Dobson v. Hartford Financial Servs.

196 F. Supp. 2d 152, 2002 WL 741657
CourtDistrict Court, D. Connecticut
DecidedMarch 8, 2002
Docket3:99CV2256 (JBA)
StatusPublished
Cited by10 cases

This text of 196 F. Supp. 2d 152 (Dobson v. Hartford Financial Servs.) 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
Dobson v. Hartford Financial Servs., 196 F. Supp. 2d 152, 2002 WL 741657 (D. Conn. 2002).

Opinion

MEMORANDUM OF DECISION ON CROSS-MOTIONS FOR SUMMARY JUDGMENT

[Doc. ## 47, 53, 57, 75]

ARTERTON, District Judge.

I. Introduction

Plaintiff Douglas Dobson is a disabled anesthesiologist whose monthly long term disability (“LTD”) payments of $10,000 per month were withheld for over a year while defendant Hartford Life and Accident Insurance Company (“Hartford”) claimed to be seeking additional proof of his continued disability. Dobson claims that Hartford improperly denied him and the purported class members interest owed to them under the terms of the LTD plan on retroactive benefits payments, in violation of ERISA § 502(a)(1)(B), 29 U.S.C. § 1132(a)(1)(B), and claims that Hartford failed to inform him or the putative class members of the existence of an “ex gra-tia” practice of paying such interest on request and under certain circumstances, in breach of Hartford’s fiduciary duty, in violation of ERISA § 502(a)(3), 29 U.S.C. § 1132(a)(3). Plaintiff also asserts a class and individual § 502(a)(3) breach of fiduciary duty claim based on Hartford’s refusal to pay accrued interest for wrongfully withheld benefits, seeking such interest or disgorgement of Hartford’s profits on such withheld sums. Plaintiff has moved for class certification [Doc. # 53] and for summary judgment on the class claims [Doc. # 47]. Hartford has cross-moved for summary judgment on plaintiffs claims for interest under § 502(a)(1)(B) and § 502(a)(3) [Doc. # 57] and on the § 502(a)(3) class claim alleging unlawful non-disclosure of the ex gratia payment policy [Doc. # 75].

Oral argument on the cross-motions was held on January 7, 2002. The next day, the Supreme Court issued its opinion in Great-West Life & Annuity Insurance Co. v. Knudson, 534 U.S. 204, 122 S.Ct. 708, 151 L.Ed.2d 635 (2002), and the day following, the Second Circuit decided Dunnigan v. Metropolitan Life Ins. Co., 277 F.3d 223 (2d Cir.2002). The Court invited supplemental briefing on the impact of these two decisions, which indisputably altered the landscape for plaintiffs ERISA claims. The question for this Court, however, is the scope and extent of these changes.

Plaintiff claims that Dunnigan now compels summary judgment in his favor on his claims under § 502(a)(1)(B) or alternatively for the § 502(a)(3) claim for interest. Defendant, in turn, argues that Dunni gan’s holding is no longer good law in light of Knudson. For the reasons discussed below, the Court agrees with both parties in part and disagrees in part. De *154 fendant’s motions for summary judgment are granted as to the class claims under § 502(a)(1)(B) and § 502(a)(8), and the ex gratia practice claim under § 502(a)(3), and denied as to the § 502(a)(3) claim for individual relief for breach of fiduciary duty. Plaintiffs motion for summary judgment is denied, and the motion for class certification is denied as moot.

II. Factual background

Dr. Dobson was employed as an anesthesiologist with West Central Anesthesiology Group, Ltd. until he became disabled in 1993 due to obstructive sleep apnea which led to excessive daytime somnolence. Dobson is a participant in West Central’s long term disability plan (“the Plan”), which provides disability benefits through an insurance policy issued by Hartford.

Hartford originally approved plaintiffs claim for LTD benefits, and began paying him a monthly benefit of $10,000, less tax withholding, in 1993. However, on April 7, 1997, Hartford informed plaintiff that his benefits would be terminated effective March 31, 1997 due to lack of proof of continuous disability. Plaintiff was invited to submit additional documentation supporting his claim of continued disability, and was informed that the file would be closed if Hartford did not receive the requested information within the next thirty days. 1

Although plaintiff did submit additional information, both he and his doctor, David Murdy, asserted that because plaintiffs disability resulted from craniofacial abnormalities which would not be expected to change favorably over time, additional clinical testing was unnecessary. Hartford, however, maintained that because Dr. Murdy’s diagnosis relied on testing performed prior to the date of onset of disability, the documentation was inadequate and a current examination and diagnosis was required. 2

Hartford did not, however, deny plaintiffs claim for benefits outright. Instead, it claimed to have “suspended” benefits, and refused plaintiffs request for documentation supporting the termination of benefits, taking the position that because the claim was not actually denied, plaintiff was not yet entitled to review the claim file documents. 3 On October 3, 1997, Hartford determined that plaintiffs proof of loss was insufficient, and finally informed plaintiff of his right to appeal that determination. 4 Plaintiff requested review of the denial pursuant to ERISA § 503 and Department of Labor regulations, and requested that Hartford reinstate his LTD benefits pending the outcome of the review process because those benefits were his family’s primary source of income. Hartford refused to do so.

During the fall of 1997, plaintiff was seen by Dr. Guillermo doPico, at the Sleep Disorders Clinic at the University of Wisconsin. Dr. doPico diagnosed plaintiff as disabled for performance of his occupation *155 as an anesthesiologist due to excessive daytime somnolence, and noted that “[a]l-though the cause of his excessive daytime somnolence may be just obstructive sleep apnea, which is actually quite significant and worse than in 1993, I feel that it is actually multifactorial.... In my opinion, the pathogenesis of his sleep disorder is very complex. It does include obstructive sleep apnea, sleep paralysis, altered sleep hygiene, phase shifting, and perhaps ‘idiopathic hypersomnia.’ ” 5 Despite this conclusion from Dr. doPico, Hartford did not reinstate benefits, but instead requested the actual test results for review; 6 requested a second opinion from a Dr. Cor-son based on his independent review of Dobson’s medical history and recent test results; 7 and on November 24, 1997, denied plaintiffs claim again based on Dr. Corson’s statement that Dobson had not undergone “an evaluation by a board certified sleep specialist at an accredited sleep center,” and therefore the proof of loss was insufficient. 8

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Bluebook (online)
196 F. Supp. 2d 152, 2002 WL 741657, Counsel Stack Legal Research, https://law.counselstack.com/opinion/dobson-v-hartford-financial-servs-ctd-2002.