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Butler v. United Healthcare of Tennessee

November 12, 2008

JOHN BUTLER, INDIVIDUALLY AND AS NEXT FRIEND OF JANIE BUTLER, PLAINTIFF,
v.
UNITED HEALTHCARE OF TENNESSEE, INC., DEFENDANT.



The opinion of the court was delivered by: Thomas W. Phillips United States District Judge

MEMORANDUM AND ORDER

Before the court are defendant's Motion to Strike Plaintiff's Filing of Purported Administrative Record ("Motion to Strike Record") [Doc. 9], defendant's Motion to Strike Plaintiff's Interrogatories, Requests for Production, and Request for Admissions, and for Protective Order ("Motion to Strike Discovery") [Doc. 14], plaintiff's Motion to Amend Complaint [Doc. 17], and plaintiff's Motion for Order Granting Oral Argument on the Pending Motions and to Resolve Conflicting Orders ("Motion for Oral Argument") [Doc. 24]. Because the motions and accompanying memoranda before the court are sufficient for the court to resolve the pending motions, plaintiff's Motion for Oral Argument is DENIED at this time, insofar as it requests oral argument on the remaining pending motions. For the reasons that follow, the remaining motions are GRANTED.

I. BACKGROUND

Plaintiff brings suit under the Employee Retirement Income Security Act ("ERISA"), 29 U.S.C. §§ 1001-1461 (2006), alleging wrongful denial of medical benefits. Plaintiff brings suit in his individual capacity and as the assignee of Janie Butler, his now ex-wife. At all times relevant to this action Ms. Butler was plaintiff's wife.

Plaintiff alleges that Ms. Butler suffers from severe depression, suicidal thoughts, and alcohol and substance abuse. Having relapsed after numerous attempts at treatment for these issues as an outpatient, Ms. Butler entered an inpatient treatment program at the Sierra Tucson Hospital ("Sierra Tucson") in Tucson, Arizona, from approximately February 15, 2005 to March 15, 2005. Plaintiff alleges that defendant only paid benefits for the first two days of Ms. Butler's stay at this facility and refused to pay any remaining costs, stating that Ms. Butler did not have the requisite history of failed treatment at lesser levels of care. In order to pay for the treatment, plaintiff alleges he secured a second mortgage against the equity in his house.

Subsequent to her release, Ms. Butler relapsed yet again. Ms. Butler received further treatment for her depression and substance abuse issues, including emergency care and psychiatric care, at various facilities in Knoxville, Tennessee and Atlanta, Georgia. Plaintiff alleges that defendant approved benefits for all treatment subsequent to her inpatient care at Sierra Tucson, yet declined to overturn its determination that the Sierra Tucson hospitalization was not medically necessary and therefore not subject to benefits.

Having exhausted all of his administrative appeals and remedies regarding payment of benefits for Ms. Butler's inpatient treatment at Sierra Tucson, plaintiff filed suit in this court on December 14, 2007 under ERISA and Tennessee statutory law.

II. ANALYSIS

A. Motion to Strike Record

Plaintiff has filed under seal his purported version of the administrative record [Doc. 11]. Defendant has moved to strike this filing [Doc. 9], arguing that the document should be stricken as not properly authenticated under Fed. R. Evid. 901. Plaintiff likewise moves the court to resolve its conflicting orders allowing both records to be filed under seal. With respect to plaintiff's motion, the court notes that any conflict created by the filing of two purported administrative records will now be resolved in the contest of defendant's Motion to Strike Record.

Regarding the substance of defendant's Motion to Strike Record, as defendant notes, because "in an ERISA claim contesting a denial of benefits, the district court is strictly limited to a consideration of the information actually considered by the administrator," Killian v. Healthsource Provident Admins., Inc., 152 F.3d 514, 522 (6th Cir. 1998), it logically follows that the determination of what the administrator actually considered is solely within the administrator's purview. Furthermore, Rule 901 of the Federal Rules of Evidence provides that "[t]he requirement of authentication or identification as a condition precedent to admissibility is satisfied by evidence sufficient to support a finding that the matter in question is what its proponent claims." Fed. R. Evid. 901(a). As plaintiff cannot know what was actually considered by the administrator, he can neither speak to what comprises the administrative record nor authenticate his submission.

Accordingly, defendant's Motion to Strike Record [Doc. 9] is granted. The court notes, however, that at a future date, plaintiff's filing may be permissible as an exhibit to his claim for denial of due process. The permissible scope of review by the court and discovery by the parties will be further discussed and explained below in the context of plaintiff's Motion to Amend Complaint and defendant's Motion to Strike Discovery.

B. Motion to Amend Complaint and Motion to Strike Discovery

Defendant moves to strike plaintiff's First Set of Interrogatories and Requests for Production of Documents Propounded to Defendant [Exh. A to Doc. 14]. Defendant contends that discovery is generally limited to the administrative record, save for a narrow exception where a plaintiff has pleaded a procedural defect such as denial of due process or conflict of interest. As plaintiff has failed to plead a procedural challenge, defendant argues, the requests for discovery should be stricken. Plaintiff responded in opposition and, in an apparent attempt to cure this defect, has moved to amend its complaint to allege that defendant "committed procedural violations contrary to [f]ederal law, denied the [p]laintif due process, and acted under an actual ...


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