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Smith v. Hartford Life and Accident Insurance Co.

United States District Court, E.D. Kentucky, Central Division, Lexington

August 15, 2019

JENNIFER LEE SMITH, Plaintiff,
v.
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY, Defendant.

          MEMORANDUM OPINION AND ORDER

          Danny C. Reeves United States District Judge.

         This case arises out of the denial of long-term disability benefits under the Employment Retirement Income Security Act of 1974 (“ERISA”). Plaintiff Jennifer Smith has filed objections to the administrative record. [Record No. 21] Smith's objections will be overruled for the reasons that follow.

         I.

         Smith is a former employee of Countrywide Financial Corporation and was a participant of the company's long-term disability insurance policy. Defendant Hartford Life and Accident Insurance Company (“Hartford”) is the underwriter of the long-term disability policy. Smith worked for Countrywide for eight years before resigning due to worsening medical conditions. Originally, Smith was denied long-term disability benefits in 2001, but the Sixth Circuit concluded that the former plan administrator conducted an arbitrary and capricious review in determining whether Smith was qualified for disability benefits. See Smith v. Cont'l Cas. Co., 450 F.3d 253 (6th Cir. 2006). The current plan administrator started paying long-term disability benefits after the Sixth Circuit's ruling. However, Hartford notified Smith on April 6, 2018');">18');">18');">18, that her long-term disability benefits were being denied because “she did not meet the policy definition of Disability.” [Record No. 18');">18');">18');">18, p. 284-89]

         Smith filed an appeal of the denial of her benefits on September 13, 2018');">18');">18');">18. Hartford then sent a notice to Smith that it needed 45 days to conduct a comprehensive medical review. [Record No. 18');">18');">18');">18, p. 296] Hartford turned over five copies of surveillance video to Smith that were used in making the initial determination to deny her long-term benefits on October 29, 2018');">18');">18');">18. Additionally, on November 1, 2018');">18');">18');">18, Hartford requested an additional 45 days to determine Smith's disability benefits. Smith objected to the extension. [Record No. 18');">18');">18');">18, p. 298] Hartford notified Smith on December 4, 2018');">18');">18');">18, that it had determined that Smith was not entitled to long-term disability benefits based on a new independent medical review by ECN consultant Dr. Matthew Chan on November 2, 2018');">18');">18');">18, and an employability analysis report addendum prepared November 14, 2018');">18');">18');">18. [Record No. 18');">18');">18');">18, p. 299-303]

         The plaintiff appealed the administrative decision to this Court on February 21, 2019. Smith has now filed objections to the administrative record seeking to exclude certain documents. Smith wishes to exclude the independent medical report from Dr. Chan and the employability analysis report addendum from the administrative record because they were generated after the plaintiff's original denial of benefits and after she had filed her appeal. Smith also seeks to exclude the surveillance video because it had not been produced to her after she had timely requested it. Finally, Smith objects to any documents that were not produced to her but are now submitted as part of the administrative record. Defendant Hartford responded to the objections, explaining that all of the documents are part of the administrative record that was considered by the plan administrator and should not be excluded. [Record No. 28]

         II.

         i. Independent Medical Report by Dr. Chan and the Employability Analysis Report Addendum

         Smith objects to the inclusion of the independent medical report and the employability analysis report addendum because they were generated after Hartford's original denial of her long-term disability benefits and after she submitted her appeal. She further objects because the documents were produced after Hartford's deadline to respond or request an extension.

         Plan administrators are required to disclose to claimants materials relied upon by the administrator in evaluating a claim for benefits. 29 U.S.C. § 1132(c). To provide a “full and fair review” the claimants must be given access to information relevant to the claimant's claim. 29 C.F.R. § 2560.503-1(h)(2)(iii). Relevant means all documents, records or other information that:

(i) Was relied upon in making the benefit determination;
(ii) Was 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;
(iii) Demonstrates compliance with the administrative processes and safeguards required pursuant to paragraph (b)(5) of this section in making the benefit determination; or
(iv) In the case of a group health plan or a plan providing disability benefits, constitutes a statement of policy or guidance with respect to the plan concerning the denied treatment option or benefit for the claimant's diagnosis, without regard to whether such advice ...

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