Papadopoulos v. Hartford Life Insurance

379 F. Supp. 2d 117, 2005 WL 1705522
CourtDistrict Court, D. Massachusetts
DecidedJuly 19, 2005
DocketCIV.A. 03-12010NMG
StatusPublished
Cited by6 cases

This text of 379 F. Supp. 2d 117 (Papadopoulos v. Hartford Life Insurance) is published on Counsel Stack Legal Research, covering District Court, D. Massachusetts primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Papadopoulos v. Hartford Life Insurance, 379 F. Supp. 2d 117, 2005 WL 1705522 (D. Mass. 2005).

Opinion

MEMORANDUM & ORDER

GORTON, District Judge.

In the instant ERISA dispute, Pericles Papadopoulos (“Papadopoulos”) alleges that his long term disability benefits were wrongfully terminated by the Hartford Life Insurance Company (“Hartford”). Papadopoulos now moves for leave to amend the complaint and both parties move for summary judgment.

I. Factual Background

A. The Plan

Fidelity Investments (“Fidelity”) maintains a long term disability benefits plan (“the Plan”) for its employees which is insured by Hartford. The Plan documentation states that Hartford is the administrator and that it:

has full discretion and authority to determine eligibility for benefits and to construe and interpret all terms and provisions of the Groups Insurance Policy.

Under the Plan, a participant is entitled to benefits if he or she is “Totally Disabled”, which is defined as follows:

(a) during the Elimination Period; and
(b) for the next 24 months, you are prevented by Disability from 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 training, education, or experience.

The “Elimination Period” is defined as “[t]he first 90 days of any one period of Total Disability”. “Disability” is defined as “any accidental bodily injury, sickness or pregnancy”.

*121 Thus, the Plan establishes a two-period system. During the first period (90-day Elimination Period plus 24 months thereafter), to be eligible for coverage the claimant must be unable to perform Ms own occupation. After that, the claimant must be prevented, by Disability, “from doing any occupation or work for which [he is] or could become qualified by training, education, or experience” (“the Any Occupation Period”). Benefits cease on the earlier of the date that the relevant condition is no longer satisfied or “the date [the claimant] refuse[s] to be examined, if The Hartford requires an examination”.

B. Plaintiffs Claim for Benefits

Papadopoulos is a former employee of Fidelity where he worked as a software engineer and was a Plan participant. He stopped working on December 23, 1997, allegedly due to “cervical radiculopathy”. On May 20, 1998, Papadopoulos submitted an application for long term benefits, claiming to be totally disabled by virtue of symptoms of “neck pains, migraines, dizziness, loss of balance, blurry vision, weak arms & legs, high blood pressure, other bodily pains”.

The application prompted Hartford to gather the medical records of Papadopou-los’s treating physicians, of which there were several. In 1995, Papadopoulos had come under the care of Dr. Albert Ackil (“Dr. Ackil”), a neurologist. Dr. Ackil diagnosed Papadopoulos with cervical radi-culopathy and opined that he “should not do any heavy lifting, greater than 20 pounds, no prolonged sitting, standing, bending, climbing, [or] hyperextension of the neck.” Dr. Ackil also restricted Papa-dopoulos from working at a computer and concluded that he was totally disabled.

Papadopoulos was also treated by Dr. Nicholas Tsanotelis (“Dr. Tsanotelis”), his primary care physician. On May 30, 2000, Hartford wrote to Dr. Tsanontelis and asked him whether he believed that Papa-dopoulos could perform sedentary work. The doctor did not respond.

Gregory Perron (“Perron”), a chiropractor, treated Papadopoulos from August, 1997 to February, 1998. At the end of that treatment, Perron concluded that Pa-padopoulos had reached his “maximum medical improvement” and that • Papado-poulos was capable of working an eight hour day and that he could “frequently carry up to 25 lbs”.

On September 15, 1998, Hartford informed Papadopoulos that his claim had been approved. It concluded that Papado-poulos had become eligible for benefits on November 25, 1997 and that, as a result, the Any Occupation Period would begin on November 25,1999.

C. Hartford Terminates Benefits

In early 1999, Hartford initiated an investigation into whether Papadopoulos would be eligible for benefits during the upcoming Any Occupation Period. To that end, in August, 1999, Hartford hired Aragon Investigations, Inc. (“Aragon”) to conduct surveillance of Papadopoulos to determine his physical limitations. The surveillance took place over several months. Ultimately,. Aragon made a video of Papadopoulos which accompanies the instant motions. The video shows a man walking normally, carrying garbage to a dumpster, carrying a child, getting into a car and driving to various places.

Hartford also retained Dr. William Fish-baugh (“Dr. Fishbaugh”) to conduct an independent medical evaluation and a Functional Capacities Evaluation of Papa-dopoulos. The Functional Capacities Evaluation never took place because Dr. Ackil refused' to permit it, stating that Papadopoulos would be physically unable *122 to participate. On March 7, 2000, Dr. Fishbaugh examined Papadopoulos. He also reviewed the medical records of Papa-dopoulos’s treating physicians. He concluded that Papadopoulos was totally disabled, “mainly because of his migraine headaches”.

In late April, 2000, Hartford contacted plaintiff and his attorney to request an interview. In addition to making several telephone calls, Hartford sent Papadopou-los a letter explaining that, if he refused to be “examined”, i.e. interviewed, his benefits could be terminated. On May 1, 2000, a Hartford representative visited Papado-poulos at his house but he refused to be interviewed.

On May 5, 2000, Hartford sent a copy of the surveillance video to Dr. Fishbaugh. After reviewing the tape, Dr. Fishbaugh changed his conclusion, stating that Papa-dopoulos is not totally disabled and “is capable of returning to work at 40 hours per week”.

On July 21, 2000, Hartford terminated Papadopoulos’s benefits. It sent him a letter stating that “sufficient medical documentation proving you áre Totally Disabled from any occupation has not been received, and you have refused an examination”. On August 30, 2000, Papadopou-los appealed the termination and wrote a letter to Hartford explaining that the Social Security Administration had conducted a three-year review and had' approved him for benefits. He also speculated that the surveillance video might depict his twin brother.

In response, "Hartford made several more attempts to arrange an interview with Papadopoulos but was unsuccessful. On December -20, 2000, Hartford sent plaintiffs file to Dr. George Kazda (“Dr. Kazda”) for another review. Hartford requested that Dr. Kazda determine Papado-poulos’s restrictions on activity and comment as to whether those restrictions were consistent with the surveillance video. Dr. Kazda concluded that Papadopoulos could perform sedentary work as long as he could “change position frequently” and did not need to lift more than 50 lbs.

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Cite This Page — Counsel Stack

Bluebook (online)
379 F. Supp. 2d 117, 2005 WL 1705522, Counsel Stack Legal Research, https://law.counselstack.com/opinion/papadopoulos-v-hartford-life-insurance-mad-2005.