Hodge v. Hartford Life & Accident Ins. Co.

298 F. Supp. 3d 1332
CourtDistrict Court, D. Idaho
DecidedDecember 27, 2017
DocketCASE NO. C17–0087–JCC
StatusPublished
Cited by2 cases

This text of 298 F. Supp. 3d 1332 (Hodge v. Hartford Life & Accident Ins. Co.) is published on Counsel Stack Legal Research, covering District Court, D. Idaho primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Hodge v. Hartford Life & Accident Ins. Co., 298 F. Supp. 3d 1332 (D. Idaho 2017).

Opinion

John C. Coughenour, UNITED STATES DISTRICT JUDGE

This matter comes before the Court on Defendant's motion for summary judgment (Dkt. No. 20), Plaintiff's cross-motion for *1337summary judgment (Dkt. No. 34), and Plaintiff's motion to supplement the administrative record (Dkt. No. 23). Having thoroughly considered the parties' briefing and the relevant record, the Court finds that oral argument is unnecessary and hereby DENIES Defendant's motion for summary judgment, GRANTS Plaintiff's cross-motion for summary judgment in part, and DENIES Plaintiff's motion to supplement the administrative record for the reasons explained herein.

I. BACKGROUND1

Plaintiff Lanette Hodge ("Hodge") last worked in January 2014 as a Licensed Practical Nurse ("LPN") for Intermountain Health Care ("Intermountain") in Idaho. (Dkt. No. 18-5 at 34.) Intermountain provided its employees with a disability insurance benefits plan ("the Plan") funded by a policy issued by Defendant Hartford Life and Accident Insurance Company ("Hartford"). (Dkt. No. 18-1 at 6.) In addition to funding the Plan, Hartford evaluated whether beneficiaries' qualified for long term disability benefits. (Id. at 20.)

1. Eligibility Under the Plan

The Plan defines two classifications of disability. Under the first classification, a beneficiary is disabled if she is unable to perform one or more of the essential duties of her own occupation-i.e. the occupation at the time of disability. (Id. at 21.) This "own occupation" period of disability generally lasts for 12 months after a beneficiary is approved for benefits. (Id. ) Under the second classification, a beneficiary is considered disabled if she is unable to perform one or more of the essential duties of "any occupation." (Id. )

The Plan defines "any occupation" as "any occupation for which you are qualified by education, training or experience, and that has an earnings potential greater than the lesser of: 1) the product of Your Indexed Pre-disability Earnings and the Initial Benefit Period Percentage; or 2) the Maximum Monthly Benefit." (Id. ) To qualify for benefits, a claimant must provide proof of loss that is "satisfactory" to Hartford. (Id. at 18.)

2. Hodge's Pre-Disability Medical History

Hodge began working as an LPN in 1984. (Dkt. No. 18-2 at 38.) In 2011, she started to experience constant pain in her right hip. (Id. at 81.) Hodge attempted to treat the pain with steroid injections, physical therapy, and a right hip bursectomy, but none of the interventions worked. (Id. ) After an MRI revealed degenerative joint disease in 2012, Hodge underwent right total hip arthroplasty (hip replacement) surgery. (Dkt. No. 18-5 at 64.)

A year after surgery, Hodge conducted a follow-up with her orthopedist Dr. Christopher Peters ("Dr. Peters"). (Id. ) Hodge continued to complain of pain in her hip and Dr. Peters gave her a primary diagnosis of right hip osteoarthritis and dysplasia. (Id. at 46.) Dr. Peters also restricted Hodge from lifting more than 15 pounds at work. (Id. at 64.) In January 2014, Intermountain determined that it could not accommodate Hodge's functional restriction and she began a leave of absence from work. (Id. at 62, 65.)

In February 2014, Hodge was reexamined and complained of continued hip pain. (Dkt. No. 18-4 at 92.) Dr. Peters recommended that Hodge undergo a revision of her total hip arthroplasty. (Id. at 94.) Hodge subsequently underwent a hip aspiration procedure followed by revision surgery that made adjustments to her prosthetic hip. (Dkt. No. 18-2 at 64.) Following *1338surgery, Dr. Peters ordered that Hodge not return to work until July 2014. (Dkt. No. 18-4 at 99.)

3. Hodge's Long Term Disability Claim

In June 2014, Hodge applied for long term disability benefits under the Plan. (Dkt. No. 18-4 at 23-27.) Hartford reviewed Hodge's medical records and determined that she qualified for long term disability benefits under the Plan's "own occupation" classification. (Dkt. No. 18-2 at 26-29.) Hodge was subsequently reevaluated multiple times by Dr. Peters, who gave a similar prognosis regarding her hip. (Dkt. No. 18-4 at 23-24, 74-75.) In October 2014, the Social Security Administration ("SSA") awarded Hodge disability benefits, with a qualifying disability date of January 14, 2014. (Id. at 67.)

In March 2015, Hartford began to investigate whether Hodge qualified for continuing disability benefits under the Plan's "any occupation" classification. (Dkt. No. 18-1 at 72-73.) Based on information it received from Dr. Peters, Hartford determined that Hodge could work in a sedentary occupation and was not eligible for disability benefits under the "any occupation" classification. (Dkt. No. 18-3 at 73-75.) Hodge appealed Hartford's denial and provided additional evidence regarding her disability. (Id. at 13-14.) Hodge's evidence included treatment information from Doctor Michael McEntire ("Dr. McEntire") who began treating Hodge for pain management after Hartford denied her disability claim. (Dkt. No. 18-3 at 13-18, 27-39.)

As part of the appeal, Hartford referred Hodge's file for an independent medical record review. (Dkt. No. 18-1 at 91.) Hartford instructed Doctor Behzad Emad ("Emad") to review Hodge's medical records, seek input from Dr. Peters and Dr. McEntire, and render an opinion on any restrictions or limitations affecting Hodge's functionality. (Id. ) Dr. Emad ultimately rendered an opinion that Hodge was able to perform full-time work with certain restrictions and limitations. (Dkt. No. 18-2 at 64-70.) Using Dr. Emad's report, a vocational case manager identified several occupations Hodge could perform. (Id. at 39.) Hartford concluded that Hodge did not qualify for the "any occupation" classification of long term disability and denied her appeal. (Dkt. No. 18-1 at 89-95.)

Hodge brings this suit pursuant to the Employee Retirement Income Security Act of 1974 ("ERISA"), 29 U.S.C. § 1001 et seq. , challenging Hartford's denial of her claim for long term disability benefits. (Dkt. No. 6-1 at 2.)

II. DISCUSSION

ERISA allows a plan participant or beneficiary "to recover benefits due to him under the terms of his plan, to enforce his rights under the terms of the plan, or to clarify his rights to future benefits under the terms of the plan." 29 U.S.C. § 1132(a)(1)(B). The parties have stipulated that ERISA governs this case, and that the Court should decide the case without a trial based on the administrative record and the parties' cross-motions for summary judgment. (Dkt. No. 16 at 2.)

A. ERISA Standard of Review

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Bluebook (online)
298 F. Supp. 3d 1332, Counsel Stack Legal Research, https://law.counselstack.com/opinion/hodge-v-hartford-life-accident-ins-co-idd-2017.