Colassi v. Hartford Life

2012 DNH 086
CourtDistrict Court, D. New Hampshire
DecidedMay 15, 2012
DocketCV-10-562-PB
StatusPublished
Cited by1 cases

This text of 2012 DNH 086 (Colassi v. Hartford Life) is published on Counsel Stack Legal Research, covering District Court, D. New Hampshire primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Colassi v. Hartford Life, 2012 DNH 086 (D.N.H. 2012).

Opinion

Colassi v . Hartford Life CV-10-562-PB 5/15/12 UNITED STATES DISTRICT COURT FOR THE DISTRICT OF NEW HAMPSHIRE

Kenneth William Colassi

v. Civil N o . 10-cv-562-PB Opinion N o . 2012 DNH 086 The Hartford Life & Accident Insurance Company, et a l .

MEMORANDUM AND ORDER

Kenneth Colassi, a former participant in the BAE Systems

Funded Welfare Benefit Plan (“Plan”), brings a pro se Employee

Retirement Income Security Act (“ERISA”) action against the Plan

Administrator, BAE Systems Inc. (“BAE”), seeking to recover

disability benefits allegedly owed him. Both Colassi and BAE

have moved for judgment on the administrative record. For the

reasons set forth below, I grant the Plan’s motion and deny

Colassi’s motion.

I. BACKGROUND1

A. Employment with BAE & the Plan

After working at BAE for many years as a programmer

1 Because Colassi has not provided a cogent statement of the record facts, I have relied on BAE’s briefing to alert me to the material facts, insofar as such facts are actually supported by the administrative record. I cite to the record with the notation “Tr.” 1 analyst, Colassi’s employment was terminated on April 1 6 , 2009.

At the time, BAE was implementing a reduction in force. 2

As an employee of BAE, Colassi was insured under the

company’s short-term disability plan, which provides short-term

income protection for an employee who becomes disabled as the

result of a covered accident or sickness. T r . 136. The Plan

names BAE as the Plan Administrator and Employer/Plan Sponsor,

and vests BAE with final responsibility for deciding appeals of

claims, determining eligibility for coverage, and paying out

benefits. T r . 1 3 4 , 1 4 1 , 146. It further provides that BAE “has

full discretion and authority to determine eligibility for

benefits and to construe and interpret all terms and provisions

of the Plan.” T r . 143.

Benefits under the Plan are payable to covered employees

who become “Totally Disabled” and furnish proof that they remain

disabled. T r . 138. The Plan explains that individuals are

“Totally Disabled” when they are prevented “from performing the

essential duties of [their] occupation” by accidental bodily

injury, sickness, mental illness, substance abuse, or pregnancy,

“and as a result, . . . earn[] less than 20% of [their] pre-

disability Weekly Earnings.” T r . 145. Claimants must provide

2 Colassi asserts that the reduction in force was pretextual, and not the true motivation for his discharge.

2 written proof that establishes their entitlement to benefits.

Tr. 142.

B. Colassi’s Medical History and Filing of Claim

In September 2008, Colassi saw his primary care physician,

Dr. Ihab Ziada, about joint pain and muscle aches. T r . 55-56.

Dr. Ziada’s notes from that session mention that Colassi had

been bitten by a tick, though D r . Ziada believed Lyme disease

was unlikely. T r . 5 6 . The notes do not mention Colassi raising

any other concerns. Id.

In a series of appointments spanning August and September

2008, Colassi visited the office of D r . David Frost, a

chiropractor. T r . 69-74. D r . Frost administered chiropractic

adjustments to alleviate Colassi’s back pain. Id.

Colassi returned to D r . Ziada’s office in December 2008,

complaining of lower back pain and muscle spasms. T r . 6 1 . D r .

Ziada’s notes indicate that Colassi had a history of

gastroesophageal reflux disease. Id. D r . Ziada prescribed

Vicodin for Colassi’s back pain and Prilosec OTC for the reflux.

Id.

In February 2009, Colassi saw D r . Ziada twice for upper

respiratory symptoms and was diagnosed with sinusitis. T r . 62-

65. D r . Ziada’s notes do not mention that Colassi complained of

reflux or back pain on either visit. 3 Colassi returned to D r . Ziada’s office on April 2 2 , six

days after his employment with BAE had been terminated, and told

the doctor that his reflux disease required him to sleep at a

45-degree angle and that he suffered severe back pain as a

result of his inability to lie flat. T r . 6 7 . In his notes, D r .

Ziada indicated that Colassi had “recently been laid off,” and

he described the appointment as “mainly a counseling dominat[ed]

session where we talked about the outcome of the reflux

symptoms, how [ ] we control i t , the back pain, what options

orthopedics might help u s , what options physical therapy and

chiropractor work might help us with.” Id.

Colassi filed a claim for short-term disability benefits on

November 1 6 , 2009 based on his acid reflux and back issues. BAE

subsequently advised Colassi that based on the date his

employment was terminated, he would have had to become disabled

no later than April 3 0 , 2009 to be eligible for benefits.

Colassi saw D r . Ziada on December 2 1 , 2009, and again

complained that his extreme reflux symptoms forced him to sleep

at a 45-degree angle, which placed “a tremendous amount of

pressure on his lower back” and resulted in “lumbar strain.”

Tr. 6 8 . Colassi stated that he was unable to sit or stand for

more than 15 or 20 minutes due to the back pain. Id. D r . Ziada

noted that he believed Colassi was in need of surgical 4 intervention to help with his reflux. Id.

C. Initial Claim Process

In response to a request from Hartford-Comprehensive

Employee Benefit Service Company (“Hartford”), the Claims

Administrator under the Plan, D r . Ziada completed an Attending

Physician’s Statement of Functionality (“APS”) on December 2 2 ,

2009. T r . 7 7 . D r . Ziada stated that Colassi’s injury was

secondary to a “[r]ogue dilation proced[ure] on his lower

esophageal sphincter,” and caused a primary diagnosis of “lower

esophageal sphincter incompetence.” Id. He listed lower back

pain, insomnia, and fatigue as secondary diagnoses, and burning

in the chest, lower back pain, asthma, shortness of breath, and

fatigue as Colassi’s subjective symptoms. Id. On the

functional capability portion of the form, D r . Ziada indicated

that Colassi could occasionally lift up to 20 pounds, and could

sit, stand, and walk for a total of 1 hour per day. Tr. 7 8 .

On January 2 4 , 2010, Colassi’s attorney, Ronald Eskin,

provided Hartford with the treatment notes of D r . Ziada and D r .

Frost that have been summarized above. The file was referred to

medical case manager Kristina Baggett, R.N., for a determination

about whether Colassi’s condition supported a disability

finding.

5 After reviewing the file, M s . Baggett noted that there were

“[n]o exam findings, diagnostics, or RLS [restrictions and

limitations] as of 4/22/09” and that clarification was needed.

Tr. 118. On March 1 0 , 2010, she faxed a letter to D r . Ziada

requesting that he confirm that Colassi’s April 22 “office visit

was primarily a counseling session regarding [ ] options for

ongoing treatment.” T r . 9 3 . The letter stated that the notes

of D r . Ziada’s session contained “no indication of a full body

physical exam, updated diagnostics performed at that time or

specific restrictions or limitations being placed [on] M r .

Colassi at that time.” Id. The following day, D r . Ziada signed

the letter that M s . Baggett had faxed to him, and faxed i t ,

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Related

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2012 DNH 086, Counsel Stack Legal Research, https://law.counselstack.com/opinion/colassi-v-hartford-life-nhd-2012.