Meyer v. Hartford Life and Acc. Ins. Co.

320 F. Supp. 2d 1256, 2004 U.S. Dist. LEXIS 10247, 2004 WL 1253054
CourtDistrict Court, M.D. Florida
DecidedApril 24, 2004
Docket8:03-cv-00666
StatusPublished
Cited by3 cases

This text of 320 F. Supp. 2d 1256 (Meyer v. Hartford Life and Acc. Ins. Co.) is published on Counsel Stack Legal Research, covering District Court, M.D. Florida primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Meyer v. Hartford Life and Acc. Ins. Co., 320 F. Supp. 2d 1256, 2004 U.S. Dist. LEXIS 10247, 2004 WL 1253054 (M.D. Fla. 2004).

Opinion

ORDER

LAZZARA, District Judge.

This cause comes before the Court on Defendant’s Motion for Summary Judgment With Incorporated Memorandum of Law (dkt. 20), Statement of Undisputed Facts (dkt. 21), and supporting exhibits (dkt. 22), and Plaintiffs Memorandum of Law in Opposition to Motion for Summary Judgment (dkt. 34). Also before the Court are Plaintiffs Motion for Summary Judgment (dkt. 27), memorandum of law (dkt. 28), and supporting exhibits (dkt. 29), and Defendant’s Response to Cross-Motion for Summary Judgment (dkt. 36) and Statement of Disputed Facts (dkt. 37). After careful consideration of the arguments, the applicable law, and the file, the Court concludes that Defendant’s Motion for Summary Judgment (dkt. 20) should be granted, and that Plaintiffs Motion for Summary Judgment (dkt. 27) should be denied.

Plaintiff’s Claims

This is an action brought by Plaintiff Ann Meyer (“Meyer”) under the Employee Retirement Income Security Act of 1974 (“ERISA”), as amended, 29 U.S.C. §§ 1001, et seq., for long-term disability (“LTD”) benefits under a Group Long Term Disability Benefits Plan (“the Plan”). Plaintiff, a former employee of Publix Supermarkets, Inc. (“Publix”), alleges that she is entitled to benefits under the Plan because she is totally disabled from performing the material duties of her own occupation due to Bell’s Palsy.

Factual Background

Meyer became employed by Publix on November 10, 1990. She became an insured participant in the Publix LTD Plan on September 1,1993, and continued working until September 8, 2000. (Dkt. 12, ex. B, Administrative Record (“A.R.”), pp. 34- *1259 35.) When she last worked, she was employed by Publix as a pharmacy technician earning $2,004.97 per month, working four days per week, ten hours per day. Meyer stopped working on September 8, 2000 as a result of a facial and trigeminal nerve palsy (referred to as “Bell’s Palsy”), which caused paralysis to the right side of her face! (A.R. 48 & 81.) The paralysis apparently resulted from a herpes zoster infection (referred to as “shingles”). (Id.) Plaintiff immediately sought treatment from various medical providers and while Plaintiff initially experienced some improvement following the onset of her paralysis, she continued having pain and numbness into 2001. (A.R. 64-67 & 84.)

Meyer filed her LTD claim on January 9, 2001, claiming that she had been prevented from working since September 8! 2000, because “the [r]ight side of [her] face (eye, ear, nose, mouth) has nerve damage.” (A.R. 39 & 44-49.) She listed her treating medical providers for this condition as Dr. William F. Rowland (“Dr. Rowland”), for providing initial treatment; Drs. Stuart Strikowsky (“Dr. Strikowsky”) and Roberto Bellini (“Dr. Bellini”), for emergency room treatment; Dr. William L. Taldone (“Dr. Taldone”), an ophthalmologist; Dr. Mitchell B. Miller (“Dr. Miller”), an otolar-yngologist; Dr. Thomas H. Harrison (“Dr. Harrison”), a neurologist; and Florida Community Imaging Center (“FCIC”). (AJEU3-44.)

