Frerichs v. Hartford Life & Accident Insurance

875 F. Supp. 2d 923, 2012 WL 2366423, 2012 U.S. Dist. LEXIS 85838
CourtDistrict Court, D. Minnesota
DecidedJune 21, 2012
DocketCivil No. 10-3340 (SRN/LIB)
StatusPublished
Cited by2 cases

This text of 875 F. Supp. 2d 923 (Frerichs 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
Frerichs v. Hartford Life & Accident Insurance, 875 F. Supp. 2d 923, 2012 WL 2366423, 2012 U.S. Dist. LEXIS 85838 (mnd 2012).

Opinion

MEMORANDUM OPINION AND ORDER

SUSAN RICHARD NELSON, District Judge.

This matter is before the Court on Defendant’s Motion for Summary Judgment [Doc. No. 47] and Plaintiffs Motion for Summary Judgment [Doc. No. 52], For the reasons set forth herein, Defendant’s motion is denied, and Plaintiffs motion is granted.

Plaintiff Craig Frerichs graduated from the University of Minnesota Dental School in 1978 and began working in his field immediately thereafter. (See Administrative Record (“AR”)-HART000725.) From 1999 through 2006, he was employed by PDG, PA/The Dental Specialists (“PDG” or “Park Dental Group”). (AR-HART000652.) Frerichs was an eligible plan participant in his employer’s benefit plan (the “Plan”), for which PDG obtained a group insurance policy (the “Policy”) from Defendant Hartford Life and Accident Insurance Company (“Hartford”). (AR-HART000903-27.) The Policy provided long-term disability coverage and other benefits to eligible employees. (Id.)

In July 2006, Dr. Frerichs filed a claim for long-term disability under the Policy, identifying spinal degeneration and depression as his disabling conditions. (AR-HART000710.) Initially, Hartford approved Plaintiffs claim and paid benefits from May 2006 until April 2009. (AR-HART000023.) However, after receiving an anonymous tip in 2008, Hartford investigated Plaintiffs claim and conducted surveillance of Dr. Frerichs. (AR-[926]*926HART000188.) Following its investigation and review of Plaintiffs claim, Hartford terminated his long-term disability benefits in April 2009. (HART000023-29.) Dr. Freriehs appealed the termination decision. (AR-HART000275-96.) Hartford briefly reinstated Freriehs’ disability benefits from April to August 2009 while he recovered from rotator cuff surgery (AR-HART000002), but, in November 2009, affirmed its decision that Plaintiffs back pain and depression did not render him totally disabled from working as a dentist. (AR-HART000002-12.)

Plaintiff filed the instant action on August 4, 2010, alleging that Hartford breached its contract by failing to provide long-term disability benefits, in violation of ERISA, 29 U.S.C. § 1132(a)(1)(B). (Compl. [Doc. No. 1].) The parties have filed cross motions for summary judgment.

I. BACKGROUND

A. The Policy

The Policy delegates to Hartford “full discretion and authority to determine eligibility for benefits and to construe and interpret all terms and provisions of the Policy.” (AR-HART000922.) The Policy defines an employee as “disabled” when he or she is “prevented from performing one or more of the Essential Duties of Your Occupation.” (AR-HART000918.) An “essential duty” is one that: “(1) is substantial, not incidental; (2) is fundamental or inherent to the occupation; and (3) can not be reasonably omitted or changed.” (Id.) “Your Occupation” means “your occupation as it is recognized in the general workplace. Your Occupation does not mean the specific job you are performing for a specific employer or at a specific location.” (AR-HART000921.)

