Mellian v. Hartford Life & Accident Insurance

161 F. Supp. 3d 545, 2016 U.S. Dist. LEXIS 17291, 2016 WL 552723
CourtDistrict Court, E.D. Michigan
DecidedFebruary 12, 2016
DocketCase No. 14-10867
StatusPublished
Cited by4 cases

This text of 161 F. Supp. 3d 545 (Mellian v. Hartford Life & Accident Insurance) is published on Counsel Stack Legal Research, covering District Court, E.D. Michigan primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Mellian v. Hartford Life & Accident Insurance, 161 F. Supp. 3d 545, 2016 U.S. Dist. LEXIS 17291, 2016 WL 552723 (E.D. Mich. 2016).

Opinion

OPINION AND ORDER REGARDING CROSS-MOTIONS TO AFFIRM OR REVERSE THE DECISION OF THE PLAN ADMINISTRATOR

Gerald E. Rosen, United States District Judge

I. INTRODUCTION

In the present suit, Plaintiff Teri Lynn Mellian challenges the decision by Defendant Hartford Life and Accident Insurance Company to deny her claim for continued benefits under a group long term disability policy (the “Policy”) issued by Defendant to Plaintiffs employer, Atkore International. This Court’s subject matter jurisdiction over this case rests upon Plaintiffs claim for benefits under an employee welfare benefit plan governed by the Employee Retirement Income Security Act of 1974 (“ERISA”), 29 U.S.C. § 1001 et seq.

Presently before the Court are Plaintiffs and Defendant’s cross-motions to reverse or affirm, respectively, the Defendant insurer’s determination that as of March 1, 2013, Plaintiff was no longer eligible for long term disability benefits under the Policy. In support of her motion to reverse this decision, Plaintiff argues (i) that the Court should review the Defendant insurer’s decision de novo, and (ii) that, regardless of the governing standard of review, Defendant’s decision impermissibly rests on a file review by non-examining medical consultants who unduly discounted or, in some instances, wholly failed to consider the opinions and findings of Plaintiffs treating physicians. For its part, Defendant contends (i) that the more deferential “arbitrary and capricious” standard governs this Court’s review, and (ii) that its denial of Plaintiffs claim for long term disability benefits is properly supported by the findings of two board-certified independent medical consultants that as of March 1, 2013, Plaintiff was capable of performing the essential duties of her position as an accounting specialist.

The parties’ cross-motions have been fully briefed and are ready for decision. Upon reviewing the parties’ submissions, the pleadings, and the administrative record, the Court finds that the relevant allegations, facts, and legal arguments are adequately presented in these materials, and that oral argument would not significantly aid the decisional process. Accordingly, the Court will decide the parties’ motions “on the briefs,” see Local Rule 7.1(f)(2), U.S. District Court, Eastern District of Michigan, in accordance with the guidelines articulated by the Sixth Circuit in Wilkins v. Baptist Healthcare System, Inc., 150 F.3d 609, 619 (6th Cir.1998).1 This opin[550]*550ion and order sets forth the Court’s findings of fact and conclusions of law. To the extent that any findings of fact constitute conclusions of law, they are adopted as such. To the extent that any conclusions of law constitute findings of fact, they are so adopted.

II. FINDINGS OF FACT

A. The Parties

Plaintiff Teri Lynn' Mellian began her employment with Atkore International in November of 2000, working in the company’s Unistrut International Division in Wayne, Michigan. As an Atkore employee, Plaintiff was eligible for short and long term disability benefits. The particular long term disability policy that governs here (the “Policy”) was issued to Atkore in June of 2011 by Defendant Hartford Life and Accident Insurance Company. (See Administrative Record (“AR”) at 5.)

B. The Relevant Terms of the Policy

This case arises from Plaintiffs request for long term' disability benefits under the Policy. In order to be considered “disabled” under the Policy, a claimant must be , “prevented from performing one or more of the Essential Duties of’ her own occupation during a 180-day “Elimination Period” and for the first 24 months following this elimination period, and must have current monthly earnings that are less than 60'percent of her pre-disability earnings. (Id. at 7, 19.)2 The claimant’s own “Occupation” is defined in the Policy as the occupation “as it is recognized in the general workplace,” and not the “specific job” that the claimant has performed “for a specific employer or at a specific location.” (Id. at 22.) In addition, an “Essential Duty” of a job is defined as a duty that is a “substantial, not incidental” part of the job, is “fundamental or inherent to the occupation,” and “cannot be reasonably omitted or changed.” (Id. at 20.)

The Policy confers upon the Defendant insurer the “full discretion and authority to determine eligibility for benefits and to construe and interpret all terms and provisions of the Policy.” (Id. at 31.) In addition, the Policy grants Defendant the power to determine whether the proof submitted in support of a claim for benefits is “satisfactory” to establish the claimant’s disability. (Id. at 16.)

C.Plaintiffs Relevant Medical History

On November 1, 2010, Plaintiff underwent back fusion surgery to address the effects of a motor vehicle accident that occurred in 2007. The surgery was performed by Dr. Brady T. Vibert, an orthopedic specialist. Plaintiff was off work and drew short term disability benefits from November of 2010 until early February of 2011. Upon her return to work, Plaintiff was placed in an accounting position that entailed a significant amount of sitting and computer use, along with document filing and retrieval, making copies of and scanning documents, and putting together binders. (See id. at 90.)

When the lengthy sitting involved in her accounting position aggravated her back pain, Plaintiff work station was changed to a standing desk. (See id. at 89.) This adjustment, in turn, led to pain in Plaintiffs feet. On June 7, 2012, an orthopedic surgeon, Dr. Allan M. Grant, performed surgery on Plaintiffs right foot to remove a “significant” bunion and correct a bone/toe condition, and screws were placed in Plaintiffs foot in the course of this procedure. (Id. at 309-10.) Plaintiff was approved for short term disability benefits from the [551]*551date of this surgery until December 5, 2012.

In the course of several follow-up visits to Dr. Grant’s office, X-rays indicated that Plaintiffs foot was healing well after her surgery, but she complained of continued pain and swelling at the surgical'site. (See id. at 166-71.) At an October 31, 2012 office visit, Dr. Grant noted that Plaintiffs “bunion pain is gone,” but opined that Plaintiffs continued pain in her foot was likely due to a reaction to the hardware inserted into her foot during surgery, and he recommended that this hardware be removed. (Id. at 166.) Following this procedure, an X-ray showed successful removal of the hardware and “minimal swelling” in Plaintiffs right foot. (Id. at 165.) At an office visit on December 12, 2012, Plaintiff was instructed to “weight-bear as tolerated” with her right foot and to “return as needed,” (id.), and she was given a note stating that she could return to work on January 14, 2013 with the restriction that she be permitted to sit or stand “[a]s [t]olerated,” (id. at 282).

During this same time period, Plaintiff also was seen by the physician who performed her 2010 back surgery, Dr. Vibert.

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Bluebook (online)
161 F. Supp. 3d 545, 2016 U.S. Dist. LEXIS 17291, 2016 WL 552723, Counsel Stack Legal Research, https://law.counselstack.com/opinion/mellian-v-hartford-life-accident-insurance-mied-2016.