Lalli v. Hartford Insurance

854 F. Supp. 2d 1156, 2012 WL 602740, 2012 U.S. Dist. LEXIS 23312
CourtDistrict Court, D. Utah
DecidedFebruary 23, 2012
DocketCase No. 1:10-cv-00152
StatusPublished
Cited by2 cases

This text of 854 F. Supp. 2d 1156 (Lalli v. Hartford 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
Lalli v. Hartford Insurance, 854 F. Supp. 2d 1156, 2012 WL 602740, 2012 U.S. Dist. LEXIS 23312 (D. Utah 2012).

Opinion

MEMORANDUM DECISION AND ORDER

DEE BENSON, District Judge.

Before the Court is Plaintiff John M. Lalli’s (“Plaintiff’) Motion for Summary Judgment or Judgment on the Administrative Record, and Defendant Hartford Life and Accident Insurance Company’s (“Defendant”) Cross-Motion for Summary Judgment. Both motions are made pursuant to Rule 56 of the Federal Rules of Civil Procedure. The underlying issue in the case is whether Defendant’s decision to revoke Plaintiffs long-term disability insurance benefits was reasonable under an arbitrary and capricious standard of review.

I. FINDINGS OF FACT

A. Plaintiffs History

Plaintiffs disability insurance benefits were revoked by Defendant in February 2010 on the ground that Plaintiff was no longer disabled. (Pl.’s Mem. Supp. Mot. Summ. J. 6 (Dkt. No. 17)). It is the reasonability of that decision that is at the heart of the present controversy.

Plaintiff is a sixty-year-old man who spent his entire professional life in the insurance industry. (Pl.’s Mem. Supp. Mot. Summ. J. 3 (Dkt. No. 17)). Throughout his thirty-year career, Plaintiff started up, owned, operated, sold, and re-opened multiple health insurance brokerages. Id. at 3-4. His insurance brokerages insured major auto dealers, manufacturers, and large businesses in Utah, Nevada, and Arizona. Id. at 3. Plaintiff was the recipient of numerous awards including recognition [1158]*1158in the Regents Blue Cross and Blue Shield President’s Club, and accolades as the top producer for Intermountain Healthcare and Educator’s Mutual. Id. at 4.

Plaintiff accepted an offer from Van Gilder Insurance Company in 2000 to work as a “producer.” (Pl.’s Mem. Supp. Mot. Summ. J. 4 (Dkt. No. 17)). Plaintiffs job was to produce new business for Van Gilder, and to assist account executives and other support staff in retaining previously produced business. (Def.’s Mem. Opp’n to Pl.’s Mot. Summ. J. 6 (Dkt. No. 20)). As an employee of Van Gilder, Plaintiff participated in the Van Gilder Corporation Group Disability Insurance Plan issued by Defendant (“the Plan”). Id. at 4. The Plan was governed by the Employee Retirement Income Security Act of 1974 (“ERISA”). Plaintiff worked for Van Gilder for six years. Id. at 2.

In May 2006, Plaintiff was hospitalized with pneumonia. Id. at 7. While in the hospital, his medical providers found a “lung mass.” Id. Plaintiff spent approximately a week in the hospital, received a battery of tests, and was subsequently diagnosed with Chronic Fatigue Syndrome, Epstein Barr Virus (“EBV’), Valley Fever, and Fibromyalgia. (Pl.’s Mem. Supp. Mot. Summ. J. 4 (Dkt. No. 17)). The symptoms that accompanied his diagnosis were documented by Plaintiffs treating physician, Dr. Sam Wilson, as cough, fatigue, insomnia, fevers, chills, sweats, and pneumonia. (Def.’s Mem. Opp’n to Pl.’s Mot. Summ. J. 7,8 (Dkt. No. 20)). As a result of his physical condition, Plaintiff resigned from Van Gilder in June 2006.

