Rampton v. Anthem Blue Cross Life and Health Ins. Co.

Background

Cheryl Rampton, the widow of Mr. Audie Roldan, was the beneficiary of a group life insurance policy underwritten and issued by Anthem Blue Cross Life and Health Ins. Co. The policy provided $25,000 in basic life insurance benefits and $300,000 in voluntary life insurance benefits. After Roldan died in late 2022, Anthem paid the basic benefits but denied the voluntary-benefit claim, stating that evidence of insurability was required and that no application had been submitted. Rampton appealed, and Anthem upheld the denial. She then filed this case in July 2023.

In November 2023, Anthem produced documents forming part of the administrative record, but redacted portions based on attorney-client privilege and the work-product doctrine. Attorney-client privilege generally protects certain confidential communications between a lawyer and client. The work-product doctrine generally protects materials prepared for litigation. Rampton asked the court to compel production, arguing that the ERISA fiduciary exception required disclosure of information concerning plan administration.

The Parties’ Arguments

Rampton argued that Anthem was an ERISA fiduciary because it reviewed and denied her claim, reviewed her appeal, and issued the final denial. She also argued that Anthem had discretion to decide whether evidence of insurability was satisfactory and that the fiduciary exception applied to both attorney-client communications and work product.

Anthem argued that the fiduciary exception did not apply to work product and that Anthem was not a fiduciary because it was not named in the employer’s plan and did not possess the plan document. Anthem also argued that its responsibility was limited to applying eligibility rules established by the employer.

Court’s Analysis

The court concluded that an entity can be an ERISA fiduciary even if it is not a named fiduciary in the plan. ERISA also recognizes functional fiduciaries—entities that exercise discretionary authority or responsibility in plan administration. The court found that Anthem had final authority to determine Roldan’s eligibility and had authority to grant, deny, and review denied claims. The court therefore concluded that Anthem must be treated as an ERISA fiduciary in a general sense.

The court rejected Anthem’s argument that the fiduciary exception could apply to attorney-client privilege but not to the work-product doctrine. It explained that the exception has limits. Communications concerning plan administration generally fall within the exception, while communications prepared to defend the fiduciary against personal civil or criminal exposure may remain protected. The court relied on the distinction between the plan-administration materials discussed in Stephan and the materials concerning personal liability discussed in Mett.

The court stated that the disputed documents’ inclusion in the administrative record and the privilege log’s limited descriptions suggested that the redacted communications concerned Anthem’s eligibility determination. Those facts were not conclusive, however. The court also agreed with Rampton’s concerns about the privilege log’s lack of detail and the apparent timing of many documents, which appeared to have been created before the claim was denied or appealed.

Disposition

The court granted in part and denied in part Rampton’s request to compel the information. If the redacted information concerned Anthem’s eligibility determination, the court granted the request to lift the redactions and ordered Anthem to produce the information in unredacted form promptly. If the information concerned potential civil or criminal consequences of Anthem’s actions, the court ordered Anthem to promptly revise and update its privilege log with enough detail to explain why the material fell within the protected category.

If Anthem’s revised privilege log remained insufficient and the dispute continued, the parties were ordered to submit a joint letter brief addressing whether the court should review the redacted material privately, in camera, to determine which category applied.