Mike Ruple v. Hartford Life & Accident Insurance

340 F. App'x 604
CourtCourt of Appeals for the Eleventh Circuit
DecidedAugust 11, 2009
Docket09-11287
StatusUnpublished
Cited by16 cases

This text of 340 F. App'x 604 (Mike Ruple v. Hartford Life & Accident Insurance) is published on Counsel Stack Legal Research, covering Court of Appeals for the Eleventh Circuit primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Mike Ruple v. Hartford Life & Accident Insurance, 340 F. App'x 604 (11th Cir. 2009).

Opinion

PER CURIAM:

Mike Ruple appeals a summary judgment ruling entered in favor of Hartford Life and Accident Insurance Company (“Hartford”). Ruple filed this lawsuit under the Employee Retirement Income Security Act of 1974 (“ERISA”), 29 U.S.C. §§ 1001, et seq., seeking reinstatement of long-term disability benefits, which Hartford had denied after determining that he was not disabled within the meaning of the applicable benefits policy. The district court found that Hartford’s decision to deny benefits was not wrong and granted summary judgment for Hartford. We agree with the district court and affirm.

BACKGROUND

Ruple’s former employer had in place a disability benefits policy (“the policy”) as part of its employee welfare benefit plan. The policy was originally administered by Continental Casualty Company, aka CNA, (“CCC”), but in 2004 Hartford took over administration of claims made under the policy.

The policy had a short-term disability benefits portion providing disability benefits if the employee was unable to perform his regular occupation. These short-term benefits would be paid for 36 months. After the 36-month period, the employee would have to demonstrate eligibility for long-term disability benefits in order to continue receiving disability benefits.

The long-term disability portion stated: After the Monthly Benefit has been payable for 36 months, “Disability” means that Injury or Sickness causes physical or mental impairment to such a degree of severity that You are:
(1) continuously unable to engage in any occupation for which You are or become qualified by education, training or experience; and
(2) not working for wages in any occupation for which You are or become qualified by education, training or experience.

Additionally, the policy required the claimant to provide proof of disability. The policy stated, in relevant part:

Proof of Disability
The following items, supplied at Your expense, must be a part of Your proof of loss. Failure to do so may delay, suspend or terminate Your benefits:
5. Objective medical findings which support Your Disability. Objective medical findings include but are not limited to tests, procedures, or clinical examinations standardly [sic ] accepted in the practice of medicine, for Your disabling condition(s).

Ruple ceased work for his employer in January 1999 due to back pain, and began receiving short-term disability benefits from CCC. Later, CCC began paying Ru-ple long-term disability benefits. At some point, CCC terminated longterm benefits and Ruple filed' suit. CCC and Ruple requested dismissal of the suit pursuant to a settlement agreement in 2004; CCC then resumed paying long-term disability benefits to Ruple. After Hartford took over administration of the policy, Hartford reviewed Ruple’s claim, determined that *607 he was not disabled within the meaning of the policy that same year, and terminated his benefits.

Hartford’s administrative record contained the following evidence submitted by Ruple in support of his claim that he was disabled from any occupation and thus entitled to long-term disability benefits:

Ruple saw a neurosurgeon in August 1999 who noted that Ruple’s cervical and lumbar MRI studies revealed “no evidence of any abnormality.” The surgeon did not recommend surgery.

Records from the Birmingham Pain Center, where Ruple was a patient starting in January 1999, indicated that Ruple was initially seen by Dr. Cheryl Goyne who stated that Ruple had “chronic low back pain with symptoms suggestive of right L5-S1 radiculopathy” and that “[h]is exam is quite benign.” She also wrote “[j]ust need to keep the possibility in mind that this patient may ultimately be seeking disability to help alleviate the burden of child support.” At his next visit on February 25, 1999, Dr. Goyne noted that the C-spine MRI was read out as normal but that some abnormalities were shown on the thoracic MRI. Dr. Goyne also wrote

The patient did bring up the subject of disability today. He apparently has a good disability policy through work. I was very clear with him that I do not think that this is a disabling lesion. I think that it would be in his best interest to try to retrain to do something else but I cannot say that he is disabled on the basis of these small thoracic disks and I do think we can get him better with proper pain management.

In May of that year, Dr. Goyne noted that Ruple was in a fair amount of pain. In a follow-up appointment, however, Dr. Goyne found that he was “pretty much back to baseline,” although still having some pain. She also stated

The big issue with him right now is disability. His short-term disability will be up in six weeks ... As I told him, my feeling is that it would be most wise to retrain for another position within his company. I did feel that it would be difficult for him to continue his present work with the problems he has in his thoracic spine and do consider his work somewhat risky given that it would not be difficult for him to have thoracic compression if he were to rupture one of the protruded disks. However, I do not feel that his present injury should result in a permanent total disability and again I think he should look towards retraining.

After that visit, Ruple switched to a different doctor at the Birmingham Pain Center — Dr. Gossman. Dr. Gossman noted in June 1999 that Ruple seemed to be experiencing pain, but that “[ojbviously, this is a situation where there could be some addictive / manipulative problem. However, I am going to give him the benefit of the doubt at this point in time and try to work with him.” In July, Dr. Goss-man wrote that Ruple is still not working and reported that the pain wakes him at night. Dr. Gossman, however, stated that he was “a bit concerned” and that Ruple’s “MRI does not look very significant,” that he “moves fairly comfortably in the office when we are not discussing pain [including] bending over to pick up things,” and that Ruple “really does not look that uncomfortable.” Dr. Gossman encouraged Ruple “to seek employment and talk with his workplace about the possibility of working a modified schedule of some sort.” Over the next few months, Ruple received a series of thoracic epidural steroid injections which reportedly brought him significant relief.

In 2002, CCC determined that Ruple was no longer entitled to benefits under *608 the policy. Its letter referred to a report by Dr. Heather Sabo that Ruple was able to perform alternative work with no lifting over 10 pounds, standing and walking for 4 hours per day and sitting for 8 hours per day with breaks as needed. CCC also discussed a vocation assessment which identified available gainful occupations that Ruple could perform. This denial led to his first lawsuit which, as stated above, ended in a settlement and reinstatement of benefits.

In November 2004 after taking over administration of the policy, Hartford interviewed Ruple.

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Bluebook (online)
340 F. App'x 604, Counsel Stack Legal Research, https://law.counselstack.com/opinion/mike-ruple-v-hartford-life-accident-insurance-ca11-2009.