Dorholt v. Hartford Life & Accident Insurance

417 F. Supp. 2d 1094, 2006 U.S. Dist. LEXIS 7781, 2006 WL 475280
CourtDistrict Court, D. Minnesota
DecidedFebruary 28, 2006
DocketCiv.05-602 ADM/JSM
StatusPublished

This text of 417 F. Supp. 2d 1094 (Dorholt v. Hartford Life & Accident Insurance) is published on Counsel Stack Legal Research, covering District Court, D. Minnesota primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Dorholt v. Hartford Life & Accident Insurance, 417 F. Supp. 2d 1094, 2006 U.S. Dist. LEXIS 7781, 2006 WL 475280 (mnd 2006).

Opinion

MEMORANDUM OPINION AND ORDER

MONTGOMERY, District Judge.

I. INTRODUCTION

On December 2, 2005, oral argument before the undersigned United States District Judge was heard on Plaintiff Deborah Dorholt f/k/a Deborah Larsen’s (“Plaintiff’ or “Dorholt”) Motion for Summary Judgment [Docket No. 18] and Defendant Hartford Life and Accident Insurance Company’s (“Defendant” or “Hartford”) Motion for Summary Judgment [Docket No. 13]. Plaintiff originally filed suit in state court, alleging breach of contract based on Defendant’s denial of her claim for long term disability benefits. Defendant removed the action to federal court alleging the state law claim is preempted by the Employee Retirement Income Security Act (“ERISA”) [Docket No. 1]. For the reasons set forth herein, Plaintiffs Motion for Summary Judgment is denied and Defendant’s Motion for Summary Judgment is granted.

II. BACKGROUND

Dorholt worked as a paramedic at North Memorial Health Care (“NMHC”) from March 2, 1987 to July 6, 1999. Tostrud Aff. [Docket No. 16] at HART00151. During her employment with NMHC, Dorholt participated in NMHC’s long term disability plan, insured by Hartford. The Plan gives Hartford the “discretion and authority to determine eligibility for benefits and to construe and interpret all terms and provisions of the Group Insurance Policy.” Id. at HART00191. Hartford defines disability as an injury that prevents the employee “from performing one or more of the Essential Duties of Your Occupation.” Id. at HART00168. After twenty-four months of coverage, the definition of disability narrows, requiring the employee to *1096 be “prevented from performing one or more of the Essential Duties of Any Occupation.” Id. “Any Occupation means an occupation for which you are qualified by education, training or experience” and that meets a minimum “earnings potential” requirement set forth in the plan. Id.

On July 6, 1999, Dorholt was injured in a car accident. Id. at HART00829. Do-rholt, while wearing her seatbelt, was stopped at an intersection when another car collided into the rear of her car. Id. She experienced head and back pain, and visited a chiropractor, Doctor Martin Eng (“Dr.Eng”), after the accident. Id. at HART00829, 00841. Dr. Eng ultimately diagnosed Dorholt as having “a severe whiplash sprain/strain and a disc herniation in the low back.” Id. at HART00849, 00870. As a result of her injury, Dorholt did not return to work. 1 Id.

Lumbar spine and cervical MRIs conducted on August 26 and 30,1999, revealed multi-level disc degeneration. Id. at HART00867-00868. On September 9, 1999, Doctor Susan Evans (“Dr.Evans”), a neurologist, evaluated Dorholt, and determined that Dorholt suffered from cervical and lumbar strains. Id. at HART00791. At a follow-up visit on September 30, 1999, after further testing, Dr. Evans diagnosed cervical and lumbar radiculopathy. Id. at HART00813.

On September 9, 1999, forty-one year old Dorholt applied for long term disability benefits. Id. at HART0904. On November 15, 1999, Hartford approved Dorholt’s application for long term disability benefits and notified Dorholt of her obligation to periodically provide documentation of continued disability. Id. at HART00807. Do-rholt continued to be seen by Drs. Eng and Evans. On March 2, 2000, Dr. Eng completed an Attending Physician’s Statement of Continued Disability (“APS”) form and restricted Dorholt from lifting/carrying more than twenty pounds or pushing, pulling, or reaching/working overhead. Id. at HART00788. On July 5, 2000, Dr. Evans filled out a Physical Capacities Evaluation (“PCE”) form, indicating that Dorholt was capable of sedentary, part-time work, and could sit for two hours, stand for four hours, and walk for three hours with rest. Id. at HART0955-0956. In August 2000, Dr. Eng completed another APS form, noting that Dorholt could not stand, walk, sit, lift, carry, push, pull, or drive for more than fifteen to thirty minutes without experiencing pain and could not lift objects heavier than twenty pounds. Id. at HART00757. Dr. Eng also noted that Do-rholt most likely had permanent injuries with limitations that would last several years. Id. At the same time, Dr. Evans provided office notes stating that Dorholt had reinflamed her back injury. Id. at HART00759.

Dr. Evans continued to see Dorholt on a regular basis and often noted no improvement in Dorholt’s level of pain despite the use of medication and physical therapy. Id. at HART00667, 00689, 00707. In January 2001, Dorholt had two lumbar epidural steroid injections, which provided no reported pain relief. Id. at HART00317-00327, 00667. On April 17, 2001, Hartford reminded Dorholt of the clause in her insurance policy requiring her to be disabled from any occupation after the two years “own occupation” period of disability. Do-rholt was advised an investigation would be conducted to determine if she continued to qualify for benefits. Id. at HART00737. On May 2, 2001, Dr. Evans completed an APS form, opining Dorholt could stand for thirty minutes before pain; could walk, sit, *1097 lift, and carry for fifteen minutes before having pain; has increased pain in her neck and back when pushing, pulling, or driving; and could not lift greater than fifteen pounds. Id. at HART00729. In an accompanying PCE form, Dr. Evans noted that Dorholt could sit for two hours, stand for one hour, and walk for two hours in an eight hour work day, but also noted that “Patient cannot work [due] to injuries.” Id. at HART00730-00731.

On August 29, 2001, Dr. Evans wrote Dorholt “is not to work more than 4 hours per day, with no repetitive movement of the neck and back, as well as no lifting greater than 20 lbs. These restrictions will remain in effect until the patient is reevaluated.” Id. at HART00661. In office notes from the same day, Dr. Evans stated:

I think at this point [Dorholt] is ready to go back to work. I will have her go back to work on her restrictions of no repetitive movement of the neck and back. She will go back to work at four hour days, five days a week, with a weight restriction of 20 pounds. I will reevaluate her in six weeks after she finds work. I did explain to her that I think she will have flare-ups and pain from time to time, but I do think it is time for her to go back to work.

Id. at HART00663.

On September 20, 2001, Dorholt began working part-time at Mainsl Services as a care attendant for disabled children. 2 Id. at HART0916. That same day, Hartford referred Dorholt’s file to the Medical Advisory Group (“MAG”) for review to determine whether Dorholt could work an eight hour day. Id. at HART00658.

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417 F. Supp. 2d 1094, 2006 U.S. Dist. LEXIS 7781, 2006 WL 475280, Counsel Stack Legal Research, https://law.counselstack.com/opinion/dorholt-v-hartford-life-accident-insurance-mnd-2006.