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Davis v. Hartford Life & Accident Insurance Co.

United States District Court, W.D. Kentucky, Louisville Division

August 26, 2019

RICHARD E. DAVIS, Plaintiff,
v.
HARTFORD LIFE & ACCIDENT INSURANCE COMPANY, Defendant.

          MEMORANDUM OPINION AND ORDER

          CLARIA HORN BOOM, UNITED STATES DISTRICT COURT JUDGE

         This matter is before the Court upon cross motions for summary judgment. [R. 113; R. 115] This case revolves around Defendant Hartford Life & Accident Insurance Company's (“Hartford Life”) decision to cease providing Plaintiff Richard E. Davis (“Davis”) with disability benefits under a plan governed by the Employee Retirement Income Security Act of 1974 (“ERISA”), 29 U.S.C. §§ 1132(e)(1), 1132(f). Hartford Life had previously provided Davis with Short Term Disability (“STD”) benefits, as well as Long Term Disability (“LTD”) benefits. Hartford provided these LTD benefits because it determined that Davis was disabled due primarily to spinal complications related to his multiple myeloma. However, Hartford later decided that Davis's disability no longer precluded him from “Any Employment” under the terms of the applicable insurance plan and ceased providing LTD benefits. For the reasons below, the Court will hold that Hartford Life's termination of benefits decision was proper, will DENY Davis's Motion for Summary Judgment and will GRANT Hartford Life's Motion for Summary Judgment on all claims.

         I. Statement of Undisputed Facts [1]

         A. The Benefits Plan

         Davis was an employee of U.S. Bank and worked as a Senior Application Developer. [AR 550] Hartford Life issued Group Insurance Policy GLT-675173 (“the Policy”) to the U.S. Bank where Davis worked. [AR 004-052] This Plan insured the LTD component of the employees' welfare benefit plan, which was established and maintained by U.S. Bank (the “Plan”). Id. As part of his employment, Mr. Davis was insured under the LTD Policy - providing a monthly benefit of $4, 461.35 in the event Mr. Davis became, and remained, Disabled through age sixty-six (66). Id. [AR 348]

         U.S. Bank vested Hartford with full discretionary authority to construe and interpret the terms of the Policy and to determine eligibility for benefits thereunder as evidenced by the following language in the Policy: “We[2] have full discretion and authority to determine eligibility for benefits and to construe and interpret all terms and provisions of the Group Insurance Policy.” [AR 0033]. The Plan defined “Disability” and “Disabled” in the following manner:

1. during the Elimination Period, you are prevented from performing one or more of the Essential Duties of Your Occupation;
2. for the 24 months following the Elimination Period, you are prevented from performing one or more of the Essential Duties of Your Occupation, and as a result your Current Monthly Earnings are less than 80% of your Indexed Pre- Disability Earnings;
3. after that, you are prevented from performing one or more of the Essential Duties of Any Occupation.

[AR 034] “Any Occupation” is defined as “an occupation for which you are qualified by education, training or experience, and that has an earnings potential greater than an amount equal to the lesser of the product of your Indexed Pre-disability Earnings and the Benefit Percentage for which you enrolled and the Maximum Monthly Benefit shown in the Schedule of Insurance.” [AR 0034] Davis was responsible for submitting proof of continued disability under the Policy, which states:

         We will terminate benefit payment on the first to occur of:

1. the date You are no longer Disabled as defined;
2. the date You fail to furnish Proof of Loss, when requested by us . . . .

[AR 023]; see also [AR 0030] (“We may request Proof of Loss throughout Your Disability. In such cases, we must receive the proof within 30 days of the request.”).

         B. Timeline of Events

         1. Hartford Life initially awards LTD to Davis

         Hartford Life initially approved a STD request for Davis from October 2011 through April 2012. [AR 217-18] In a letter dated November 16, 2011, the Hartford Life notified Davis that his STD benefits would expire on April 17, 2012. [AR 378-79] The letter further notified Davis that if he expected his disability would extend beyond that, he was required to fill out and submit an LTD Income Benefits Questionnaire (“LTD Questionnaire”). Id. When Davis returned the LTD Questionnaire, he informed Hartford Life that he had previously been out of work due to multiple myeloma which damaged his spine and caused back pain. [AR 1212-1213]

         Davis' oncologist, Dr. Reddy, initially noted that his multiple myeloma was in remission and Davis was capable of sedentary and light-level work off and on between April 8, 2011 and January 2012. [AR 1879-82, 1918-33] However, on February 7, 2012, Dr. Reddy informed Hartford Life that he was limiting Davis to working four (4) hours per day through at least September 2012. [AR 1868, 1873] A Hartford Medical Case Management (“MCM”) nurse concluded that the restriction and limitations were supported, though noted that Davis was improving and should recover before the end of the STD benefits period. [AR 201]

         Then, in April 2012, Dr. Reddy opined that Davis could only sit, stand, or walk a half hour at a time for a total of two (2) hours each of sitting or standing in a day and three (3) hours walking. [AR 1854] Because the physical exams in Dr. Reddy's office visit notes did not explain the decline in capacity as opposed to the expected recovery, Hartford obtained updated orthopedic office visit notes for additional information before referring the claim internally for a second medical review. [AR 0196, 1859-61] These notes indicated that Davis reported subjective levels of pain, but also that Davis declined an epidural injection; electing instead for further physical therapy. [AR 191] Hartford Life's MCM nurse noted that the subjective complaints were supported by abnormalities in the spinal MRI and it was reasonable for Davis to complete a round of physical therapy before returning to work. [AR 189] This nurse recommended updating the file after Davis was re-evaluated in September 2012. Id.

         Based on its MCM nurse's recommendation and conclusions, Hartford Life approved LTD benefits for Davis by a letter dated June 28, 2012. [AR 187088, 0343-45] This letter also explained the definition of “Disability” under the Policy and that, after April 18, 2014, he would have to be disabled from “Any Occupation” as defined in the Policy. Id.

         For the first twenty-four (24) months, the LTD policy defined “Disabled” as being unable to perform one or more of the essential duties of Davis' occupation. As a Senior Application Developer, Davis' job duties consisted of:

• Developing a working understanding of customers business needs in order to engineer ...

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