Krum v. Hartford Life & Accident Insurance

942 F. Supp. 2d 1171, 55 Employee Benefits Cas. (BNA) 2408, 2013 WL 1768563, 2013 U.S. Dist. LEXIS 58909
CourtDistrict Court, D. Utah
DecidedApril 24, 2013
DocketCase No. 2:11-cv-932
StatusPublished
Cited by1 cases

This text of 942 F. Supp. 2d 1171 (Krum v. Hartford Life & Accident Insurance) is published on Counsel Stack Legal Research, covering District Court, D. Utah primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Krum v. Hartford Life & Accident Insurance, 942 F. Supp. 2d 1171, 55 Employee Benefits Cas. (BNA) 2408, 2013 WL 1768563, 2013 U.S. Dist. LEXIS 58909 (D. Utah 2013).

Opinion

MEMORANDUM DECISION AND ORDER

ROBERT J. SHELBY, District Judge.

Plaintiff Cheryl E. Krum has filed an action against Defendant Hartford Life and Accident Insurance Company (Hartford) in which she alleges that her long-term disability benefits were inappropriately denied her by Hartford in violation of the Employee Retirement Income Security Act (ERISA). The matter is now before the court on Ms. Krum’s Motion for Summary Judgment (Dkt. No. 19). Because the court agrees with Ms. Krum that the denial of her disability benefits was an abuse of discretion, her motion is GRANTED.

BACKGROUND 1

Ms. Krum worked for many years as a registered nurse for Intermountain Healthcare (Intermountain) at the Utah Valley Regional Medical Center. (R. at 402.) She began work in 1995 and continued working until October 30, 2009, when she was sixty years old. (R. at 410.) During the four years before she stopped working, Ms. Krum found it more and more difficult to perform her nursing duties because she was increasingly short of breath and suffering from arthritis. (R. at 403.) As a result, Ms. Krum left her job and applied for long-term disability (LTD) benefits from Hartford.2 The LTD benefits were a feature of a Group Policy that Intermountain maintained with Hartford. Under the terms of the Group Policy, a claimant is eligible for benefit payments provided that the claimant meets the Group Policy’s definition of disability. At first, a claimant must show that she is prevented from performing one or more of the essential duties of her own occupation. But after twelve months, the claimant must show that she cannot perform the essential duties of “Any Occupation.” (R. at 20.) The Group Policy defines any occupation as follows:

Any Occupation means 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 Predisability Earnings and the Initial Benefit Period Percentage; or
[1174]*11742) the Maximum Monthly Benefits.

(R. at 19.)

Hartford received a completed LTD claim application from Ms. Krum on February 23, 2010. (R. at 341; 410-18.) This application included an Attending Physician’s Statement (APS) from Dr. Michael Pearce, who was Ms. Krum’s treating physician. In his report, he diagnosed Ms. Krum with constrictive bronchiolitis, rheumatoid arthritis, and obstructive sleep apnea. (R. at 407.) Dr. Pearce also indicated that the “[e]xpected duration of any current restriction(s) or limitation(s)” was “unknown.” (R. at 408.) Internal notes for Hartford dated March 4, 2010, indicate the following initial impressions of Ms. Krum’s condition:

[Employee is] unlikely to [return to work] due to constrictive bronchiolitis, a nonreversible obstructive lung disease. [Employee is] comorbid with [rheumatoid arthritis] and [obstructive sleep apnea] .... [Attending Physician] noted [that the employee] is unable to walk a few hundred feet without stopping to catch breath.... Her condition is chronic and progressive and unlikely to improve.

(R. at 65-66.)

