United States District Court, W.D. Kentucky, Louisville Division
RICHARD E. DAVIS, Plaintiff,
HARTFORD LIFE & ACCIDENT INSURANCE COMPANY, Defendant.
MEMORANDUM OPINION AND ORDER
HORN BOOM, UNITED STATES DISTRICT COURT JUDGE
matter is before the Court on the motion of Plaintiff Richard
E. Davis (“Davis”) to strike the Declarations of
Adam Garcia and Gail Gross [R. 119 (Redacted) Mot. to Strike;
R. 120 (Unredacted) Mot. to Strike] attached to Defendant
Hartford Life & Accident Insurance Company's
(“Hartford Life”) Motion for Summary Judgment [R.
115-2, Ex. A, Garcia Decl.; R. 115-4, Ex. C, Gross Decl.].
Hartford Life responded and Davis replied. [R. 127; R. 135
(Redacted) Pl. Reply; R. 133 (Unredacted) Pl. Reply] Thus,
this matter is ripe for decision. For the reasons set forth
below, the Court will DENY Davis's
Motion to Strike.
dispute arises from Hartford Life's denial of Davis's
disability benefits claim. [R. 1, Compl.] Hartford Life is
the underwriter, insurer, and administrator of the long term
disability (“LTD”) insurance policy at issue in
this lawsuit. Id. ¶ 7. Davis, a former U.S.
Bank employee, alleges that he stopped working in 2011 and
“has remained continuously disabled and unable to
function on a full-time basis in any gainful
employment.” Id. at ¶ 9. Hartford Life
provided Davis with short term disability benefits
(“STD”) from October 2011 through April 2012 and
LTD benefits from April 2012 to April 2014. Id. at
¶10; [R. 5, Ans., at ¶¶ 6, 10] Following these
two time periods, Hartford Life terminated Davis's
disability benefits on April 18, 2014. [R. 5, Ans., at ¶
8] Davis filed this action pursuant to the Employee
Retirement Income Security Act of 1974 (“ERISA”),
29 U.S.C. §§ 1132(e)(1), 1132(f), seeking
enforcement of the contractual terms of the LTD policy, to
obtain past benefits, to receive reinstatement for payment of
future benefits, to obtain declaratory relief, other
equitable relief, and reasonable attorney's fees and
costs. [R. 1, Compl., at ¶¶ 4, 40, 43, 48]
protracted litigation and several orders from this Court
touching on discovery issues and dismissing certain claims
from the Complaint, the Court entered an Order establishing
deadlines for dispositive motions. [R. 112] The parties
complied. See [R. 113 (Redacted) Pl. Mot. Summ. J.;
R. 114 (Unredacted) Pl. Mot. Summ. J.; R. 115, Def. Mot.
Summ. J.; R. 117 (Redacted) Pl. Resp.; R. 118 (Unredacted)
Pl. Resp.; R. 122, Def. (Redacted) Resp.; R. 123 (Unredacted)
Def. Resp.; R. 129 (Redacted) Pl. Reply; R. 130 (Unredacted)
Pl. Reply; R. 132 (Redacted) Def. Reply; R. 133 (Unredacted)
Def. Reply] However, while the parties' dispositive
motions were pending, Davis filed the instant Motion to
Strike, lodging several arguments in support of striking the
Declarations of Adam Garcia (the “Garcia
Declaration”) and Gail Gross (the “Gross
Declaration”), which Hartford Life attached in support
of its Motion for Summary Judgment.
The Garcia Declaration
Declaration, Gross states that he is the Senior Director for
Group Insurance Claims on behalf of Hartford Life. [R. 115-2,
Ex. A, Garcia Decl., at ¶ 1.] His Declaration describes
the relationship between the various Hartford entities. He
states that the Hartford Financial Services Group, Inc.
(“HIG”) is “a holding company that includes
a family of subsidiary and affiliate companies and does not
transact any business. HIG's subsidiary and affiliate
companies underwrite and sell a wide range of insurance
products.” Id. at ¶ 2. Hartford Life is
one such entity that issues and underwrites, among other
things, group LTD insurance policies. Id. at ¶
3. Hartford Fire Insurance Company (“Hartford
Fire”) is another subsidiary of HIG, but according to
Garcia, “does not issue or underwrite group or
disability products.” Id. at ¶ 4. Garcia
explains that “[f]or administrative purposes, Hartford
Fire pays the salaries of all of the employees of all of
HIG's subsidiary and affiliate companies.”
