Goewert v. Hartford Life & Acc. Ins. Co.

442 F. Supp. 2d 724, 2006 U.S. Dist. LEXIS 74960, 2006 WL 2092426
CourtDistrict Court, E.D. Missouri
DecidedJuly 26, 2006
Docket4:06CV263 CDP
StatusPublished
Cited by3 cases

This text of 442 F. Supp. 2d 724 (Goewert v. Hartford Life & Acc. Ins. Co.) is published on Counsel Stack Legal Research, covering District Court, E.D. Missouri primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Goewert v. Hartford Life & Acc. Ins. Co., 442 F. Supp. 2d 724, 2006 U.S. Dist. LEXIS 74960, 2006 WL 2092426 (E.D. Mo. 2006).

Opinion

442 F.Supp.2d 724 (2006)

Mark E. GOEWERT, Plaintiff,
v.
HARTFORD LIFE & ACCIDENT INSURANCE COMPANY, Defendant.

No. 4:06CV263 CDP.

United States District Court, E.D. Missouri, Eastern Division.

July 26, 2006.

*725 *726 Gregory A. Oliphant, Law Office of Gregory A. Oliphant, St. Louis, MO, for Plaintiff.

Richard J. Pautler, Thompson Coburn, St. Louis, MO, for Defendant.

MEMORANDUM AND ORDER

PERRY, District Judge.

This matter is before the Court on defendant Hartford Life & Accident Insurance Company's motion for summary judgment. Plaintiff Mark Goewert filed this suit under the Employee Retirement Income Security Act of 1974 ("ERISA"), as amended, 29 U.S.C. § 1001 et seq., alleging that Hartford wrongly denied his claim for long-term disability benefits. Hartford argues that its denial of Goewert's appeal as untimely was not arbitrary and capricious. Goewert asserts that exhaustion of administrative remedies was not mandatory. He also argues that if the Court finds exhaustion was required, he substantially complied with the exhaustion requirement, or alternatively, that his exhaustion is excused because of the futility exception. I find that Hartford's denial was not arbitrary and capricious. Goewert did not exhaust his administrative remedies in a timely manner and the futility exception to exhaustion does not apply. I will grant summary judgment to Hartford.

I. Background

Mark Goewert was employed as a Registered Nurse at Barnes Hospital, where he participated in a group employee welfare benefit plan ("Plan"). Hartford Life & Accident Insurance Company operated as a fiduciary and underwriter for the Plan. For the first two years of a participant's disability, the Plan uses an "own occupation" standard, granting benefits if a participant is unable to perform his own occupation. However, after two years the Plan uses an "any occupation" standard, granting benefits only if a participant is unable to perform any occupation.

Goewert filed a claim for long-term disability benefits in late 1997. In a letter dated January 19, 1998, Hartford approved the claim and granted benefits. Hartford informed Goewert on September 7, 1999, that it had started an investigation into whether his benefits should continue past February 19, 2000, which was the two-year mark upon which the standard for receiving benefits changes to the "any occupation" standard. In an April 17, 2000, letter Hartford denied continued benefits to Goewert, stating that Goewert did not qualify under the Plan's definition of "Total Disability."

On May 8, 2000, one of Goewert's physicians, Dr. Giuffra, sent a letter to Hartford in response to the denial of benefits, stating that he believed Goewert was unable to perform his own or any other occupation. Hartford acknowledged the receipt of Dr. Giuffra's letter and notified Goewert that it did not have the corresponding treatment notes. Hartford received additional medical records, but on July 14, 2000, it informed Goewert that its decision to deny benefits had not changed. In this letter Hartford explained what Goewert should do if he disagreed with its decision:

If you disagree with our denial decision, the Employees Retirement Income Seurity *727 Act of 1974 ("ERISA") provides you with the right to appeal our decision and review pertinent documents in your claim file. If you do not agree with the reason why your claim was denied, in whole or in part, and you wish to appeal our decision, you must write to us within sixty (60) days of the date of this letter. Your letter, which must be signed and dated by you or your legal representative, should clearly outline your position and any issues or comments you have in connection with your claim and our decision to deny your request for benefits under the Policy.

On November 1, 2004, legal counsel for Goewert wrote Hartford appealing the denial of Goewert's 2000 long-term benefits claim and requesting an independent review of his file. Hartford denied the appeal as untimely on November 11, 2004.

II. Discussion

1. Legal Standards

The standards for summary judgment are well settled. In determining whether summary judgment should issue, the Court views the facts and inferences from the facts in the light most favorable to the nonmoving party. Matsushita Elec. Indus. Co., Ltd. v. Zenith Radio Corp., 475 U.S. 574, 587, 106 S.Ct. 1348, 89 L.Ed.2d 538 (1986). The moving party has the burden to establish both the absence of a genuine issue of material fact and that it is entitled to judgment as a matter of law. Fed.R.Civ.P. 56(c); Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 247, 106 S.Ct. 2505, 91 L.Ed.2d 202 (1986); Celotex Corp. v. Catrett, 477 U.S. 317, 322, 106 S.Ct. 2548, 91 L.Ed.2d 265 (1986). Once the moving party has met this burden, the nonmoving party may not rest on the allegations in its pleadings but by affidavit or other evidence must set forth specific facts showing that a genuine issue of material fact exists. Fed.R.Civ.P. 56(e). At the summary judgment stage, I will not weigh the evidence and decide the truth of the matter, but rather I need only determine if there is a genuine issue for trial. Anderson, 477 U.S. at 249, 106 S.Ct. 2505.

The first step in evaluating a denial of benefits claim under ERISA is determining the appropriate standard of review. Although, the Eighth Circuit has said that exhaustion of administrative remedies is a threshold legal question that should be reviewed de novo, Kinkead v. Southwestern Bell Corp. Sickness & Accident Disability Benefit Plan, 111 F.3d 67, 67 (8th Cir.1997), this Court is not deciding whether to deny Goewert's claim based on a failure to exhaust theory. Rather, the Court is reviewing Hartford's denial of benefits for failure to appeal in a timely manner. For evaluating a challenge to a denial of benefits, de novo review is appropriate unless the plan grants its administrator discretionary authority to determine benefit eligibility or construe the terms of the plan. Janssen v. Minneapolis Auto Dealers Ben. Fund, 447 F.3d 1109, 1113 (8th Cir.2006) (citing Firestone Tire & Rubber Co. v. Bruch, 489 U.S. 101, 115, 109 S.Ct. 948, 103 L.Ed.2d 80 (1989)). If a plan gives discretion to a plan administrator, the plan administrator's decision is reviewed under a deferential abuse of discretion standard. Id. Generally, if an administrator's decision is "extraordinarily imprudent or extremely unreasonable, the court is likely to find that there has been an abuse of discretion." Cox v. Mid-America Dairymen, Inc.,

Related

Cite This Page — Counsel Stack

Bluebook (online)
442 F. Supp. 2d 724, 2006 U.S. Dist. LEXIS 74960, 2006 WL 2092426, Counsel Stack Legal Research, https://law.counselstack.com/opinion/goewert-v-hartford-life-acc-ins-co-moed-2006.