On March 9, 2010, Hartford approved Ms. Krum’s LTD application and told her that her benefits would begin on May 1, 2010. (R. at 116-19.) Hartford also asked Ms. Krum to provide proof of her application for Social Security Disability (SSD) benefits. (R. at 116.) Under the terms of the Group Policy, Hartford was entitled to reduce its payment to a disabled employee by the amount of SSD benefits that the employee received. (R. at 17-18.) Hartford asked Ms. Krum to provide this material promptly to “avoid any delays in processing [her] claim for benefits.” (R. at 117.) Ms. Krum was awarded SSD benefits on June 29, 2010, which were made retroactive to become effective at the beginning of April 2010. (R. at 224.) Social Security awarded Ms. Krum a monthly benefit of $1,396.00, which was then applied to reduce Hartford’s monthly liability under the policy from $2,512.92 to $1,116.92. (R. at 109, 119, 224.) Since Hartford had paid Ms. Krum the full amount under the policy from May 1, 2010, to July 31, 2010, Ms. Krum refunded to Hartford under the terms of a Repayment Agreement the overpayment she received from her SSD benefits during these three months. (R. at 111.)3

On November 4, 2010, Ms. Krum received a letter from Hartford reminding her that she would only continue to receive LTD benefits after the year-long period ending on May 1, 2011, if she could show that she was disabled from performing “Any Occupation,” and not just her own occupation, as those terms were defined under the LTD policy. (R. at 101.) Hartford informed Ms. Krum that it had begun its review to determine whether she would continue to qualify for benefits after May 1, 2011, and asked Ms. Krum to send an updated APS from her doctor. (Id.)

Dr. Pearce submitted a new APS on December 3, 2010. (R. at 267-68.) He described the findings from Ms. Krum’s physical examination as “globally decreased breath sounds.” One of the questions on Hartford’s APS form asked Dr. Pearce to mark the number of hours that a patient would be able to sit, stand, or walk in a “general workplace environment.” Dr. Pearce marked “8” under the column for “Sit” and did not mark anything under the columns for “Stand” and “Walk.” (R. at 268.) Dr. Pearce stated that Ms. Krum could occasionally (1-33% of the time) lift [1175]*1175up to twenty pounds and that she did not have any psychiatric or cognitive impairments. (Id.) The form also asked: “Can the patient participate in vocational rehabilitation services (this may include work-site accommodations, identifying alternative work, and or retraining assistance)?” Dr. Pearce marked “No.” (Id.) He stated that the expected duration of Ms. Krum’s condition was “lifelong.” (Id.)

On January 15, 2011, Hartford sent copies of Dr. Pearce’s APS to Ms. Krum’s two other primary treating physicians: Dr. Scott Bingham and Dr. Richard Call.4 Both doctors stated that they agreed with the restrictions and limitations described by Dr. Pearce in his APS. (R. at 271-72.) Hartford’s internal notes from this time summarize Dr. Pearce’s APS as follows:

[Dr. Pearce] states [Ms. Krum] may sit up to 8 hours, may occasionally lift up to 20 lbs and states no other restrictions are in place. [As detailed in her Claimant Questionnaire, Ms. Krum] remains able to quilt and sew at home. She reports she is able to fix meals for herself and her family.

(R. at 62.)

On February 11, 2011, Hartford assigned Ms. Krum’s file to Sue Brooks Sweet to prepare an Employability Analysis Report. Ms. Sweet submitted her report on February 17, 2011, in which she concluded that Ms. Krum retained the ability to perform sedentary work. (R. at 276.) Ms. Sweet identified a number of sedentary occupations that she believed (1) fell within the scope of Ms. Krum’s education, training, and experience; (2) could be performed subject to the restrictions and limitations that Dr. Pearce had identified; and (3) had a wage level at or above the minimum wage requirement for the Group Policy’s definition of disability. (R. at 278.) Ms. Sweet’s search returned four occupations classified by the Occupation Access System (OASYS)5

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942 F. Supp. 2d 1171, 55 Employee Benefits Cas. (BNA) 2408, 2013 WL 1768563, 2013 U.S. Dist. LEXIS 58909, Counsel Stack Legal Research, https://law.counselstack.com/opinion/krum-v-hartford-life-accident-insurance-utd-2013.