McCloud v. Hartford Life & Accident Insurance

910 F. Supp. 2d 1226, 2012 WL 5411348, 2012 U.S. Dist. LEXIS 158973
CourtDistrict Court, D. Oregon
DecidedNovember 6, 2012
DocketNo. 1:11-CV-3122-CL
StatusPublished
Cited by1 cases

This text of 910 F. Supp. 2d 1226 (McCloud v. Hartford Life & Accident Insurance) is published on Counsel Stack Legal Research, covering District Court, D. Oregon primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
McCloud v. Hartford Life & Accident Insurance, 910 F. Supp. 2d 1226, 2012 WL 5411348, 2012 U.S. Dist. LEXIS 158973 (D. Or. 2012).

Opinion

ORDER

PANNER, District Judge.

Magistrate Judge Mark D. Clarke filed a Report and Recommendation [# 23], and the matter is now before this court. See 28 U.S.C. § 636(b)(1)(B), Fed.R.Civ.P. 72(b). Plaintiff filed objections to the report. Accordingly, I have reviewed the file of this case de novo. See 28 U.S.C. § 636(b)(1)(C); McDonnell Douglas Corp. v. Commodore Bus. Mach., Inc., 656 F.2d 1309, 1313 (9th Cir.1981). I find no error and conclude the report is correct.

Magistrate Judge Clarke’s Report and Recommendation [# 23] is adopted. Defendant’s motion for summary judgment [# 13] is GRANTED.

IT IS SO ORDERED.

REPORT AND RECOMMENDATION

CLARKE, United States Magistrate Judge.

Plaintiff Steven McCloud brings this action under the Employee Retirement Income Security Act (ERISA), 29 U.S.C. §§ 1001 et seq., alleging wrongful denial of long-term disability benefits. This Court has jurisdiction pursuant to 28 U.S.C. § 1331 and 29 U.S.C. § 1132(e). Before the Court are the parties’ cross motions for summary judgment. For the reasons set forth below, the Court recommends that the plaintiff’s motion for summary judgment be denied and defendant’s motion for summary judgment’ be granted.

BACKGROUND

Plaintiff Steven McCloud (McCloud) worked for American International Group, Inc. (AIG) until October 6, 2006, when he submitted a claim for disability benefits based on depression and bipolar disorder. AR 530-31, 534-35.1 The claims administrator for AIG’s Group Benefit Plan (Plan) is the defendant, Hartford Life and Accident Insurance Company (Hartford).

Hartford originally approved McCloud’s claim for disability benefits based on a [1228]*1228medical report showing that he suffered from depression and bipolar disorder that prevented him from working his job as a claims adjuster. AR 530-31, 534-35. As a “mental illness,” this condition entitled him to 24 months of long term disability benefits under the Plan. AR 21. With just under four months remaining under this limitation, Hartford informed McCloud that his benefits were nearing exhaustion and would be terminated on April 9, 2009. AR 336-39.

Shortly thereafter, his treating physician, Dr. Yolanda Suarez, notified Hartford of McCloud’s heart condition, for which he was hospitalized, and which prevented him from physical activity. AR 266-67. Dr. Suarez’s statement included a physical capabilities evaluation (PCE); her assessment was that McCloud had the ability to “sit, stand, and/or walk one hour at a time, with each activity limited to one hour per day.” AR 267.

As a physical disability, the heart condition qualified McCloud for benefits outside of the 24-month limitation. AR 237. Hartford therefore stopped the timer on his disability benefits, and McCloud continued to receive them without tolling the limitation. Id. Hartford advised McCloud at the time of this determination that, should his physical condition resolve, he would have 78 days remaining under his 24 month eligibility for disability for a mental illness. Id.

On August 19, 2009, Dr. Suarez submitted an updated PCE to Hartford based on her evaluation of McCloud. AR 206-07. Dr. Suarez determined that McCloud could: Sit up to eight hours in a workday, for thirty minutes at a time; stand up to four hours in a workday, for fifteen to thirty minutes at a time; walk up to three hours in a workday, for fifteen to thirty minutes at a time; drive up to two hours in a workday; lift, push or pull up to 20 pounds frequently. Id. He was not capable of climbing or crawling, but was capable of balancing, stooping, kneeling and crouching occasionally, reaching occasionally at waist level and above, but never below waist level; handling, fingering, and feeling constantly. Id. Based on this evaluation, along with an Employability Analysis Report, and the rest of McCloud’s file, Hartford determined that McCloud no longer met the plan’s definition of disability based on a physical condition. AR 198-202. Thus, the 24 month limitation went back into effect, and Hartford continued to pay benefits to McCloud for his disability based on a mental illness until they were exhausted on November 6, 2009. AR 201.

McCloud appealed the decision to terminate his physical disability benefits, and in June 2010 he submitted supplemental documentation to support his claim, including medical reports from his currently treating physicians. AR 80, 126. Hartford then referred McCloud’s claim file to the University Disability Consortium (UDC) for a medical records review. AR 101-02. Dr. James H. Bress prepared a written report for UDC dated June 30, 2010 reviewing all of the medical records provided. AR 67-74.

Dr. Bress’ UDC report was included with the entire record that was then reviewed by Judith Rose, a Hartford Appeals Specialist. Her report of July 1, 2010 quoted extensively from Dr. Bress’ review and evaluation, but also noted that “[t]he medical information made available by Mr. McCloud’s own providers does not corroborate his report of limitations in function preventing him from performing occupational activities at a sedentary to light physical demands level.” AR 66. She concluded that “although the documentation does support that Mr. McCloud is diagnosed with medical conditions, the record ... no longer corroborates that he continues to satisfy the policy definition of [1229]*1229Disability.” AR 61-67. Hartford thus affirmed its decision to terminate benefits on September 2, 2009.

On October 11, 2011 McCloud filed this action challenging Hartford’s termination of his long term disability benefits.

LEGAL STANDARDS

I. Standard of Review

A denial of benefits by an ERISA plan administrator is reviewed de novo “unless the benefit plan gives the administrator or fiduciary discretionary authority to determine eligibility for benefits or to construe the terms of the plan.” Firestone Tire and Rubber Co. v. Bruch, 489 U.S. 101, 115, 109 S.Ct. 948, 103 L.Ed.2d 80 (1989). The grant of discretion must be unambiguous. Abatie v. Alta Health & Life Ins. Co., 458 F.3d 955, 963 (9th Cir. 2006) (en banc) (citing Kearney v. Standard Ins. Co., 175 F.3d 1084 (9th Cir.1999) (en banc)). In this case the parties do not dispute that the Plan grants the administrator discretionary authority and that this Court must review Hartford’s decision for an abuse of discretion.

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Bluebook (online)
910 F. Supp. 2d 1226, 2012 WL 5411348, 2012 U.S. Dist. LEXIS 158973, Counsel Stack Legal Research, https://law.counselstack.com/opinion/mccloud-v-hartford-life-accident-insurance-ord-2012.