Eweka v. Hartford Life & Accident Insurance

955 F. Supp. 2d 556, 2013 WL 3381370, 2013 U.S. Dist. LEXIS 94855
CourtDistrict Court, E.D. Virginia
DecidedJuly 3, 2013
DocketCivil Action No. 1:12cv1055
StatusPublished
Cited by2 cases

This text of 955 F. Supp. 2d 556 (Eweka v. Hartford Life & Accident Insurance) is published on Counsel Stack Legal Research, covering District Court, E.D. Virginia primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Eweka v. Hartford Life & Accident Insurance, 955 F. Supp. 2d 556, 2013 WL 3381370, 2013 U.S. Dist. LEXIS 94855 (E.D. Va. 2013).

Opinion

MEMORANDUM OPINION

T. S. ELLIS, III, District Judge.

At issue in this Employee Retirement Income Security Act (ERISA)1 action is defendant’s threshold motion (i) to dismiss two of plaintiffs four asserted claims arising out of the termination of plaintiffs long-term disability benefits and (ii) to strike plaintiffs jury demand. For the reasons stated below, defendant’s motion to dismiss must be granted in part and denied in part and plaintiffs jury demand must be stricken.

I.2

Only a brief recitation of the factual record is necessary for resolution of defendant’s motion. Thus, the record reflects that from January 2006 until January 2008, plaintiff Joseph I. Eweka (“Eweka”) was employed as a Home Furnishings Consultant with American Signature Furniture (“American Signature”) in Newport News, Virginia. In connection with this employment, Eweka participated in an ERISA employee welfare benefit plan that provided group short-term and long-term disability insurance benefits pursuant to a policy (“the Policy”) that was issued to American Signature by defendant Hartford Life and Accident Insurance Company (“Hartford”).

On July 31, 2007, Eweka ceased active employment with American Signature for medical reasons related to his back, including degenerative disc disease and spinal stenosis. Shortly thereafter, in August 2007, Eweka filed a claim for short-term disability benefits under the Policy, which Hartford later approved in September 2007.

In January 2008, Eweka’s employment with American Signature was terminated because he had not returned to work within the six-month limited disability period. Eweka thus applied for long-term disability benefits under the Policy in January 2008. He later provided Hartford with certain requested medical and employment information in support of his claim and Hartford eventually approved Eweka’s claim for long-term disability benefits in March 2008.

Hartford continued to pay long-term disability benefits to Eweka pursuant to the Policy for more than a year, from March 2008 to mid-2009.3 During this period, [560]*560Hartford’s representatives frequently-called Eweka for verbal updates regarding Eweka’s medical condition and to verify that he. was at his residence. Also, Hartford periodically, both by telephone and in writing, requested updated medical information from Eweka to support Eweka’s entitlement to continued long-term disability benefits. In response, Eweka provided Hartford with the requested updated medical documentation, including medical reports prepared in December 2008 and June 2009 by Dr. Richard Radna, a New York City surgeon who had performed Eweka’s back surgery in 1992.

In July 2009, a Hartford investigator met with Eweka to conduct a home visit and personal interview. During the interview, Eweka was shown clips from two surveillance videos that had been taken by a private investigator at Hartford’s direction. According to Hartford, these video clips captured Eweka engaged in activities that contradicted his self-reported medical limitations and his claimed inability to work in any occupation. Yet, Eweka conclusorily alleges that these video clips were “defective and manipulated” by Hartford. Compl. at 6. He further alleges that he asked the Hartford investigator to correct certain “errors and falsehoods” contained in the investigator’s written report of the July 2009 interview, but that the Hartford investigator declined to do so. Compl. at 7.

Following the July 2009 interview, Hartford continued to investigate Eweka’s entitlement to continued long-term disability benefits. Soon thereafter, Hartford learned that Eweka had previously been convicted of bank fraud in a federal court and was then — in the summer of 2009— still serving a period of supervised release.4 Thus, in August 2009, Hartford contacted Eweka’s federal probation officer and advised the officer that Hartford was in the process of investigating Eweka for possible insurance fraud. At around the same time, Hartford also apparently notified the Virginia State Police of its ongoing investigation of the bona fides of Eweka’s claim for benefits.

On or about October 5, 2009, Hartford notified Eweka that his long-term disability benefits had been terminated based on Hartford’s determination that Eweka was no longer disabled under the terms of the Policy. According to Eweka, this termination decision was based solely on, as he put it, (i) the “defective and manipulated surveillance videos” taken by the Hartford investigator and (ii) the medical opinion of a doctor who never met or examined Eweka and who based his medical opinion solely on the “defective and manipulated videos.” Compl. at 7-8.

Eweka appealed Hartford’s termination decision on October 22, 2009 and contem[561]*561poraneously requested a copy of his entire claim file. Hartford thereafter sent Eweka a copy of his claim file in December 2009, but omitted from the materials provided certain medical documents. Hartford also sent Eweka a letter in mid-January 2010 requiring that he undergo an independent medical evaluation to be arranged and scheduled by Hartford. This independent medical examination was later conducted by Dr. Winifred Bragg on January 29, 2010. According to Eweka, prior to the examination, Hartford required that he sign a document acknowledging that Dr. Bragg’s medical findings would not be disclosed to him.

By letter dated March 1, 2010, Hartford denied Eweka’s appeal of the termination of his long-term disability benefits. Again, Eweka claims that Hartford’s decision in this regard was based solely on the “defective and manipulated surveillance videos” and alleged “inconsistencies.” Compl. at 9. Eweka also claims that Hartford ignored “crucial objective medical evidence” supporting Eweka’s continued disability. Id.

In September 2010,5 Eweka sent another request to Hartford for his entire claim file. Hartford, in response, sent Eweka additional materials in October 2010 that Hartford represented comprised Eweka’s “administrative record.” Compl. at 11. But again, Eweka claims certain pertinent medical records were omitted from the materials provided to him, including a December 2008 medical report from Dr. Radna and Dr. Bragg’s independent medical evaluation. Although Hartford eventually provided Eweka with a copy of Dr. Bragg’s independent medical evaluation in August 2012 — after Eweka had sent a third written request for such information — Hartford never provided Eweka with a copy of Dr. Radna’s December 2008 report. According to Eweka, both of these medical reports are favorable to him and support his claim of continued disability.

In September 2012, Eweka filed the instant matter in federal court alleging that Hartford violated various provisions of ERISA in connection with the termination of his long-term disability benefits pursuant to the Policy. Specifically, in Count One, Eweka contends that Hartford wrongfully terminated his long-term disability benefits, in violation of 29 U.S.C. § 1132(a)(1)(B). In Count Two, Eweka alleges that Hartford breached its fiduciary duties by (i) failing to send him certain requested medical records from his claim file in a timely manner and (ii) failing to rule on his appeal within the statutory timeframe, all in violation of 29 U.S.C.

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955 F. Supp. 2d 556, 2013 WL 3381370, 2013 U.S. Dist. LEXIS 94855, Counsel Stack Legal Research, https://law.counselstack.com/opinion/eweka-v-hartford-life-accident-insurance-vaed-2013.