Hertz v. Hartford Life & Accident Insurance Co.

991 F. Supp. 2d 1121, 2014 WL 97308, 2014 U.S. Dist. LEXIS 3103
CourtDistrict Court, D. Nevada
DecidedJanuary 10, 2014
DocketNo. 3:12-CV-00141-LRH-RAM
StatusPublished
Cited by3 cases

This text of 991 F. Supp. 2d 1121 (Hertz v. Hartford Life & Accident Insurance Co.) is published on Counsel Stack Legal Research, covering District Court, D. Nevada primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Hertz v. Hartford Life & Accident Insurance Co., 991 F. Supp. 2d 1121, 2014 WL 97308, 2014 U.S. Dist. LEXIS 3103 (D. Nev. 2014).

Opinion

ORDER

LARRY R. HICKS, District Judge.

Before the Court is Defendant Hartford Life and Accident Insurance Company’s (“Hartford”) Motion for Summary Judgment. Doc. # 50.1 Plaintiff Barbara Hertz (“Hertz”) filed a Response (Doc. # 57), to which Hartford replied (Doc. #58). Also before the Court is Hertz’s Motion for Judgment Under Federal Rule of Civil Procedure 52. Doc. # 52. Hartford filed a Response (Doc. # 55), to which Hertz replied (Doc. # 60).

I. Introduction

This is an action for long term disability (“LTD”) benefits pursuant to the Employee Retirement and Income Security Act of 1974 (“ERISA”), 29 U.S.C. § 1001 et seq., brought by Hertz against Hartford. The suit stems from Hartford’s alleged wrongful termination of Hertz’s LTD benefits. Hertz commenced this action on March 15, 2012, after exhausting all administrative remedies required under ERISA. Doc. # 1. On May 9, 2012, Hertz filed a First Amended Complaint (“FAC”). Doc. # 10. On June 27, 2013, Hartford filed the present Motion for Summary Judgment. Doc. # 50. On June 28, 2013, Hertz filed the present Motion for Judgment Under Federal Rule of Civil Procedure 52. Doc. #52.

II. Findings of Fact

“In bench trials, [Federal Rule of Civil Procedure] 52(a) requires a court to ‘find the facts specially and state separately its conclusions of law thereon.’ ” Vance v. American Hawaii Cruises, Inc., 789 F.2d 790, 792 (9th Cir.1986) (quoting F.R.C.P. 52(a)). The following constitutes the Court’s findings of fact based on the Administrative Record (“AR”), the parties’ uncontested admissions, and extrinsic evidence submitted with the Motions presently before the Court.

A. Hertz’s Long Term Disability Coverage Under The Plan

At all relevant times, Hertz was employed by Intuit, Inc. Doc. # 10, ¶ 5; Doc. # 11, ¶ 5. As a result of her employment, Hertz was, and continues to be, a participant in The Group Long Term Disability Plan (the “Plan”), an employee welfare benefit plan regulated by ERISA. Doc. # 10, ¶ 6; Doc. # 11, ¶ 6; AR 000001-50. The Plan designates and names Hartford as the claims fiduciary for benefits provided under the policy. AR 000034, 37. [1125]*1125Hartford both administers and pays benefits under the Plan. Doc. # 10, ¶ 12, ¶ 16; Doc. # 11, ¶ 12, ¶ 16. Hartford also has “full discretion and authority to determine eligibility for benefits and to construe and interpret all terms and provisions of [the Plan].” AR 000019. The Plan provides LTD benefits equal to 66 2/3 percent of the participant’s pre-disability income if the participant meets the Plan’s definition of “Disability” and remains disabled through a 180-day elimination period. AR 000008-10. In order to qualify for LTD benefits, a participant must provide proof of his or her disability as defined by the Plan. AR 000018. The Plan provides that benefits will be terminated when a participant no longer meets the definition of “Disabled” or when a participant fails to provide proof of his or her disability when requested by Hartford. AR 000011. “Disability” or “Disabled” is defined in the Plan as follows:

during the Elimination Period and for the next 24 months [the participant is] 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.
Your failure to pass a physical examination required to maintain a license to perform the duties of Your Occupation does not alone mean that you are Disabled.

AR 000020. “Essential Duty” is defined as “a duty that: 1. is substantial, not incidental; 2. is fundamental or inherent to the occupation; and 3. can not be reasonably omitted or changed.” AR 000021. The Plan applies a ‘Your Occupation” definition of “Disability” for the first 24 months. AR 000020. Thereafter, the more stringent “Any Occupation” definition of “Disability” applies. AR 000020. “Any Occupation” is defined as “an occupation for which you are qualified by education, training or experience, and that has an earning potential greater than an amount equal to the lesser of the product of your Indexed Pre-disability Earnings and the Benefit Percentage and the Maximum Monthly Benefit shown in the Schedule of Insurance.” AR 000020.

On October 13, 2006, Hertz stopped working as a Customer Service Manager at Intuit, Inc. due to lumbar degenerative disc disease and cervical degenerative disc disease. AR 000069, 561. On March 14, 2007, Hartford approved Hertz’s claim for LTD benefits. AR 000051-53. Hartford determined that Hertz’s condition, limitations, and restrictions prevented her from performing the material duties of her own sedentary occupation. Doc. # 10, ¶ 29; Doc. #11, ¶ 29. Periodically thereafter, Hartford re-evaluated Hertz’s claim and requested supplemental information from her physicians. AR 000494-552, 581, 582.

On June 18, 2007, Hartford informed Hertz that she would be required to apply for Social Security Disability (“SSD”) benefits. AR 000055-56. Hertz applied for SSD benefits and the Social Security Administration (“SSA”) determined that she was disabled as of October 16, 2006. AR 000057-60. On February 6, 2008, Hertz informed Hartford that she had been awarded SSD Benefits in the amount of $1,064 per month. AR 000541. On February 13, 2008, Hartford informed Hertz [1126]*1126that it had overpaid her in the amount of $9,680.16 based on her receipt of SSD Benefits. AR 000063-64. Hartford also informed Hertz that her net monthly benefit would be reduced to $1,248.89 based on the offset from her monthly receipt of SSD Benefits. AR 000063-64. Thereafter, Hertz repaid to Hartford the total amount of overpayment due to her receipt of SSD Benefits. AR 000539-40.

On November 13, 2008, Hartford notified Hertz that the first twenty-four (24) months of her LTD benefits, during which time her “Disability” was evaluated by reference to ‘Tour Occupation,” was set to expire on April 21, 2009. AR 000575-576. Hartford further advised Hertz that it would be initiating an investigation to determine if she qualified for LTD benefits under the more stringent “Any Occupation” definition of “Disability.” AR 000575-576. Finally, Hartford requested that Hertz and her treating physician complete and return several forms related to her disability. AR 000575-576.

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991 F. Supp. 2d 1121, 2014 WL 97308, 2014 U.S. Dist. LEXIS 3103, Counsel Stack Legal Research, https://law.counselstack.com/opinion/hertz-v-hartford-life-accident-insurance-co-nvd-2014.