Farr v. Hartford Life & Accident Insurance

564 F. Supp. 2d 1255, 2008 U.S. Dist. LEXIS 85850, 2008 WL 2663301
CourtDistrict Court, D. Kansas
DecidedJune 30, 2008
DocketCivil Action 07-1242-MLB
StatusPublished

This text of 564 F. Supp. 2d 1255 (Farr v. Hartford Life & Accident Insurance) is published on Counsel Stack Legal Research, covering District Court, D. Kansas primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Farr v. Hartford Life & Accident Insurance, 564 F. Supp. 2d 1255, 2008 U.S. Dist. LEXIS 85850, 2008 WL 2663301 (D. Kan. 2008).

Opinion

MEMORANDUM AND ORDER

MONTI L. BELOT, District Judge.

This matter comes before the court on cross motions for summary judgment. Plaintiff Janice M. Farr filed a motion for summary judgment (Docs. 12, 13), which has been fully briefed (Docs. 17, 18) and is ripe for decision. Defendant Hartford Life and Accident Insurance Company (“Hartford”) filed a motion for judgment on the administrative record (Docs. 14, 15), which has also been fully briefed (Docs. 16, 21) and is ripe for decision.

In addition, Hartford filed a motion to strike and for attorneys’ fees (Docs. 19, 20), which relates to an exhibit (Doc. 18 Exh. 3) attached to plaintiffs reply brief; plaintiff responded (Doc. 22); and Hartford replied (Doc. 23).

This is an action under the Employee Retirement Income Security Act of 1974 (“ERISA”), 29 U.S.C. §§ 1001 et seq. *1258 ERISA governs employee benefit plans. 29 U.S.C. § 1003. Plaintiff brings her claim under 29 U.S.C. § 1132(a)(1)(B), which grants the right to bring a civil action under ERISA “to recover benefits due to [a plan participant] under the terms of his plan, to enforce [a plan participant’s] rights under the terms of the plan, or to clarify [a plan participant’s] rights to future benefits under the terms of the plan.”

I.FACTS

Plaintiff was at one time a participant in an employee welfare, long term disability plan (“LTD Plan”) sponsored by her then employer, Via Christi Health System (“Via Christi”). Via Christi is the LTD Plan administrator; Hartford issued and delivered the LTD Plan; and Hartford has full discretion to determine the viability of claims for benefits under the LTD Plan. The LTD Plan grants this discretion to Hartford to determine benefit claims. It provides: “We have full discretion and authority to determine eligibly for benefits and to construe and interpret all terms and provisions of the Group Insurance Policy.”

The LTD Plan provided long-term disability benefits to qualified, eligible participants who satisfied all terms and conditions of the policy of insurance insuring the LTD Plan. The LTD Plan provides:

Disability or Disabled means that during the Elimination Period and for the next 24 months you are prevented by:
1. accidental bodily injury;
2. sickness;
3. Mental Illness;
4. Substance Abuse; or
5. pregnancy,
from performing one or more of the Essential Duties of Your Occupation, and as a result your Current Monthly Earnings are no more than 80% of your Indexed Pre-disability Earnings.
After that, you must be so prevented from performing one or more of the Essential Duties of Any Occupation.
Your failure to pass a physical examination required to maintain a license to perform the duties of Your Occupation does not alone mean that you are Disabled.

The LTD Plan defines “Any Occupation” as:

Any Occupation means an occupation for which you are qualified by education, training or experience, and that has an earnings potential greater than an amount equal to the lesser of the product of your Indexed Pre-disability Earnings and the Benefit Percentage and the Maximum Monthly Benefit shown in the Schedule of Insurance.

While an employee of Via Christi, plaintiff became unable to perform one or more of the essential duties of her occupation, and she last worked on July 12, 2004. As of her last day at work, plaintiffs “Pre-Disability Earnings” were $4333.33 per month. Plaintiff submitted a claim for benefits to Hartford on October 22, 2004. The LTD Plan provides for an “elimination period” of ninety days, during which plaintiff did not receive benefits. Hartford approved plaintiffs claim for benefits on December 6, 2004; it paid benefits for twenty-four months during the “own occupation” period, from October 15, 2004 through November 30, 2006.

Hartford then requested information from plaintiff to determine whether plaintiff qualified for “any occupation” benefits under the LTD Plan. Hartford asked plaintiff: “Please list the name(s), addresses) and telephone numbers of any physicians that you have consulted and/or been treated by within the last 18 months.” Plaintiff represented to Hart *1259 ford that she had been treated by Dr. Georgia Ohlberg (“Dr. Ohlberg”) in the eighteen months prior to May 1, 2006, and also informed Hartford that “prior physicians have been listed on prior forms. No change.” In other portions of the administrative record, it shows that a Dr. Littell last saw plaintiff in August 2004, Dr. Mills last saw plaintiff in September 2004, and Dr. Fields last saw plaintiff in December 2004. In addition, there is no indication in the administrative record of plaintiff advising Hartford that any physician other than Dr. Ohlberg treated her subsequent to May 1, 2006. 1

Dr. Ohlberg submitted to Hartford an “Attending Physicians Statement” regarding plaintiff; she was the only treating provider to submit an attending physician statement. In a February 13, 2006, Physical Capacities Evaluation (“PCE”) completed by Dr. Ohlberg, the doctor concluded that plaintiff was capable of handling, fingering, and feeling constantly. A copy of Dr. Ohlberg’s PCE was provided to plaintiff. 2 Plaintiff never submitted to Hartford any document signed by Dr. Ohl-berg after February 13, 2006 in which Dr. Ohlberg expressed an opinion contrary to her February 13, 2006 determination that plaintiff was capable of handling, fingering and feeling “constantly.”

Dr. Joseph E. Tuthill (“Dr. Tuthill”), a medical doctor specializing in internal medicine, reviewed plaintiffs medical records from December 2, 2002 to July 27, 2006 and spoke with Dr. Ohlberg. Dr. Tuthill concluded in September 2006: 1) his medical opinion was that plaintiff was capable of consistently performing the physical abilities outlined by Dr. Ohlberg on the PCE of February 13, 2006; 2) based on his review of the submitted documents, it was his medical opinion, with a reasonable degree of medical certainty, that plaintiff was not restricted from performing full-time work; and 3) in his opinion, based on the information he had received, there were no medically supported restrictions.

In October 2006, Dr. Michael H. Mun-hall (“Dr. Munhall”), a medical doctor specializing in physical medicine and rehabilitation performed an independent medical examination of plaintiff. Dr. Munhall submitted the report of his examination, which provided an expert opinion of plaintiffs physical capacities, to Hartford. Dr.

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Bluebook (online)
564 F. Supp. 2d 1255, 2008 U.S. Dist. LEXIS 85850, 2008 WL 2663301, Counsel Stack Legal Research, https://law.counselstack.com/opinion/farr-v-hartford-life-accident-insurance-ksd-2008.