Goldman v. HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY

417 F. Supp. 2d 788, 2006 U.S. Dist. LEXIS 7118, 2006 WL 461857
CourtDistrict Court, E.D. Louisiana
DecidedFebruary 23, 2006
DocketCiv.A. 03-0759
StatusPublished
Cited by11 cases

This text of 417 F. Supp. 2d 788 (Goldman v. HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY) is published on Counsel Stack Legal Research, covering District Court, E.D. Louisiana primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Goldman v. HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY, 417 F. Supp. 2d 788, 2006 U.S. Dist. LEXIS 7118, 2006 WL 461857 (E.D. La. 2006).

Opinion

ORDER AND REASONS

VANCE, District Judge.

This is an action for review of the denial of long-term disability benefits under an employee disability benefit plan governed by the Employee Retirement Income Security Act of 1974, 29 U.S.C. §§ 1001, et seq. Plaintiff Gilbert Goldman now moves for summary judgment and defendant Hartford Life and Accident Company moves to strike Goldman’s pleadings and to impose sanctions. For the reasons stated below, the Court DENIES Goldman’s motion for summary judgment and DENIES Hartford’s motion to strike and for sanctions.

I. BACKGROUND

Gilbert Goldman is a former employee of Baroid, a division of the Halliburton Company. On March 23, 2001, Goldman injured his head, arm and neck while he worked as a mud engineer on an offshore drilling rig. This action stems from Goldman’s attempts to collect long-term disability benefits as a result of this accident.

A. The Plan

Goldman’s claims in this case arise under the Halliburton long-term disability insurance plan. (See Admin. Rec. at H- *791 1792-H-1832). Defendant Hartford Life and Accident Insurance Company insures the plan and also makes benefit determinations under the plan. {See Admin. Rec. at H-1821 (“The Hartford reserves the right to determine if your proof of loss is satisfactory.”)). An employee is eligible for benefits under the plan if he has a “disability,” as that term is defined by the plan. The plan provides two definitions of disability. During the 180-day “Elimination Period” 1 and the next two years, a “disability” is an injury or illness that prevents the employee from performing an essential duty of his occupation and causes him to suffer a decline in earnings. {See Admin. Rec. at H-1801). At the end of that time period, the definition of disability changes to mean an injury or illness that prevents the employee from performing an essential duty of any occupation for which he is qualified that provides the potential to make more than 60% of his predisability earnings. {See Admin. Rec. at H-1801). Benefits under the plan are equal to 60% of lost income for the first three years of disability and are reduced to 30% of lost income thereafter. {See Admin. Rec. at H-1797-H-1798).

To make a claim for benefits under the plan, an employee must provide Hartford with written notice of disability and proof of loss establishing the disability. {See Admin. Rec. at H-1820-H-1821). If Hartford denies the claim, the plan requires Hartford to provide the claimant with written notice of the decision, including the specific reasons for the denial, the specific policy provisions on which the denial is based, a description of any additional information necessary for processing the claim, and an explanation of the claims appeal procedure. {See Admin. Rec. at H-1821).

Once Hartford denies a claim, the claimant may appeal the decision for a full and fair review of the claim. (See Admin. Rec. at H-1822). The plan provides that appeals will be decided within 60 days under most circumstances and within 120 days in all cases. (See Admin. Rec. at H-1822).

B. Procedural History

On February 3, 2003, Goldman sued Hartford in Louisiana state court for long-term disability benefits under the plan. Hartford removed the action to this Court in March 2003 on the ground that this Court had jurisdiction over Goldman’s claims under the Employee Retirement Income Security Act, 29 U.S.C. §§ 1001, et seq. Around the time that Hartford removed Goldman’s action to this Court, Goldman applied with Hartford for long-term disability benefits under the plan. The Court stayed this action in order to allow the parties to complete the administrative review process on Goldman’s claims. Hartford ultimately denied Goldman’s claim on the ground that he was not a covered employee eligible for benefits under the plan.

On October 27, 2004, this Court found that Hartford had abused its discretion in determining that Goldman was not covered by the plan. The Court determined that Goldman was, in fact, a covered employee and remanded the matter to Hartford for a determination of whether Goldman was entitled to benefits under the terms of the plan. (See Rec. Doc. 129).

On November 30, 2004, Hartford informed Goldman that it needed additional information in order to evaluate his reopened claim for benefits. (See Admin. Rec. at H-1131-H-1134). On December *792 21, 2004 and January 28, 2005, Hartford again requested additional information from Goldman. (See Admin. Rec. at H-1119-H-1120, H-1114-H-1115). On March 10, 2005, Hartford denied Goldman’s claim for benefits on the ground that Goldman had failed to provide it with sufficient proof of loss in a timely manner. (See Admin. Rec. at H-1107-H-1113). In its March 10, 2005 letter, Hartford provided Goldman with a detailed list of the information that it still needed from him in order to determine his eligibility for benefits under the plan. (See Admin. Rec. at H-1110-H-1112). Hartford also informed Goldman that he had the right to administratively appeal Hartford’s decision. (See Admin. Rec. at H-1112).

After Hartford denied his claim, Goldman did not appeal administratively, but instead moved in this Court for a judgment determining that Hartford owed him benefits. (See Rec. Docs. 131-36). The Court denied Goldman’s motion because his first case was closed and the matter was still before Hartford. (See Rec. Doc. 139). Goldman moved for reconsideration of the Court’s April 5, 2005 order, and the Court denied his motion. (See Rec. Doc. 145). The Court again explained that its October 27, 2004 decision that Goldman was covered under the plan did not establish that he was entitled to benefits under the plan. The Court stated that this action was closed and that Goldman could file a new civil action in this Court if, after exhausting his administrative remedies with Hartford, he remained dissatisfied with Hartford’s disposition of his claim. Goldman filed a second motion for reconsideration, which the Court denied. (See Rec. Doc. 154). The Court reiterated that the action was closed and warned Goldman’s counsel that additional filings of this nature could subject him to sanctions.

Goldman appealed Hartford’s decision to deny his claim for benefits by letter dated May 2, 2005. (See Admin. Rec. at H-1639). On June 14, 2005, Hartford informed Goldman that it needed additional time to render a decision on his May 2, 2005 appeal and that a decision would be made no later than July 31, 2005. (See Admin. Rec. at H-1787-H-1789). On July 20, 2005, Hartford rendered a decision on Goldman’s appeal. (See Admin. Rec.

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417 F. Supp. 2d 788, 2006 U.S. Dist. LEXIS 7118, 2006 WL 461857, Counsel Stack Legal Research, https://law.counselstack.com/opinion/goldman-v-hartford-life-and-accident-insurance-company-laed-2006.