Kohut v. Hartford Life & Accident Insurance

710 F. Supp. 2d 1139, 2008 U.S. Dist. LEXIS 103924
CourtDistrict Court, D. Colorado
DecidedDecember 16, 2008
DocketCivil Action 08-cv-00669-CMA-MJW
StatusPublished
Cited by10 cases

This text of 710 F. Supp. 2d 1139 (Kohut v. Hartford Life & Accident Insurance) is published on Counsel Stack Legal Research, covering District Court, D. Colorado primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Kohut v. Hartford Life & Accident Insurance, 710 F. Supp. 2d 1139, 2008 U.S. Dist. LEXIS 103924 (D. Colo. 2008).

Opinion

ORDER AND MEMORANDUM OF DECISION

CHRISTINE M. ARGUELLO, District Judge.

This is an Employee Retirement Income Security Act (“ERISA”) case. Plaintiff alleges that Defendants improperly denied his claim for long-term disability benefits under an ERISA-governed plan, breached a fiduciary duty to him, and wrongfully withheld requested plan documents. This matter comes before the Court on: (1) “Plaintiffs Rule 72(a) Objection to Magistrate Order Denying Discovery,” (Doc. # 12); and (2) “Plaintiffs Motion for Partial Summary Judgment Regarding the Proper Standard of Review in this ERISA-Governed Case,” (Doc. # 20). Jurisdiction is proper pursuant to 29 U.S.C. §§ 1132(e)(1), 1132(f), and 28 U.S.C. § 1331.

FACTS

1. Factual Background

Pursuant to his employment as a Plumbing Project Manager with KJ Enterprises, Plaintiff was insured under a group long-term disability insurance policy (the “Policy”). The Policy was provided pursuant to the Group Short Term Disability, Long Term Disability and Life Plan for Employees of KJ Enterprises (the “Plan”). Defendant Hartford Life and Accident Insurance Company (“Defendant Hartford”) was both the issuer of the Policy, and the administrator of the Plan.

The Plan recites that Defendant Hartford has “full discretion and authority to determine the eligibility for benefits and to construe and interpret all terms and provisions of the Group Insurance Policy.” Moreover, the Plan provides that proof of a long-term disability claim “must be satisfactory” to Defendant Hartford.

In September 2004, Plaintiff stopped working for KJ Enterprises due to an alleged disability. Plaintiff submitted a claim for long-term disability benefits to Defendant Hartford, and Defendant Hartford approved this claim effective December 2004. In June 2007, Defendant Hartford notified Plaintiff that it was terminating his benefits effective May 31, 2007.

On December 5, 2007, Plaintiffs counsel faxed an appeal letter to Defendant Hartford. The letter referenced exhibits that would be mailed separately. By letter dated December 12, 2007, Defendant Hartford acknowledged receipt of Plaintiffs appeal, and, on December 13, 2007, Defendant Hartford received Plaintiffs exhibits.

*1142 By letter dated January 4, 2008, Plaintiffs counsel submitted copies of correspondence with one of Plaintiffs physicians, and asked Defendant Hartford to “add this letter to your claim file and consider it in your review of [Plaintiffs] appeal.”

On February 19, 2008, Defendant Hartford prepared an “Appeal Recommendation/Plan” for its claim file. This document recited, inter alia> that Defendant Hartford would refer the file to two independent physicians for review, and request that these physicians contact Plaintiffs own treating physicians. The document moreover stated that the “complete appeal received date” had been revised to January 8, 2009, the date Defendant Hartford had received Plaintiffs additional evidence. By letter dated February 19, 2008, Defendant Hartford informed Plaintiffs counsel that it would need additional time to complete the review of Plaintiffs appeal in light of the pending medical review.

