Baribeau v. Hartford Life and Accident Insurance Company

CourtDistrict Court, D. Connecticut
DecidedSeptember 7, 2022
Docket3:20-cv-01290
StatusUnknown

This text of Baribeau v. Hartford Life and Accident Insurance Company (Baribeau v. Hartford Life and Accident Insurance Company) is published on Counsel Stack Legal Research, covering District Court, D. Connecticut primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Baribeau v. Hartford Life and Accident Insurance Company, (D. Conn. 2022).

Opinion

UNITED STATES DISTRICT COURT DISTRICT OF CONNECTICUT Yvon R. BARIBEAU ) 3:20-CV-01290 (KAD) Plaintiff, ) ) v. ) ) HARTFORD LIFE & ACCIDENT ) INSURANCE COMPANY ) SEPTEMBER 7, 2022 Defendant.

MEMORANDUM OF DECISION Re: CROSS MOTIONS FOR SUMMARY JUDGMENT, ECF Nos. 17 & 18

Kari A. Dooley, United States District Judge: Plaintiff Yvon Baribeau brought this action under the Employee Retirement Income Security Act (“ERISA”), 29 U.S.C. §§ 1001 et seq., challenging Defendant Hartford Life and Accident Insurance Company’s determination that certain benefits he received from a third party offset the long-term disability benefits due to him under his former employer’s benefits plan. In February 2020, Plaintiff first filed for long-term disability benefits from the Defendant. On February 27, 2020, the Defendant rendered its initial decision, in which the Defendant found that Plaintiff qualified for long-term disability benefits and that the offsets should be applied against those benefits. Plaintiff timely filed an administrative appeal that was later denied on July 1, 2020. This lawsuit followed. Pending before the Court are the parties’ cross motions for summary judgment. For the reasons set forth below, the Defendant’s motion is GRANTED and the Plaintiff’s motion is DENIED. Legal Standard The standard under which courts review motions for summary judgment is well established. “The court shall grant summary judgment if the movant shows that there is no genuine dispute as to any material fact and the movant is entitled to judgment as a matter of law.” Fed. R. Civ. P. 56(a). A fact is “material” if it “might affect the outcome of the suit under the governing law,” while a dispute about a material fact is “genuine” if “the evidence is such that a reasonable jury could return a verdict for the nonmoving party.” Anderson v. Liberty Lobby, Inc., 477 U.S.

242, 248 (1986). Undisputed Facts Plaintiff was employed as a cardiovascular/thoracic surgeon at Catholic Medical Center (“CMC”). Def.’s L.R. 56(a)(1) Statement (“Def.’s L.R.”) ¶ 1, ECF No. 17-2. Plaintiff stopped working at CMC on August 14, 2019, citing increased back pain that radiated into his lower extremities. Id. ¶ 4. Plaintiff had also been diagnosed with and treated for Dupuytren’s disease affecting both hands, which he claimed affected his ability to safely use fine instruments. Id. During his employment, Plaintiff had been eligible to participate in CMC’s employee welfare benefits plan (the “CMC Plan”). Id. ¶ 2. The CMC Plan included long-term disability benefits that were funded through a group life insurance policy (the “LTD Policy”) bearing Policy

No. GLT675734, which was issued by the Defendant to CMC. Id. ¶¶ 2–3. The CMC Plan “granted the Insurance Company full discretion and authority to determine eligibility for benefits and to construe and interpret all terms and provisions of the Policy.” Id. ¶ 22; Joint Administrative Record (“A.R.”) 75, ECF No. 16. In February 2020, after exhausting his available short-term disability benefits, Plaintiff made a claim for long-term disability benefits under the CMC Plan’s LTD Policy. Def.’s L.R. ¶¶ 3, 5. The Defendant determined that Plaintiff was “Disabled from his Own Occupation” and approved Plaintiff’s claim under the CMC Plan and LTD Policy, with long-term disability benefits effective February 13, 2020. Id. ¶ 7. Plaintiff’s gross monthly benefits from the LTD Plan, before any deductions, are $15,000. Id. ¶ 16. Gross monthly long-term disability benefits under the LTD Policy are offset by “Other Income Benefits” as defined by the LTD Policy. Id. ¶ 14. The LTD Policy defines “Other Income Benefits,” in relevant part, as:

[T]he amount of any benefit for loss of income, provided to you or to your family, as a result of the period of Disability for which you are claiming benefits under this plan. This includes any such benefits for which you or your family are eligible or that are paid to you, to your family or to a third party on your behalf, pursuant to any . . .

plan or arrangement of coverage, whether insured or not, or as a result of employment by or association with the Employer or as a result of membership in or association with any group, association, union or other organization . . . .

A.R. 38. The Plaintiff is also a participant in a long-term disability income plan sponsored by the American Medical Association (the “AMA Plan”), with disability benefits funded through a group insurance policy issued by New York Life Insurance Company to the AMA Group Insurance Trust. Def.’s L.R. ¶ 8. To be insured through the AMA Plan, a person must be an Eligible Member, which is defined, in relevant part, as: A person who is . . . any active member of or physician who is eligible for membership in the American Medical Association “AMA” (as defined in the AMA Constitution and Bylaws as amended from time to time). Such member must be at ACTIVELY ENGAGED FULL TIME-WORK in the practice of medicine; medical research; administration of medical facilities or services; programs of internship or residence; or a combination of those activities . . . .

A.R. 428. The Plaintiff receives monthly disability benefits of $10,000 under the AMA Policy. Def.’s L.R. ¶ 13. Plaintiff, after having applied for Social Security Disability Income benefits, also receives those benefits on a monthly basis, retroactive to February 2020. Id. ¶¶ 18–19. The Defendant determined that the Plaintiff’s monthly disability benefits from the AMA Plan constituted “Other Income Benefits” as defined by the LTD Policy and offset that amount against the benefits due to Plaintiff under the LTD Policy. Id. ¶ 17. By administrative appeal, Plaintiff challenged this determination, as well as the determination that Plaintiff’s Social Security

Disability Income benefits offset benefits due under the LTD Policy. Id. ¶ 20. By a letter dated July 1, 2020, the Defendant rendered a decision on Plaintiff’s appeal and upheld its determination that the disability benefits under the AMA Plan, as well as the Social Security Disability Income benefits, are “Other Income Benefits” as defined by the LTD Policy and were therefore properly deducted from Plaintiff’s gross monthly benefits under the LTD Policy and CMC Plan. Id. ¶ 21. This action followed. Discussion Plaintiff challenges the Defendant’s determination that Plaintiff’s benefits from the AMA Policy should be deducted as “Other Income Benefits” from the gross monthly benefits due under the LTD Policy. ERISA benefit disputes of this nature are often resolved on a motion for summary

judgment. See Muller v. First Unam Life Ins. Co., 341 F.3d 119, 124 (2d Cir. 2003); see also Suarato v. Building Services 32BJ Pension Fund, 554 F. Supp. 2d 399, 414–15 (S.D.N.Y. 2008) (“It is appropriate to consider a challenge under ERISA to the denial of disability benefits as a summary judgment motion reviewing the administrative record.”); Katzenberg v. First Fortis Life Ins. Co., 500 F. Supp. 2d 177, 190–91 (E.D.N.Y. 2007) (discussing whether a “motion for judgment on the administrative record” should be considered a motion for judgment on the pleadings, a motion for summary judgment, or a motion for a bench trial on the papers).

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Bluebook (online)
Baribeau v. Hartford Life and Accident Insurance Company, Counsel Stack Legal Research, https://law.counselstack.com/opinion/baribeau-v-hartford-life-and-accident-insurance-company-ctd-2022.