Artz v. Hartford Life & Accident Ins Co

CourtDistrict Court, E.D. Wisconsin
DecidedJune 1, 2023
Docket2:21-cv-00391
StatusUnknown

This text of Artz v. Hartford Life & Accident Ins Co (Artz v. Hartford Life & Accident Ins Co) is published on Counsel Stack Legal Research, covering District Court, E.D. Wisconsin primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Artz v. Hartford Life & Accident Ins Co, (E.D. Wis. 2023).

Opinion

UNITED STATES DISTRICT COURT EASTERN DISTRICT OF WISCONSIN

DONALD H ARTZ,

Plaintiff, Case No. 21-cv-0391-bhl v.

HARTFORD LIFE & ACCIDENT INS CO

Defendant. ______________________________________________________________________________

ORDER AFFIRMING PLAN ADMINISTRATOR’S DECISION ______________________________________________________________________________

Plaintiff Donald Artz is challenging a plan administrator’s denial of his claim for long-term disability benefits under an ERISA benefit plan provided through his employer, WEC Energy Group (WEC). Artz worked for WEC for more than 20 years, serving as a Senior Electric Distribution Controller. For most of his tenure, Artz suffered from multiple sclerosis (MS). When his MS symptoms worsened in 2019, Artz stopped working and applied for long-term disability benefits. The plan administrator, Defendant Hartford Life and Accident Company (Hartford), conducted an extensive review of Artz’s medical situation, including materials from professionals retained by Artz and others retained by the plan administrator, and then denied Artz’s claim both initially and on appeal. Hartford concluded that while Artz’s MS precluded him from working the job he had at WEC, it did not prevent him from working in the same position at other companies, and thus he did not qualify for long term disability benefits under the plan’s requirements. Artz now asks this Court to reverse. Because Artz has not shown that Hartford’s decision was “arbitrary and capricious,” Artz’s challenge will be denied and judgment entered for Hartford. BACKGROUND A. Donald Artz Was a Long-Time Employee of WEC Who Suffered from MS. Donald Artz began working as a Senior Electric Distribution Controller at WEC in 1998. (ECF No. 31 at 1, 3.) Like other Distribution Controllers, WEC required Artz to work rotating twelve-hour shifts, one week on the day shift, followed by a week of night shifts. (ECF No. 29-1 at 25, 27.) Artz was diagnosed with MS in 2003 but nevertheless continued in his position at WEC for more 16 years without incident. (ECF No. 31 at 1, 16.) Artz was able to do so, at least in part, because the role of Distribution Controller was a primarily sedentary position. (ECF No. 29-1 at 63.) In the fall of 2019, Artz began experiencing worsening fatigue while working, a problem he associated with his MS. (ECF No. 29-2 at 203.) Indeed, fatigue is a well-known symptom of MS, particularly in patients, like Artz, who have a considerable history with the disease. (ECF No. 29-3 at 13.) Artz asked to change his twelve-hour work shift to an eight-hour shift, (ECF No. 29-2 at 203), but WEC denied his request. (ECF No. 29-1 at 78.) Artz consulted medical professions to address his fatigue. On October 17, 2019, he saw his treating physician, Dr. Bhupendra Khatri, MD and complained that he found it “difficult to stay focused during a 12-hr shift.”1 (ECF No. 29-3 at 5.) After an examination, Dr. Khatri believed Artz’s MS was relapsing. (Id. at 8.) A November 1, 2019 MRI showed “a significant lesion load due to multiple sclerosis in the brain and cervical spine.” (Id. at 13.) Artz ultimately stopped working at WEC on November 27, 2019. (ECF No. 29-2 at 23.) After leaving work, Artz took advantage of both Family and Medical Leave Act and “paid time off” before applying for and receiving STD benefits. (ECF No. 31 at 10.) B. WEC Provided a Long-Term Disability Plan Administrated by Hartford. As a full-time WEC employee, Artz was eligible to participate in both short-term disability (STD) and long-term disability (LTD) benefit plans. (ECF No. 29-2 at 191; ECF No. 29-3 at 233.) WEC’s LTD plan was administered by the Hartford Life and Accident Company. (ECF No. 31 at 2.) Under Hartford’s LTD plan, employees who become disabled within the meaning of the plan, and remain disabled for a specific period of time, can obtain monthly disability benefits. (ECF No. 29-2 at 174; ECF No. 29-3 at 261.) The process for obtaining LTD benefits includes the submission of medical records and a notice of claim to Hartford, documenting the timeline, cause, and prognosis of the claimed disability. (ECF No. 29-2 at 182–83.)