B. Medical Evidence 2005-2006

1. Back Pain

Beginning in approximately 1986, Dr. Freriehs experienced back strain and associated pain. (AR-HART000726.) He found that chiropractic care and massage were helpful in managing his back pain. (Id.) While at work at Park Dental on September 15, 2005, Plaintiff reported that he was “bending over a patient and twisting” in order to obtain a better view, when he experienced extreme pain in his back and legs. (AR-HART000708.) Dr. Frerichs contends that the pain was so extreme that it took his breath away, sending him to the floor. (AR-HART000727.) Dr. Freriehs met with his treating physician, Dr. Theodore Groskreutz, the following day. (AR-HART000680.) Dr. Groskreutz noted Plaintiffs chronic lower back pain had been present for at least a three year period and that an MRI showed degenerative disc disease. (Id.) Dr. Groskreutz prescribed a steroid, a Medrol Dosepak, and ordered an MRI of Freriehs’ lumbar spine. (Id.) Dr. Freriehs was off work for approximately 43 days and returned to full-time work on December 1, 2005. (AR-HART000716-17.)

During his time off work in September 2005, Dr. Freriehs treated with orthopedic surgeon Dr. Bryan Lynn at the Institute for Low Back and Neck Care in Minneapolis. (AR-HART000652.) Dr. Lynn noted that Frerich’s medical history was significant for lower back pain and depression. (Id.) He reviewed Plaintiffs most recent MRI scans, which he found to demonstrate moderately advanced disc degeneration at L4-5, with noted reactive end-plate changes. (Id.)

Dr. Freriehs underwent left L5 nerve root block surgery on September 27, 2005, and reported a 60% decrease in pain symptoms following the procedure. (AR-HART000654.) At a follow-up visit with [927]*927Dr. Lynn on October 10, 2005, however, he reported a return in pain symptoms. (AR-HART000656.)

On October 20, 2005, Dr. Frerichs underwent a laminectomy of the L5-S1 level, performed by Dr. Lynn. (AR-HART000660.) At a follow-up appointment with Dr. Lynn on November 3, 2005, Dr. Frerichs reported feeling much better following the surgery. (AR-HART000663.) Dr. Lynn discussed Dr. Frerichs’ possible return to work on a part-time basis: “I suggested he wear [a] brace to try and help with his twisting.” (Id.) In a narrative attached to his 2006 application for long-term disability benefits, Dr. Frerichs stated that while the surgery alleviated much of his pain, “there was no way the surgeon could restore my abilities to what they once were.” (AR-HART000729.) Plaintiff indicated that it became “increasingly more evident that [his] back pain affect[ed] everything [he did] in the office.” (Id.) Dr. Frerichs noted that he could not sit without pain and that he could not take narcotic pain medications because of their adverse effect on his concentration and thinking. (Id.) As a result, he became “very distraught and deeply depressed.” (Id.) On February 25, 2006, he took an overdose of his wife’s Ativan tablets in an attempt to commit suicide. (Id.) He was admitted to the hospital for severe depression. (AR-HART000668.)

Also in February 2006, Dr. Frerichs met with Dr. Lynn, who reported that Frerichs had been doing very well until recently, when he fell on the floor. (Id.) Dr. Lynn diagnosed “acute exacerbation of low back pain.” (Id.) Dr. Lynn recommended that Plaintiff continue taking Ibuprofen and recommended that he consider the use of a muscle relaxant. (Id.)

Dr. Frerichs continued treatment with Dr. Lynn, who recommended that Dr. Frerichs undergo a Functional Capacities Evaluation (“FCE”) to “quantify his physical limitations.” (AR-HART000673.) Dr. Lynn recommended the FCE in light of Plaintiffs multiple issues:

The patient has multiple issues, he reports, related to concerns regarding his ability to continue work as a dentist. In my experience, it would be extraordinarily unusual for someone to be completely disabled from work following a lumbar discectomy. I believe a very large percentage of Mr. Frerichs’ overall functional disability is related to his depression.

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Bluebook (online)
875 F. Supp. 2d 923, 2012 WL 2366423, 2012 U.S. Dist. LEXIS 85838, Counsel Stack Legal Research, https://law.counselstack.com/opinion/frerichs-v-hartford-life-accident-insurance-mnd-2012.