Ingravallo v. Hartford Life and Accident Ins. Co.

563 F. App'x 796
CourtCourt of Appeals for the Second Circuit
DecidedApril 24, 2014
Docket13-2006-cv
StatusUnpublished
Cited by6 cases

This text of 563 F. App'x 796 (Ingravallo v. Hartford Life and Accident Ins. Co.) is published on Counsel Stack Legal Research, covering Court of Appeals for the Second Circuit primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Ingravallo v. Hartford Life and Accident Ins. Co., 563 F. App'x 796 (2d Cir. 2014).

Opinion

SUMMARY ORDER

Defendant-Appellant Hartford Life and Accident Insurance Co. (“Hartford”) appeals from the judgment of the District Court denying Hartford’s motion for summary judgment on the administrative record, granting summary judgment for Plaintiff-Appellee Diana Ingravallo, and awarding Ingravallo approximately $19,000 in benefits on her claim pursuant to the Employee Retirement Income Security Act of 1974 (“ERISA”), 29 U.S.C. § 1001 et seq. See Ingravallo v. Hartford Life & Acc. Ins. Co., 10-cv-5150 (FB)(JO), 2013 WL 1346283 (E.D.N.Y. Apr. 3, 2013). We assume the parties’ familiarity with the underlying facts and procedural history, to which we refer only as necessary to explain our decision to reverse.

BACKGROUND

Beginning in August 1997, Diana Ingra-vallo was employed by BDP International (“BDP”) as an air import coordinator. 1 Her full-time, sedentary job required her to sit for most of an eight-hour day, and, occasionally, to lift or carry a small amount of weight. Also in the late 1990s (exactly when is unclear), Ingravallo was diagnosed with relapsing-remitting multiple sclerosis (“MS”), but she was able to work as a coordinator at BDP until May 2005, when she suffered an exacerbation that caused her to experience difficulty walking, among other serious symptoms. In consequence, *798 her treating neurologist opined that she was “no longer able to work in any capacity,” and advised that she withdraw from work “on a permanent basis.” Joint App’x at 864. She stopped working that year.

As a BDP employee, Ingravallo participated in the company’s long-term disability plan (the “Plan”), which is governed by ERISA and administered by Hartford. The Plan defines “disability” as “Injury or Sickness” that “causes physical or mental impairment to such a degree of severity” that the claimant is “continuously unable to perform the Material and Substantial Duties of [her] Regular Occupation” and is “not Gainfully Employed.” Id. at 26 (emphasis omitted). It grants Hartford “discretionary authority to determine [a claimant’s] eligibility for and entitlement to benefits.” Id. at 843. Ingravallo duly applied for benefits under the Plan.

In September 2005, Hartford determined that the exacerbation of Ingravallo’s symptoms rendered her disabled under the Plan and qualified her to receive long-term disability benefits. In 2006, under applicable regulations, the Social Security Administration (“SSA”), too, determined that In-gravallo was disabled and qualified her for governmental benefits, which Ingravallo then began to receive.

Prompted by inconsistencies that it perceived between Ingravallo’s then-recent accounts of her condition and the accounts provided by her treating neurologist, in late 2008 Hartford undertook a re-assessment of Ingravallo’s eligibility for benefits. Several months later, having obtained an updated peer review of her medical condition and two brief surveillance videos, covertly made, of Ingravallo performing chores outside her home, Hartford determined that Ingravallo no longer met the Plan’s definition of “disabled.” In response to her request for an administrative review, Hartford sought an additional medical evaluation and Ingravallo submitted further input from her treating neurologist. In 2010, Hartford upheld the denial. In support of its detailed final decision it cited, among other factors, the opinions of its medical reviewers, inconsistencies in the reports of Ingravallo and her neurologist, observations derived from the surveillance video regarding her current functional capacities, and observations by an investigator who met with Ingravallo for several hours.

Ingravallo then sought judicial review of Hartford’s decision. On cross-motions for summary judgment on the administrative record, the District Court concluded that Hartford’s denial of coverage was arbitrary and capricious and granted Ingraval-lo’s motion for summary judgment and damages. See Ingravallo, 2013 WL 1346283, at *9. The Court pointed, for support, to three perceived errors in Hartford’s determination: (1) that Hartford did not “provide a cogent reason for its disagreement with the [SSA],” id. at *7; (2) that Hartford’s medical reviewers did not address “an important detail”: the “presence of ‘black holes’ on Ingravallo’s most recent MRIs,” id. at *8; and (3) that, although “th[e] videos undoubtedly show Ingravallo doing things that she claimed not to be able to do,” the videos “d[id] not constitute substantial evidence that she is able to [work],” id.

On appeal, Hartford contends that the District Court erred in this conclusion. We agree.

DISCUSSION

In an ERISA action, “we review the district court’s grant of summary judgment based on the administrative record de novo and apply the same legal standard as the district court.” Hobson v. Metro. Life Ins. Co., 574 F.3d 75, 82 (2d Cir.2009). Where “written plan documents confer upon a plan administrator the discretionary authority to determine eligibility, we *799 will not disturb the administrator’s ultimate conclusion unless it is arbitrary and capricious.” Id. (internal quotation marks omitted). An administrator’s decision to deny benefits is arbitrary and capricious only if it was “without reason, unsupported by substantial evidence or erroneous as a matter of law.” Id. at 83 (internal quotation marks omitted). Substantial evidence is “such evidence that a reasonable mind might accept as adequate to support the conclusion reached by the administrator and requires more than a scintilla but less than a preponderance.” Durakovic v. Bldg. Serv. 32 BJ Pension Fund, 609 F.3d 133, 141 (2d Cir.2010) (internal quotation marks omitted). Ingravallo bears the burden of proving that she continues to be eligible for disability benefits. See Critchlow v. First UNUM Life Ins. Co. of Am., 378 F.3d 246, 256 (2d Cir.2004). And, under the Plan, a claimant’s “proof of loss” must comprise “[ojbjective medical findings,” which include, but are not limited to, “tests, procedures, or clinical examinations standardly accepted in the practice of medicine.” Joint App’x at 37.

Hartford first challenges the District Court’s criticism that Hartford should have provided a more substantial explanation for its decision because it ran counter to the SSA’s (unchanged) disability determination. Although we have “encourage[d] plan administrators, in denying benefits claims, to explain their reasons for determining that claimants are not disabled where the SSA arrived at the opposite conclusion,” Hobson, 574 F.3d at 92, administrators are not bound by an SSA’s award of benefits—as the District Court acknowledged. See Black & Decker Disability Plan v. Nord,

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563 F. App'x 796, Counsel Stack Legal Research, https://law.counselstack.com/opinion/ingravallo-v-hartford-life-and-accident-ins-co-ca2-2014.