1 Artz also saw four other physicians around this time period as a part of routine care: Drs. Fernandez, Jahnke, Shah, and Moretti. Dr. Edmund Fernandez, MD is Artz’s family doctor. (ECF No. 29-3 at 86.) Dr. Fernandez saw Artz a few times in 2019 including in July, October, and November. (Id. at 90, 149, 170.) Hartford points out that Dr. Fernandez said Artz had not had any decrease in “concentration” or “motivation,” but this was in reference to Artz’s depression, not cognitive abilities. (Id. at 170.) Dr. Fernandez also saw Artz in February 2020. (ECF No. 29-3 at 197.) That visit likewise did not report any abnormal neurological exams. (Id. at 199.) Artz sought treatment from Dr. Renee Jahnke for urinary urgency, apparently unrelated to his MS. (Id. at 100–01.) Finally, Artz saw ophthalmologist Dr. Scott Moretti in August 2019 and February 2020. (Id. at 113, 190.) Based on a visual functional evaluation, Dr. Moretti found Artz capable of all tasks. (Id. at 76–77.) The Hartford plan sets forth specific requirements for obtaining LTD benefits. To be considered disabled under the plan, a plan participant must show that he or she is not able to perform the Essential Duties of his or her occupation for a significant period of time. (ECF No. 29-3 at 274.) The Essential Duties of an occupation are ones that are substantial to the position because they are “fundamental or inherent to the occupation” and “cannot be reasonably omitted or changed.” (Id.) An individual’s ability to work the number of hours in his “regularly scheduled workweek” is an essential duty. (Id.) The plan is clear, however, that a participant’s occupation is not the same as his actual position with his actual employer. Rather, the term refers to the participant’s occupation “as it is recognized in the general workplace…[it] does not mean the specific job [y]ou are performing for a specific employer at a specific location.” (Id. at 277.) The participant’s disability must also be pervasive enough that he or she is unable to perform his or her occupation through an “Elimination Period” and for an additional 24 months during which the participant’s monthly income is less than 80 percent of his or her income prior to becoming disabled. (Id. at 261, 274.) Then, after that time period, a participant qualifies for benefits if he or she cannot perform any occupation for which he is “qualified by education, training, or experience” with a similar earnings potential. (Id. at 274.) C. Hartford Denied Artz’s Claim for LTD Benefits. Artz submitted a claim for long-term disability benefits under the Hartford plan on December 2, 2019. (ECF No. 32 at 7.) Artz later provided Hartford with a December 4, 2019 statement from Dr. Khatri opining that Artz could work only eight hours per day and only on the day (not night) shift. (ECF No. 29-2 at 212–13.) After receiving this opinion, Hartford asked WEC if it could accommodate Dr. Khatri’s recommended restrictions. (ECF No. 29-1 at 79.) WEC replied that it could not. (Id. at 77–81.) At the same time he was seeking LTD benefits from Hartford, Artz also attempted to secure Social Security Disability (SSD) benefits. In connection with that effort, Artz sought additional confirmation on the limits on his ability to work and consulted Dr. Al Baltrusaitis, DO, and an occupational therapist, Jodi Kitzrow. Artz provided Hartford with the assessments he received from Dr. Baltrusaitis and Kitzrow (as well as Dr. Khatri’s). (See ECF No. 29-2 at 23.) Dr. Baltrusaitis evaluated Artz on December 26, 2019. (ECF No. 29-3 at 53.) Dr.

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Bluebook (online)
Artz v. Hartford Life & Accident Ins Co, Counsel Stack Legal Research, https://law.counselstack.com/opinion/artz-v-hartford-life-accident-ins-co-wied-2023.