In the years following his diagnosis, Plaintiff was unable to return to the physical or mental condition he had previously enjoyed. For instance, in March 2009, Dr. Wilson wrote, “[Plaintiff] is a patient of mine who suffers from Chronic Fatigue Syndrome, Uncontrollable Hypertension, and Valley Fever. He is unable to work more than [three] days a week for [three] hours a day. He gets extremely fatigued very quickly and cannot physically handle a stress load.” (Pl.’s Mem. Supp. Mot. Summ. J. 4 (Dkt. No. 17)).

In addition, Dr. John Whitaker, a specialist who treated Plaintiff twelve times beginning in May 2008, stated in a lengthy report in February 2010 that his treatments had “served to improve [Plaintiffs] pain and fatigue,” but the treatments did not “reverse the course of his illness, but only serve[d] to give him a relative few hours of respite.” Id. at 5. Notably, Dr. Whitaker prescribed mild exercise for Plaintiff, including golf. Id. at 4. Dr. Whitaker also reported:

[Plaintiff] has had occasion to visit me and at first during the visit, he is alert and interactive, participating in his own care plan and avidly involved in the conversation. Then typically, as the hour grows late, he begins quickly to fade. I see his eyes lose focus, he loses track of the conversational flow, and has to ask repeatedly what we are talking about. His speech literally begins to slur a bit and his eyes droop and he asks to finish the visit so he can go rest. On these occasions I have had to make arrangements for him to have a ride home. This has happened regularly and frequently enough that I now ask him to have someone bring him to the visits, and we have shortened our visit time to prevent overtiring him.
It is clear to me that [Plaintiff] would not be able to work at this time on the basis of cognitive dysfunction alone, even without taking into consideration his pain and fatigue, which are considerable.

Id. at 6.

B. Plaintiffs Receipt of Disability Benefits

Plaintiff received short-term disability benefits from Defendant from June 24, [1159]*11592006 through September 22, 2006. Id. at 7. In conjunction with Plaintiffs short-term disability claim, Dr. Wilson submitted an Attending Physician Statement (“APS”) indicating a primary diagnosis of pneumonia and a growth in the lung, with a secondary diagnosis of EBV and Valley Fever. (Def.’s Mem. Opp’n to Pl.’s Mot. Summ. J. 7 (Dkt. No. 20)). Dr. Wilson also stated that Plaintiff was unable to do the following activities for greater than forty-five minutes: standing, walking, sitting, lifting/carrying, reaching/working overhead, pushing, pulling, and driving. Id. Dr. Wilson also stated his belief that Plaintiff would be disabled for approximately three months. Id. In a second APS dated August 8, 2006, Dr. Wilson diagnosed Plaintiff with Valley Fever and EBV and re-estimated that Plaintiff should be able to return to work in December 2006. Id. at 8.

After fulfilling its obligation under Plaintiffs short-term plan, Defendant then approved Plaintiffs long-term disability claim on September 18.2006. Id. Plaintiff informed Defendant on November 17, 2006 that because of his persistent fatigue he would not recover by the December 2006 date that Dr. Wilson had predicted. Id. Between 2006 and 2009, Plaintiff underwent numerous tests, but his condition improved little. See id. at 10-11. Defendant paid Plaintiff disability benefits for over three years, until February 12, 2010. Id. at 16.

C. Defendant Denies Plaintiffs Disability Benefits

Pursuant to the terms of the Plan, Defendant required Plaintiff to provide continuing proof that he meets the definition of “disabled.” (Def.’s Mem. Opp’n to PL’s Mot. Summ. J. 2 (Dkt. No. 20)). The Plan initially defined disabled as the inability to perform “one or more of the essential duties” of Plaintiffs own occupation. (Def.’s Reply Supp. Mot. Summ. J. 10 (Dkt. No. 33) (emphasis added)).

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Cite This Page — Counsel Stack

Bluebook (online)
854 F. Supp. 2d 1156, 2012 WL 602740, 2012 U.S. Dist. LEXIS 23312, Counsel Stack Legal Research, https://law.counselstack.com/opinion/lalli-v-hartford-insurance-utd-2012.