Giertz-Richardson v. Hartford Life & Accident Insurance

536 F. Supp. 2d 1280, 2008 U.S. Dist. LEXIS 17896, 2008 WL 648988
CourtDistrict Court, M.D. Florida
DecidedMarch 7, 2008
Docket8:06-cv-1874-T-24 MAP
StatusPublished
Cited by10 cases

This text of 536 F. Supp. 2d 1280 (Giertz-Richardson v. Hartford Life & Accident Insurance) is published on Counsel Stack Legal Research, covering District Court, M.D. Florida primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Giertz-Richardson v. Hartford Life & Accident Insurance, 536 F. Supp. 2d 1280, 2008 U.S. Dist. LEXIS 17896, 2008 WL 648988 (M.D. Fla. 2008).

Opinion

ORDER

SUSAN C. BUCKLEW, District Judge.

This cause comes before the Court on the parties’ cross-motions for summary judgment and responses thereto. (Doc. Nos. 55, 56, 63 and 65.)

I. Standard of Review

Summary judgment is appropriate “if the pleadings, depositions, answers to interrogatories and’ admissions on file, together with the affidavits, if any, show that the moving party is entitled to judgment as a matter of law.” Fed.R.Civ.P. 56(c). The Court must draw all inferences from the evidence in the light most favorable to the non-movant and resolve all reasonable doubts in that party’s favor. See Porter v. Ray, 461 F.3d 1315, 1320 (11th Cir.2006) (citation omitted). The moving party bears the initial burden of showing the Court, by reference to materials on file, that there are no genuine issues of material fact that should be decided at trial. See id. (citation omitted). When a moving party has discharged its burden, the non-moving party must then go beyond the pleadings, and by its own affidavits, or by depositions, answers to interrogatories, and admissions on file, designate specific facts showing there is a genuine issue for trial. See id. (citation omitted).

II. Background 1

This action is governed by the Employee Retirement Income Security Act of 1974, *1283 29 U.S.C. § 1001 et seq. (“ERISA”). Plaintiff Holly Giertz-Riehardson (“Plaintiff’) is challenging Defendant Hartford Life and Accident Insurance Company’s (“Defendant”) decision to terminate payment of long-term disability (“LTD”) benefits to her. (Doc. No. 1, ¶ 6.) Plaintiff is a participant, or beneficiary, of an ERISA welfare benefit plan funded by a group insurance policy (the “Policy”) issued by Defendant. (Id. at ¶¶2-3.) The Policy gives Defendant “full discretion and authority to determine eligibility for benefits and to construe and interpret all terms and provisions” of the Policy. (Doc. No. 1, Exh. A at 27.)

According to the Policy, LTD benefits are payable to a participant if: the participant becomes disabled while insured under the policy; the participant remains disabled throughout and beyond the elimination period; the participant is, and has been during the elimination period, under the regular care of a physician; and the participant submits proof of loss satisfactory to Defendant. (Id. at 9.) The Policy defines “disability” or “disabled” thusly:

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.

(Id. at 29.) Eligibility for LTD benefits is conditioned on the participant providing Defendant with satisfactory proof of disability. (Id. at 23.) Defendant may request proof of loss throughout the participant’s disability, and has the right to determine whether the proof of loss is satisfactory. (Id. at 23-24.) Payment of LTD benefits stops when a participant is no longer disabled, or when a participant fails to furnish proof of loss, when requested by Defendant. (Id. at 10.)

Plaintiff was employed by JM Family as a Vice President for JM & A Group World Omni Financial (“JM & A”). (Doc. No. 63, ¶ 6.) JM & A’s written job description of Plaintiffs position provided that Plaintiff:

Plans, directs and coordinates specific short and long-term initiatives that support organizational and corporate growth and objectives. Conceptualizes, recommends and develops new programs, strategies and approaches for the achievement of maximizing organizational performance and business success while linking business and people components. Collaborates with President, General Manager and Sr. Management in establishing group, company or corporate-wide priority improvement, programs and/or initiatives.
Maintains and constantly works towards supporting and improving the impact of the organization’s and companies’ overall effectiveness. Establishes high performance standards for the company(s) that ensures “Increased Productivity” and “Service Excellence.” May seek out and assist in developing strong operational efficiencies and processes in various departments. Maximizes and builds management and leadership effectiveness throughout the organization.
Directs planning, research and development efforts in defining strategic goals, objectives and programs for the achievement of the company’s growth and overall profitability. Directs and communicates results of studies to as *1284 sess organization’s performance against plans.
Provides leadership and management direction to various operating units to ensure overall effectiveness. May be responsible for the successful operation of a major group(s), division(s), company(s) or department(s).

(A.R.H-448.) 2 Plaintiff was diagnosed with Multiple Sclerosis (“MS”) in 1997, and continued to work until June of 2000. (A.R.H-472, H-154.) On October 1, 2000, Plaintiff applied for LTD benefits, claiming a disability due to MS. (A.R.H-1219.) Her claim was approved and Defendant paid benefits to her from January 2001 through December 2004.

On June 10, 2002, Defendant informed Plaintiff that according to her group policy, in order to be eligible for LTD benefits, she must meet a new definition of disability:

Totally Disabled means that:
1. during the Elimination Period; and
2. for the next 24 months,
you are prevented by Disability from doing all the material and substantial duties of your own occupation on a full-time basis. After that, and for as long as you remain Totally Disabled, you are prevented by Disability from doing any occupation or work for which you are, or could become, qualified by:
1. training; or
2. education; or
3. experience.

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Bluebook (online)
536 F. Supp. 2d 1280, 2008 U.S. Dist. LEXIS 17896, 2008 WL 648988, Counsel Stack Legal Research, https://law.counselstack.com/opinion/giertz-richardson-v-hartford-life-accident-insurance-flmd-2008.