Martucci v. Hartford Life Insurance

863 F. Supp. 2d 269, 2012 WL 1034815, 2012 U.S. Dist. LEXIS 46276
CourtDistrict Court, S.D. New York
DecidedMarch 27, 2012
DocketNo. 10 Civ. 6231 (BSJ) (RLE)
StatusPublished
Cited by4 cases

This text of 863 F. Supp. 2d 269 (Martucci v. Hartford Life Insurance) is published on Counsel Stack Legal Research, covering District Court, S.D. New York primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Martucci v. Hartford Life Insurance, 863 F. Supp. 2d 269, 2012 WL 1034815, 2012 U.S. Dist. LEXIS 46276 (S.D.N.Y. 2012).

Opinion

Memorandum & Order

BARBARA S. JONES, District Judge.

Plaintiff Carol Martucci brings this action against Defendant Hartford Life In[271]*271surance Company to recover short-term and long-term disability benefits denied under ERISA § 502(a)(1)(B). 29 U.S.C. § 1132(a)(1)(B). Plaintiff and Defendant have submitted cross-motions for summary judgment. For the following reasons, Plaintiffs motion for summary judgment is DENIED and Defendant’s motion for summary judgment is GRANTED.

Background

The facts are taken from the administrative record contained in the July 25, 2011 declaration of Debra McGee.1

In December 2005, Plaintiff began working 40-hour weeks at JP Morgan Chase as a branch operation support employee in a telephone call center, a desk job where the bulk of her work involved using a computer and telephone while seated. She was an eligible participant in JP Morgan Chase’s Disability Leave Policy (“STD Plan”), which provided short-term disability benefits, and in the Long Term Disability Policy (“LTD Plan”), which provided long-term disability benefits. The STD Plan was administered by Defendant, which made the final decisions about benefits claims, while JP Morgan Chase paid any disability benefits that were approved.

In 2005, Dr. David S. Bell, M.D., Plaintiffs treating physician, began following Plaintiffs health, monitoring her for symptoms of Chronic Fatigue Syndrome (CFS) and fibromyalgia. On August 21, 2009, Plaintiff stopped working due to the effects of CFS and fibromyalgia and, on August 24, 2009, Plaintiff filed a claim for short-term disability benefits under the STD Plan. Plaintiff then returned to work on September 9, 2009, only to stop work again on September 18, 2009.

On October 12, 2009, Defendant made an initial determination to deny Plaintiffs claim for short-term disability benefits. On December 8, 2009, Plaintiff appealed. On January 29, 2010, Defendant decided her appeal, again denying Plaintiffs claim. Despite the onset of CFS and fibromyalgia, both the initial determination and appeals decision found that Plaintiff was not disabled under the definitions of the STD Plan.

The STD Plan gives Defendant “complete authority” to determine whether employees qualify as disabled and defines disability as an injury or illness that prevents an employee from “performing] the material and substantial duties of [her] position on an active employment basis.” Admin. Rec. at 000003, 000022. Under this plan definition, an employee is disabled when they can no longer maintain an “active employment basis,” which is defined as “performing all the duties that pertain to your work on a regular basis at the place where they are normally performed or where they’re required to be performed by JPMorgan Chase.” Admin. Rec. at 000003.

During the initial review, Beverly G. Brown, a nurse for Defendant, conducted an initial intake interview over the phone with Plaintiff on September 8, 2009. On October 1, 2009, Plaintiff faxed a record of medical documents to Defendant, which included an August 24, 2009 letter from Dr. Bell, a September 8, 2009 examination report from David M. Pike, a physician assistant, two examination reports from Dr. Bell dated September 23, 2009 and September 30, 2009, a September 30, 2009 note from Dr. Bell excusing Plaintiff from [272]*272work, and an October 7, 2009 letter from Dr. Bell replying to Defendant’s request for clarification of Plaintiffs condition.

In his August 24 letter, Dr. Bell confirmed Plaintiffs CFS and fibromyalgia diagnoses, concluding that she was not completely disabled but should have her activity restricted to a 30-hour workweek without any overtime. Admin. Rec. at 000175. Pike’s September 8 report assessed Plaintiff with fatigue and fibromyalgia but placed Plaintiffs overall health status as normal and within the “Adult Normal” category. Admin. Rec. at 000179. Dr. Bell’s September 23 report noted that Plaintiff stated that she could not work due to pain in her hands and fatigue and that she would be reassessed the following week. Admin. Rec. at 000178. During the following week’s visit, documented in the September 30 report, Dr. Bell noted Plaintiffs CFS and fibromyalgia diagnoses but again classified Plaintiffs general health as “Adult Normal.” Admin. Rec. at 000177.

The September 30 report also recommended that Plaintiff take one month off from work and then be reevaluated; Dr. Bell then signed the September 30 work release note, which stated that Plaintiff was “unable to work from September 30 to October 30.” Admin. Rec. at 000176. After receiving these examination reports and letters, Defendant requested further information from Dr. Bell, who responded in the October 7 letter that working full-time was “very difficult” for Plaintiff and that he believed Plaintiffs subjective self-assessment that she could not work a 40-hour workweek. Admin. Rec. at 000180. Due to her self-assessment, he again recommended that Plaintiff take one month of leave from work and be excused from working overtime.

Paula Ennis, a nurse for Defendant, then completed a review of these records and made notes in Plaintiffs file. Ability Analyst Patrick Flores evaluated the initial administrative record and, in an October 12, 2009 letter, denied Plaintiffs claim because she had not met the definition of disability under the STD Plan. Admin. Rec. at 000122-25. Flores explained that Plaintiff had not established a “documented loss of function” beyond her CFS and fibromyalgia diagnoses and her self-reported symptoms of pain. Admin. Rec. at 000124.

Upon filing her December 8, 2009 appeal, Plaintiff provided additional medical records to Defendant. These records included results from four tests: an October 2009 SF-36 questionnaire, a June 24, 2009 orthostatic test, a November 2, 2009 NM whole blood volume test, and a November 2009 cardiopulmonary exercise test. The cardiopulmonary exercise test was performed by Dr. Betsy Keller, who has a Ph.D. in Exercise Science and is a professor of Exercise and Sports Sciences at Ithaca College. The test examined Plaintiffs tolerance for physical exertion in terms of oxygen capacity. Plaintiff was rated in four categories: maximum oxygen consumption, anaerobic threshold, ventilation, and hemodynamic response.

According to Dr. Keller, Plaintiffs ventilation and hemodynamic response scores were normal, although her maximum oxygen consumption and anaerobic threshold scores placed her in the “moderate [to] marked” category because her “functional aerobic impairment” was 53 percent lower than “active age-matched females.” Admin. Rec. at 000160. Dr. Keller indicated that “many normal” household chores, such as folding laundry, carrying a basket of laundry up a flight of stairs, making a bed, raking leaves, or putting away groceries, would physically exhaust Plaintiff based on the amount of oxygen needed to perform those tasks. Dr. Keller also remarked that “most job tasks” require “less [273]*273than 5 METS” and that Plaintiff peaked at 4.1 METS, concluding that Plaintiffs “ability to perform such activities is very limited” since she would have to “work at or above maximum maximum effort” to do so.2 Admin. Rec. at 000162. As Defendant emphasizes, while Plaintiff might be unable to perform the household chores listed by Dr. Keller, Dr.

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Bluebook (online)
863 F. Supp. 2d 269, 2012 WL 1034815, 2012 U.S. Dist. LEXIS 46276, Counsel Stack Legal Research, https://law.counselstack.com/opinion/martucci-v-hartford-life-insurance-nysd-2012.