Baker v. Hartford Life and Accident Ins. Co.

371 F. Supp. 2d 1352, 2005 U.S. Dist. LEXIS 10381, 2005 WL 1287998
CourtDistrict Court, M.D. Florida
DecidedApril 21, 2005
Docket8:03CV2590T17EAJ
StatusPublished

This text of 371 F. Supp. 2d 1352 (Baker v. Hartford Life and Accident Ins. Co.) is published on Counsel Stack Legal Research, covering District Court, M.D. Florida primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Baker v. Hartford Life and Accident Ins. Co., 371 F. Supp. 2d 1352, 2005 U.S. Dist. LEXIS 10381, 2005 WL 1287998 (M.D. Fla. 2005).

Opinion

*1354 ORDER

KOVACHEVICH, District Judge.

This cause comes before the Court on the following motions and responses:

1. Defendant’s Motion for Summary Judgment and Memorandum in support thereof filed November 1, 2004 (Doc. No. 20 and Doc. No. 21).
2. Affidavit in support of Defendant’s Motion for Summary Judgment filed November 1, 2004 (Doc. No. 22).
3. Plaintiffs Motion for Summary Judgment and Appendix of Cited Case Authorities filed November 1, 2004 (Doc. No. 23 and Doc. No. 25).
4. Notice of Filing in Support of Plaintiff’s Motion for Summary Judgment filed November 1, 2004 (Doc. No. 24).
5. Notice of Filing in Support of Defendant’s Motion for Summary Judgment filed November 2, 2004 (Doc. No. 26).
6. Plaintiffs Response to Defendant’s Motion for Summary Judgment filed November 18, 2004 (Doc. No. 27).
7. Defendant’s Memorandum in Opposition to Plaintiffs Motion for Summary Judgment filed November 18, 2004, and re-filed April 14, 2005 (Doc. No. 29).

Upon review of the motions and supporting memoranda, this Court finds that Defendant’s Motion for Summary Judgment is GRANTED, and Plaintiffs Motion for Summary Judgment is DENIED.

I. Procedural History

For the purpose of ruling on the motions for summary judgment, this Court accepts the following facts as true.

Plaintiff, Mabel Baker (“Ms.Baker”), initiated this action, seeking long-term disability benefits under her former employer, Meristar Management, Inc.’s (“Meris-tar”), employee benefit plan (“the Plan”)(Doc. No. 20; Doc. No. 22; Doc. No. 16). Ms. Baker worked as a masseuse for Meristar’s “Safety Harbor Spa” facility (Doc. No. 20)(citing A.R. 112). Meristar’s employee benefit plan is governed by 29 U.S.C. § 1001, et. seq., the Employee Retirement Income Security Act of 1974, as amended (“ERISA”)(Doc. No.20). Under the Plan, Meristar employees are eligible for Group Short Term Disability (“STD”) benefits and Group Long-Term Disability (“LTD”) benefits, and, therefore, as a Meristar employee, Ms. Baker was able to participate in and seek benefits under the Plan (Doc. No. 20). 1 The Defendant, Hartford Life and Accident Insurance Company (“Hartford”), serves as administrator for the Plan (Doc. No. 20). As claims administrator, Hartford has the authority to make decisions regarding benefit claims and appeals (Doc. No. 20). The Plan gives Hartford “full discretion” to interpret terms and to make decisions regarding benefits (Doc. No. 20). 2

Ms. Baker claims that while she was covered under the Plan, she became disabled and was, therefore, entitled to Long Term Disability Benefits (Doc. No. 16 and Doc. No. 23). Specifically, Ms. Baker argues that she sustained a disabilitating back injury (a herniated disc) on July 15, 2001, while she was employed with Meris-tar, and that as a result of the injury, she was no longer able to perform her job (Doc. No. 20 and Doc. No. 23)(See also *1355 A.R. 180). Subsequently, Ms. Baker sought both STD and LTD disability benefits under the Plan (Doc. No. 20). Hartford awarded Ms. Baker STD benefits through the conclusion of her short-term benefit period, which ended on January 13, 2002 (Doc. No. 20)(citing A.R. 153-155; 158; 216). However, Hartford notified Ms. Baker that it would need to assess whether or not she had a pre-existing condition before deciding whether to grant or deny her claim for LTD benefits (Doc. No. 20)(citing A.R. 153-154; 4).

After receiving medical information from Ms. Baker’s treating physician, and completing its review of the record, Hartford denied the LTD benefit claim (Doc. No. 20)(citing A.R. 6-8). Hartford’s denial was based on its conclusion that Ms. Baker had received treatment for a pre-existing condition during the 90 day “look-back” period, and because she had “received treatment for the same pre-existing condition during the 90 day ‘treatment-free’ period” (Doc. No. 20).

Ms. Baker sought an appeal to her initial denial of LTD benefits through a letter dated April 29, 2003 (Doc. No. 20)(eiting A.R. 39). In her letter, Ms. Baker stated that she was disabled due to two herniated discs caused from the July 15, 2001, injury, and claimed that the treatment prior to July 15, 2001 “was for soft-tissue injuries only” (Doc. No. 20 and Doc. No. 23)0See A.R. 39).

However, on appeal, Hartford affirmed its initial denial of Ms. Baker’s request for LTD benefits (Doc. No. 20)(citing A.R. 11-13). Hartford contends that during both the initial claim review and appeal, Hartford carefully reviewed the record, which included Plaintiffs medical records and an independent medical consultant’s report. Hartford further argues that the record supported its conclusion that Ms. Baker did not suffer disc herniations on July 15, 2001 (Doc. No. 20). Upon removal from state court, Ms. Baker filed the instant action on December 11, 2003, seeking review of her LTD benefits denial, pursuant to 29 U.S.C. § 1132(a)(1)(B) (Doc. No. 2).

On November 1, 2004, Hartford Life moved for summary judgment (Doc. No. 20). In support of its motion, Hartford relies on the Affidavit of Annette Moore (Doc. No. 22), which it states “authenticates and attaches” the Plan documents (Doc. No. 20). 3 Hartford contends that it based its denial on the evidence contained in the Administrative Record (“AR”) 4 which showed that Ms. Baker’s back injury “was caused or contributed to by a preexisting condition,” and that, therefore, its denial of LTD benefits was proper (Doc. No. 20). Hartford contends that it thoroughly reviewed Ms. Baker’s condition both before initially denying Ms. Baker’s claim, and before denying the claim on appeal (Doc. No. 20). Hartford argues that its review of the Administrative Record “included, but was not limited to” a review of Ms. Baker’s medical records and a report from independent medical consultant, Dr. Barry Turner, M.D., and, that Ms. Baker was given the opportunity to present new evidence to Hartford on appeal (Doc. No. 20). Finally, Hartford contends that the following evidence from the *1356 AR supports its decision: “(a) medical reports showing normal neurological exams after her alleged injury on July 15, 2001; (b) X-Ray and MRI reports after July 15, 2001 showing no disc herniations; and (c) the report of an independent medical consultant who concluded that the medical evidence did not show that Plaintiff suffered disc herniations on July 15, 2001” (Doc. No. 20 and Doc. No. 21).

Additionally, on November 1, 2004, Ms. Baker also moved for summary judgment (Doc. No. 23). In her motion, Ms.

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Bluebook (online)
371 F. Supp. 2d 1352, 2005 U.S. Dist. LEXIS 10381, 2005 WL 1287998, Counsel Stack Legal Research, https://law.counselstack.com/opinion/baker-v-hartford-life-and-accident-ins-co-flmd-2005.