The Plan at issue has been in effect since September 1, 1993. (Dkt. 12, ex. A, SPD CERT. 14.) The Plan is an employee welfare benefits plan sponsored and administered by Publix. The LTD benefits provided under the Plan are funded through a group policy issued by Defendant Hartford Life and Accident Insurance Company (“Hartford”) to Publix. Hartford serves as Claims 'Administrator for the Plan, and, in this capacity, decides claims and appeals for benefits to the Plan’s terms. The Plan clearly provides Hartford with discretionary authority, stating, “[t]he Hartford has full discretion and authority to determine eligibility for benefits and to construe and interpret all terms and provisions of the Group Insurance Policy.” (SPD CERT. 14, '26-28, & 38-39.) The BookleVCertifieate is the Plan document governing claims under the Plan, and the document applied by Hartford’s claims examiners to determine such claims. (Id.) The Summary Plan Description (“SPD”) references and incorporates the Booklet-Certificate as the controlling Plan document. (A.R.22-27.)

The Plan defines “Totally Disabled” as follows:

(1)during the Elimination Period; 1 and
(2) for the next 24 months, you are prevented by Disability form doing all the material and substantial duties of your own occupation on a full-time basis. After that, and for as long as you remain Totally Disabled, you are prevented by Disability from doing any occupation or work for which you are, or could become, qualified by:
(1) training;
(2) education; or
(3) experience.

*1260 (See SPD CERT. 35.) Thus, for the Elimination Period and the following 24 months, the question is whether a claimant is disabled from performing the material and substantial duties of her own occupation on a full-time basis. After 24 months of benefits, the question is whether a claimant is disabled from performing the duties of any occupation for which the claimant is reasonably qualified by training, education, or experience.

In support of her LTD application, Meyer submitted an Attending Physician Statement (“APS”), dated January 15, 2001, from her treating neurologist Dr. Harrison. (A.R.4-5.) Dr. Harrison diagnosed “facial and trigeminal nerve palsy” causing “paralysis of [right] side of face.” (A.R.5.) Dr. Harrison stated that Plaintiff had a “blurring of vision [in the right] eye” and difficulty [of] verbal communications,” and that Plaintiff “can’t blink right eye, at time must be covered.” (A.R.4.) Dr. Harrison set forth no restrictions on Plaintiffs ability to stand, walk, sit, lift/carry, reach/ work overhead, push, pull, drive, or keyboard use and repetitive hand motions. (A.R.4.) Dr. Harrison further noted that Plaintiffs condition was “improved.” (A.R.5.)

Hartford obtained from Publix a job description for Plaintiffs position as pharmacy technician. This job description showed that Plaintiff had to initiate refill requests, handle customer printouts, ensure the proper display of the product on shelves, order and receive prescription drugs and supplies, generate and reconcile third-party billing, dispose of outdated merchandise, enter information into the pharmacy computer system, reconcile insurance discrepancies, and utilize interpersonal skills. (A.R.33.) These responsibilities physically required Plaintiff to stand, walk, interact with customers, and lift and carry pharmacy merchandise (Id.) Nothing in the job description indicated that Plaintiff needed to have depth perception or the use of both eyes. (Id.)

In reviewing Meyer’s initial claim, Hartford sought and obtained medical records from Meyer’s treating providers. Dr. Harrison’s records show that his APS was based on a single office visit with Meyer on December 21, 2000. (A.R. 5 & 58-60.) At that visit, he conducted a neurological evaluation of Meyer and concluded: “(a) normal language; (b) full visual fields to confrontation.

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Related

Crume v. Metropolitan Life Insurance
417 F. Supp. 2d 1258 (M.D. Florida, 2006)
Ridge v. Hartford Life & Accident Insurance
339 F. Supp. 2d 1323 (M.D. Florida, 2004)

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Bluebook (online)
320 F. Supp. 2d 1256, 2004 U.S. Dist. LEXIS 10247, 2004 WL 1253054, Counsel Stack Legal Research, https://law.counselstack.com/opinion/meyer-v-hartford-life-and-acc-ins-co-flmd-2004.