By letter dated February 26, 2008, Plaintiffs counsel responded to Defendant Hartford’s February 19, 2008, letter, disagreeing with Defendant Hartford’s position. Specifically, in the letter, Plaintiffs counsel contended that Plaintiffs appeal was effective December 5, 2007, not January 4, 2008, and that, under relevant federal regulations, a decision on this appeal had been due on January 19, 2008. 1 Moreover, Plaintiffs counsel disagreed with Defendant Hartford that referral of Plaintiffs file to independent physicians for review constituted a “special circumstance” giving Defendant Hartford additional time to review Plaintiffs appeal under applicable federal regulations. On February 29, 2008, Defendant Hartford responded to Plaintiffs counsel’s letter.

During the month of March 2008, Defendant Hartford requested information from one of Plaintiffs treating physicians, and received reports from two independent physicians. On April 4, 2008, Defendant Hartford recorded its decision on Plaintiffs appeal. In so doing, Defendant Hartford summarized the findings of the two reviewing physicians, and concluded that “the weight of the evidence does not support the severity of symptoms claimed by [Plaintiff].” By letter dated April 4, 2008, Defendant Hartford rendered its decision denying Plaintiffs appeal.

2. Procedural History

On April 2, 2008, two days before Defendant Hartford denied Plaintiffs appeal, Plaintiff filed a complaint in this Court alleging: (1) improper denial of his appeal for benefits; (2) breach of fiduciary duty; and (3) wrongful withholding of requested Plan documents. 2

On May 19, 2008, Magistrate Judge Michael J. Watanabe held a scheduling conference in this matter in which he disallowed all discovery in this case apart from Defendant Hartford’s production of the administrative record — i.e., all documents Defendant Hartford had generated, received, or reviewed in relation to Plaintiffs disability claim, including the Plan document.

On June 2, 2008, Plaintiff objected to the magistrate judge’s order allowing no extra-record discovery. Specifically, Plaintiff argued that discovery should be permitted into Defendant Hartford’s claims administration process to determine whether its *1143 denial of his appeal had been arbitrary and capricious. On August 8, 2008, Defendants responded to Plaintiffs objection. On August 25, 2008, Plaintiff replied.

On August 25, 2008, Plaintiff filed a motion for partial summary judgment regarding the proper standard of review in this case. Specifically, Plaintiff argued that Defendant Hartford had violated various federal regulations by untimely deciding his appeal, and that this violation entitled him to de novo review of Defendant Hartford’s appeal decision. Plaintiff also argued that a newly enacted Colorado statute entitled him to de novo review of Defendant Hartford’s decision. On September 17, 2008, Defendants responded to Plaintiffs motion. On October 6, 2008, Plaintiff replied. These matters are fully briefed and ripe for review.

ANALYSIS

1. Standard of Review for Objections to Magistrate Judge’s Order

District courts review magistrate judges’ orders concerning non-dispositive motions under a “clearly erroneous or contrary to law” standard. 28 U.S.C. § 636(b)(1)(A) (2006); Fed.R.Civ.P. 72(a) (2008).

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

Related

Joel S. v. Cigna
356 F. Supp. 3d 1305 (D. Utah, 2018)
Halo v. Yale Health Plan
Second Circuit, 2016
Arapahoe Surgery Center, LLC v. Cigna Healthcare, Inc.
171 F. Supp. 3d 1092 (D. Colorado, 2016)
Shafer v. Metropolitan Life Insurance
80 F. Supp. 3d 1244 (D. Colorado, 2015)
Timm v. Prudential Insurance Co. of America
259 P.3d 521 (Colorado Court of Appeals, 2011)
Flowers v. Life Insurance Co. of North America
781 F. Supp. 2d 1127 (D. Colorado, 2011)
In Re the Marriage of Davis
252 P.3d 530 (Colorado Court of Appeals, 2011)
Benson v. Hartford Life & Accident Insurance
724 F. Supp. 2d 1187 (D. Utah, 2010)

Cite This Page — Counsel Stack

Bluebook (online)
710 F. Supp. 2d 1139, 2008 U.S. Dist. LEXIS 103924, Counsel Stack Legal Research, https://law.counselstack.com/opinion/kohut-v-hartford-life-accident-insurance-cod-2008.