Harvey v. Standard Insurance

850 F. Supp. 2d 1269, 2012 WL 1035428, 2012 U.S. Dist. LEXIS 45606
CourtDistrict Court, N.D. Alabama
DecidedMarch 29, 2012
DocketCase No. 4:10-CV-3230-VEH
StatusPublished
Cited by5 cases

This text of 850 F. Supp. 2d 1269 (Harvey v. Standard Insurance) is published on Counsel Stack Legal Research, covering District Court, N.D. Alabama primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Harvey v. Standard Insurance, 850 F. Supp. 2d 1269, 2012 WL 1035428, 2012 U.S. Dist. LEXIS 45606 (N.D. Ala. 2012).

Opinion

MEMORANDUM OPINION

VIRGINIA EMERSON HOPKINS, District Judge.

I. INTRODUCTION

Pending before the court are the following cross-motions for judgment on the merits: Plaintiffs Motion for Judgment on the Record with Submissions (doc. 8) (the “Plaintiffs Motion for Judgment”), and Defendant Standard Insurance Company’s Motion for Summary Judgment (doc. 19) (the “Defendant’s Motion for Summary Judgment”). The parties have fully briefed these Motions (see docs. 9, 11, 13, 18, 20, 21, 41, 42, and 47),1 and they are now under submission.

[1271]*1271The court has carefully considered the parties’ arguments, the evidentiary submissions and the administrative record, and the relevant applicable law. For the reasons stated in this Memorandum Opinion, the court concludes that Defendant’s Motion for Summary Judgment is due to be granted and, accordingly, Plaintiffs Motion for Judgment is due to be denied.

II. PROCEDURAL BACKGROUND

Plaintiff Sheryl Harvey (“Ms. Harvey”) is a plan participant in a short- and long-term disability benefits plan (“the Plan”) issued by Defendant Standard Insurance Company (“Standard”) to her former employer, Jeff Owens & Associates, Inc. (Doc. 17-1). This action involves Ms. Harvey’s claims for long-term disability (“LTD”) benefits under the Plan; she previously received short-term disability (“STD”) benefits from the Plan but those are not an issue before this court.

The action was commenced in the Circuit Court of Etowah County. (Doc. 1, Ex. A). Standard removed the action to this court on November 24, 2010. (Doc. 1). There is no issue regarding subject matter jurisdiction. The Complaint alleges, and Standard agrees, that the action is brought under and controlled by the Employee Retirement Income Security Act of 1974, 29 U.S.C. § 1001 et seq. (“ERISA”).

III. FACTUAL BACKGROUND2

A. The Group Policy

Standard issued the Certificate and Summary Plan Description Group Long-Term Disability Insurance, Policy No. 923454-B, to Jeff Owens & Associates, Inc., effective January 1, 2006 (the “LTD Group Policy” or “Plan”). (AR 464-91).3 The LTD Group Policy contains a 90-day benefit waiting period. (AR 468). To bridge the 90-day waiting period, employees were covered by a separate STD policy also issued by Standard. (AR 865-89). Standard paid Ms. Harvey benefits under the STD policy for the maximum benefit period.

The LTD Group Policy covers two classes of members. (AR 464-91). Ms. Harvey falls under Class 2, which includes all other members (not certified public accountants). Accordingly, she was eligible for LTD benefits based on an “Own Occupation” definition of disability for the first [1272]*127224 months, and a broader “Any Occupation” definition thereafter. (AR 467-68).

The LTD Group Policy provides, in pertinent part:

DEFINITION OF DISABILITY

You are Disabled if you meet the following definitions during the periods they apply:
A. Own Occupation Definition of Disability.
B. Any Occupation Definition of Disability
A. Own Occupation Definition of Disability
During the Benefit Waiting Period and the Own Occupation Period you are required to be Disabled only from your Own Occupation.
You are Disabled from your Own Occupation if, as a result of Physical Disease, Injury, Pregnancy or Mental Disorder:
1. You are unable to perform with reasonable continuity the Material Duties of your Own Occupation; and
2. You suffer a loss of at least 20% in your Indexed Predisability Earnings when working in your Own Occupation.
Note: You are not Disabled merely because your right to perform your Own Occupation is restricted, including a restriction or loss of license.
Own Occupation means any employment, business, trade, profession, calling or vocation that involves Material Duties of the same general character as the occupation you are regularly performing for your Employer when Disability begins. In determining your Own Occupation, we are not limited to looking at the way you perform your job for your Employer, but we may also look at the way the occupation is generally performed in the national economy. If your Own Occupation involves the rendering of professional services and you are required to have a professional or occupational license in order to work, your Own Occupation is as broad as the scope of your license.
Material Duties means the essential tasks, functions and operations, and the skills, abilities, knowledge, training and experience, generally required by employers from those engaged in a particular occupation that cannot be reasonably modified or omitted. In no event will we consider working an average of more than 40 hours per week to be a Material Duty.

(AR 473-74) (emphasis added).

Standard served as the Administrator responsible for processing and evaluating disability claims made by participants and for construing the terms of the Group Policy. (AR 464-91). The LTD Group Policy included an “Allocation Of Authority” clause that provided for Standard to “have full and exclusive authority to control and manage the Group Policy, to administer claims, and to interpret the Group Policy and resolve all questions arising in the administration, interpretation and application of the Group Policy.” (AR 487).

B. Ms. Harvey’s Occupation

Ms. Harvey worked as a bookkeeper for Jeff Owens & Associates, Inc. for more than ten years. The company provided a basic job description to Standard that described her duties, which included: (1) maintaining client payroll accounts, (2) sales tax reports; (3) balancing bank statements; (4) general phone and front desk responsibilities; (5) maintaining work lists of clients; (6) completing personal property tax returns; (7) Quickbooks software computer training; (8) call in request for corporate names for new corporations; (9) standard and customary office responsibilities such as filing, faxing, client contact, [1273]*1273and (10) during tax season, logging in and assembly of client information, and pulling and distributing tax files to the accountant. (AR 658).

C. Ms. Harvey’s Claim for STD Benefits

Ms. Harvey came out of work on April 13, 2009 due to back pain. She completed a Disability. Insurance Employer/Employee’s Statement (AR 106) and also submitted an Attending Physician’s Statement (“APS”) by her treating physician, Thomas A. Wilson, M.D., dated April 20, 2009. Dr. Wilson listed Ms. Harvey’s diagnosis as lumbar disc degeneration and scoliosis and indicated that her symptoms were back and leg pain. (AR 336). He recommended that she stop working on April 13, 2009, and return for a follow-up in six weeks. (Id.). He declined to complete the section concerning her Level of Functional Impairment. (Id.).

Free access — add to your briefcase to read the full text and ask questions with AI

Related

Smith v. Cox Enterprises, Inc.
81 F. Supp. 3d 1366 (N.D. Georgia, 2015)
Sheryl Harvey v. Standard Insurance Companyh
556 F. App'x 934 (Eleventh Circuit, 2014)
Blair v. Metropolitan Life Insurance
955 F. Supp. 2d 1229 (N.D. Alabama, 2013)
Howard v. Hartford Life & Accident Insurance
929 F. Supp. 2d 1264 (M.D. Florida, 2013)

Cite This Page — Counsel Stack

Bluebook (online)
850 F. Supp. 2d 1269, 2012 WL 1035428, 2012 U.S. Dist. LEXIS 45606, Counsel Stack Legal Research, https://law.counselstack.com/opinion/harvey-v-standard-insurance-alnd-2012.