Artz v. Hartford Life & Accident Ins Co

District Court, E.D. Wisconsin·Decided June 1, 2023·No. 2:21-cv-00391·Unknown

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.)

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