therefore barred discovery of outside materials. Tomlinson argued that the provision did not apply broadly to her claims concerning UBH’s alleged fiduciary-duty and ERISA violations, and that it did not bar discovery relevant to class certification. Second, Tomlinson asked the court to treat documents UBH produced in the earlier related proceeding as produced in this case, except for materials containing personally identifiable or protected health information specific to people in that proceeding. UBH opposed that request and argued that the issue was not ready for decision.

Rulings

The court explained that Federal Rule of Civil Procedure 26 permits discovery of nonprivileged information that is relevant to a claim or defense and proportional to the needs of the case. Although review of a benefits denial governed by an abuse-of-discretion standard is generally limited to the administrative record, the court noted that outside evidence may be considered for issues such as conflicts of interest and the effects of procedural irregularities.

The court found that UBH’s reliance on the Evidence Provision to avoid all discovery outside the administrative record was improper. It did not decide how broadly to interpret or whether to enforce that provision. Instead, it held that Tomlinson was entitled to discovery of nonprivileged information outside the administrative record when that information was otherwise relevant and proportional to the case. The court directed the parties to meet and confer about the relevance and proportionality of the specific categories of outside-record evidence, including any evidence Tomlinson sought for class certification.

The court declined to decide whether discovery produced in the earlier related proceeding should be treated as produced in this case because the dispute was not ripe. The court observed that the Ninth Circuit favors access to discovery materials from related litigation but also requires a showing of relevance and does not automatically modify a protective order. The parties had not completed their discussions about the specific areas of disagreement. Judge Joseph C. Spero therefore resolved the Evidence Provision issue in Tomlinson’s favor to the stated extent, deferred the second discovery dispute, and ordered further meet-and-confer efforts. The order did not decide the underlying ERISA claims.