Croll v. Connecticut General Life Insurance

863 F. Supp. 2d 1093, 2012 U.S. Dist. LEXIS 58317, 2012 WL 1439172
CourtDistrict Court, D. Colorado
DecidedApril 26, 2012
DocketCivil Action No. 10-cv-00735-RBJ-MEH
StatusPublished

This text of 863 F. Supp. 2d 1093 (Croll v. Connecticut General Life Insurance) is published on Counsel Stack Legal Research, covering District Court, D. Colorado primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Croll v. Connecticut General Life Insurance, 863 F. Supp. 2d 1093, 2012 U.S. Dist. LEXIS 58317, 2012 WL 1439172 (D. Colo. 2012).

Opinion

ORDER

R. BROOKE JACKSON, District Judge.

This comes before the Court on “Plaintiffs Combined Motion and Brief in Support for Summary Judgment to Reverse Defendant’s Decision to Terminate her Life Insurance Coverage.” The Court has reviewed the motion [docket #26], response [# 32], reply [# 37], administrative record [hard copy], and the parties’ respective filings regarding supplemental authority [#45-47]. The motion was ripe upon the filing of plaintiffs reply brief on November 5, 2010. The Court apologizes to the parties for the delay in resolving the ease.

[1095]*1095Facts

Martin Marietta Employee Benefit Plans

Cherisse Croll was employed as a Lead System Engineer and Functional Cognizant Engineer at Martin Marietta. R. 678. While so employed she participated in two employee benefit plans as defined in the Employee Retirement Income Security Act (“ERISA”), 29 U.S.C. § 1002(1).

First, she was insured under the Martin Marietta (now Lockheed Martin) Long Term Disability Plan (“LTD Plan”), insured and administered by the Connecticut General Life Insurance Company (“Connecticut General”). R. 884. Under the terms of the LTD Plan, an individual who becomes disabled due to sickness or accidental bodily injury is potentially eligible for LTD benefits in two stages. If she is “totally disabled from performing the duties of [her] occupation,” she will receive monthly income according to a schedule of benefits for 24 months (following a benefit waiting period). Thereafter, she can continue to receive monthly income if her “disability completely prevents [her] from engaging in any occupation for which [she is] qualified by training, education, or experience.” R. 887.

Second, she was insured under the Lockheed Martin Group Universal Life Plan (“Life Plan”), sponsored and administered by Connecticut General. R. 1-60. Among other things the Life Plan provides a waiver of an insured’s life insurance premiums if a participant suffers from “total disability.” Total disability for this purpose means that the individual has “become totally disabled by bodily injury or sickness which completely prevents [her] from engaging in any occupation or employment for wage or profit.” R. 10. This benefit, sometimes referred to as the Life Waiver of Premium or “LWOP” benefit, continues until the individual’s 65th birthday provided that the total disability continues. Ibid.

Ms. Croll’s Disability

Ms. Croll was diagnosed with Addison’s disease by an endocrinologist, Susan Sherman, M.D., on November 13,1992. R. 957, 973. That disease and related conditions cause her to suffer from fatigue, neck and back pain, depression, nausea, vomiting, and muscle weakness. R. 0646, 0648, 687, 720, 970,1147,1170,1668,1796.

Based on her medical conditions, Ms. Croll filed a claim for LTD benefits with Connecticut General after discontinuing work on April 9, 1993. R. 882. She was awarded LTD benefits effective October 10, 1993. R. 673. Ms. Croll has received her LTD benefit continuously since that time. Ms. Croll also claimed to be eligible to receive the LWOP benefit under the Life Plan. By letter dated April 6, 1996, Connecticut General approved Ms. Croll’s claim for waiver of her life insurance premium. R. 582-0583.

In 1995 Ms. Croll was also awarded disability benefits by the Social Security Administration. R. 1563-67. An Administrative Law Judge (“ALJ”) determined that she had been disabled as defined by the Social Security Act since April 20, 1993. The ALJ noted that Ms. Croll had attempted to work after the onset of her disability by (1) starting a home multimedia computer business in June 1993, which she discontinued in July 1994 due to stress and lack of earning; (2) working as a receptionist for a dentist, which she quit after one week due to her medical condition; and (3) selling housewares from her home in September 1994, which generated minimal income despite substantial help from her husband and children. R. 1563-64.

The ALJ cited the opinions of Dr. Sherman and of Kevin J. Boyle, M.D., her treating physicians at that time, that she [1096]*1096was totally disabled from any type of employment due to Addison’s disease. R. 1564. He found that “[h]er impairment and the side effects from her medication to treat the impairment prevent the claimant from performing any work requiring more than minimal exertion, concentrating on job tasks, and maintaining attendance at any job without an unreasonable number of and length of rest periods.” R. 1564. The ALJ concluded that, although Ms. Croll was 35 years old when her disability began and has a college degree, she was “unable to perform her past relevant work,” that she “does not have transferable skills to perform other work within her physical and mental residual functional capacity,” and that “there are no jobs existing in significant numbers which she can perform.” R. 1565.

Over the years that followed Dr. Sherman consistently noted her position that Ms. Croll is incapable of performing any work. See, e.g., R. 1333, 1350-1351, 1450. Dr. Sherman found Ms. Croll to be limited by fatigue and by potential exacerbation of her Addison’s disease, particularly due to stress. For the same reasons, Ms. Croll’s primary physician, Dr. Boyle, has repeatedly opined that Ms. Croll has been incapable of work. (R. 0820, 0926, 0927, 1347-1348,1451).

At the request of Connecticut General Dr. Boyle completed an attending physician’s statement on November 15, 2007. He indicated that Ms. Croll has “class 5 limitations,” remarking that she was “unable to work in any predictable fashion,” and “no return to work [is] anticipated”. R. 635. In a July 30, 2008 Physical Ability Assessment Form, Dr. Boyle indicated that “due to Addison’s disease, easy fatigue, etc., [she is] unable to work in any capacity.” R. 1778-1779.

Denial ofLWOP Benefits

In 2008 Connecticut General undertook an evaluation of Ms. Croll’s continuing entitlement to the LWOP and LTD benefits. In November 2008, it engaged PhotoFax, Inc. to conduct surveillance of Ms. Croll. The results, set forth in a Surveillance Report, R. 1753-62, were summarized by Micah Vandertulip, a “Fraud Specialist” for Connecticut General, in an internal memo dated December 3, 2008. R. 1750-51. Mr. Vandertulip states that Ms. Croll was “visibly inactive” during the first day of the surveillance period; that she was seen going to a library, a McDonald’s and a grocery store on the second day; and that she was again “visibly inactive” on the third and fourth days. Ms. Croll was videotaped walking, entering her vehicle, driving, bending over, loading groceries into her vehicle (a 24-can case of Coca Cola and multiple plastic bags, R. 1759), and conversing with an unidentified subject. According to Mr. Vandertulip, she performed these activities “in a fluid manner showing no visible signs of restriction or discomfort.” Ibid.

On January 16, 2009, Dr. Boyle drafted a letter expressing his concerns regarding Ms. Croll’s undergoing a functional capacity evaluation, which Connecticut General had requested. The letter stated in part:

She was diagnosed with Addison’s disease in approximately 1992. She is on permanent disability because of this condition. Her disability is related to exacerbations of easy fatigability and excessive fatigue related to the Addison’s disease.

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Bluebook (online)
863 F. Supp. 2d 1093, 2012 U.S. Dist. LEXIS 58317, 2012 WL 1439172, Counsel Stack Legal Research, https://law.counselstack.com/opinion/croll-v-connecticut-general-life-insurance-cod-2012.