Id. at ¶ 5.
Declaration explains that Hartford Life issued the LTD policy
involved in this lawsuit to U.S. Bank - Policy No. GLT-675173
(“the Policy”). Id. at ¶ 6. Garcia
also clarifies that “[a]s the insurance carrier that
issued the Policy, Hartford Life is responsible for the
adjudication and payment of any claims for benefits arising
thereunder.” Id. at ¶ 7. This means
Hartford Life is responsible for “the processes,
procedures, manuals and/or best practices in place for the
adjudication of LTD claims, including [Davis's] claim for
benefits under the Policy.” Id.
the Garcia Declaration sheds light on the decision process
that gives rise to this lawsuit. Garcia explains that
“Special Investigation Unit Investigative Analyst
Joseph Herman (“Herman”) terminated [Davis's]
claim for benefits under the Policy with the approval of
Claims Department Team Leader Jeremy Hunt
(“Hunt”) and Appeal Specialist Mary Floyd
(“Floyd”) upheld that decision.”
Id. at ¶ 8. Garcia explains that at the
relevant time, Herman, Hunt, and Floyd were “solely
responsible” for adjudicating claims under insurance
policies issued by Hartford Life. Id. at ¶ 9.
Further, Herman, Hunt, and Floyd were “not responsible
for adjudicating any claims under insurance policies issued
by Hartford Fire” nor did they “hold themselves
out as acting on behalf of Hartford Fire in any way.”
Id. According to Garcia, these three individuals
“handled and managed [Davis's] claims for benefits
on behalf of Hartford Life, under the authority of Hartford
Life, and pursuant to Hartford Life's processes,
procedures, manuals, and best practices.” Id.
at ¶ 10. They were supervised by managers at Hartford
Life, not Hartford Fire, and no individuals who were acting
on behalf of Hartford Fire adjudicated or paid claims arising
under the Policy. Id. at ¶¶ 11-12. In sum,
Garcia states that Hartford Life “was solely
responsible for the claim decision that forms the basis of
this lawsuit.” Id. at 13.
The Gross Declaration
Declaration, Gross states that she is the Clinical Practices
Manager for Hartford Life and has held that position since
2011. [R. 115-4, Ex. C, Gross Decl., at ¶ 1] In her
Declaration, Gross addresses Hartford Life's
“process for obtaining external medical reviews from
third-party vendors” as well as various medical
statistical information that supported a finding of whether
Davis was disabled. See Id. at ¶¶ 2-7.
According to Gross, “external reviewers do not
determine whether claims are paid or denied. Rather, the
Hartford [Life] claims analyst reviewing each claim considers
the reviewing physician's opinion in conjunction with the
relevant policy's terms and conditions, as well as many
other considerations in a claims file, in reaching his or her
decision as to ‘disability' under the relevant
policy . . . [I]n making a disability determination, a claims
analyst considers not only the review submitted by a
particular physician, but all factual, medical, and
vocational evidence submitted by a claimant or obtained by
Hartford [Life] for a particular claim.” Id.
at ¶ 5.
moves to strike both Declarations for several specific
(nearly identical) reasons. He first argues that the Court
should not consider either Declaration because it must
confine its review of this ERISA denial decision to the
administrative record. [R. 119, at pp. 1, 3-4, 13] Next,
Davis alleges that the “sham” affidavit doctrine
supports striking both Declarations. Id. at pp. 4-8,
14. Finally, Davis urges the Court to strike both under the
Federal Rules of Civil Procedure. See id. at pp.
8-12 (alleging the Garcia Declaration should be stricken
under Rule 56(c) and 37(e); 14-15 (alleging the Gross
Declaration should be stricken under Rule 56(c)).
developing these specific arguments, Davis first attacks the
validity of the two Declarations in question on the basis
that each contains a “material
misrepresentation.” [R. 119, at pp. 2, 12] As will be
discussed next, once unpacked, this general argument is
really an appeal for the Court to undertake a de
novo review ...