Reetz v. Hartford Life & Accident Ins. Co.

294 F. Supp. 3d 1068
CourtDistrict Court, W.D. Washington
DecidedFebruary 16, 2018
DocketCASE NO. C17–0084JLR
StatusPublished
Cited by8 cases

This text of 294 F. Supp. 3d 1068 (Reetz v. Hartford Life & Accident Ins. Co.) is published on Counsel Stack Legal Research, covering District Court, W.D. Washington primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Reetz v. Hartford Life & Accident Ins. Co., 294 F. Supp. 3d 1068 (W.D. Wash. 2018).

Opinion

JAMES L. ROBART, United States District Judge

I. INTRODUCTION

Before the court are Plaintiff Kristen Reetz's and Defendant Hartford Life and Accident Insurance Company's ("Hartford") cross motions for judgment under Federal Rule of Civil Procedure 52, (Pl. Mot. (Dkt. # 29) ); (Def. Mot. (Dkt. # 31).) Each party opposes the other's motion for judgment. (Pl. Resp. (Dkt. # 33); Def. Resp. (Dkt. # 32).) The court has considered the motions, the parties' submissions in opposition to and in support of the motions, the administrative record, and the applicable law. Being fully advised,1 the court grants Ms. Reetz's motion for judgment and denies Hartford's motion for judgment.2

*1071II. FINDINGS OF FACT

This case arises from Hartford's denial of long-term disability ("LTD") benefits to Ms. Reetz. (See Compl. (Dkt. # 1) ¶¶ 5.2-5.3.) Ms. Reetz's medical history, as well as the facts behind Hartford's termination of LTD benefits, are long and complex. The court details the relevant facts below.

A. Initial Issuance of Disability Benefits

Ms. Reetz began working at Byram Health Care, Inc. ("Byram") as a senior customer service representative in October 1999. (Admin. Record ("AR") (Dkt. ## 21-23) at 1393.)3 As described by Byram, this position is a sedentary level occupation, requiring six hours of sitting at a time, for a total of seven hours of sitting per day. (Id. at 1214; see also id. at 256 (Hartford describing the position as "involving sitting most of the time").) Alternating sitting and standing as needed is not allowed. (Id. ) There would be a 30-minute break during the eight-hour work day, and a typical work-week consists of 40 total work hours, with 35 of those hours spent sitting. (See id. )

While at Byram, Ms. Reetz participated in a LTD benefit plan, administered by Hartford. (AR at 33; see generally id. at 8-51.) The Plan provides benefits to covered employees who become disabled through sickness or accidental injury and defines "disability" as:

Disability or Disabled means You are prevented from performing one or more of the Essential Duties of:
1) Your Occupation during the Elimination Period
2) Your Occupation, for the 2 year(s) following the Elimination Period, and as a result Your Current Monthly Earnings are less than 80% of Your Indexed Pre-disability Earnings; and
3) After that, Any Occupation.

(Id. at 21 (emphasis omitted).) "Essential duties" are further defined as a duty that:

1) Is substantial, not incidental;
2) Is fundamental or inherent to the occupation; and
3) Cannot be reasonably omitted or changed Your ability to work the number of hours in Your regularly scheduled work week in an Essential duty.

(Id. ) "Your Occupation" does not mean the specific job that the claimant is performing for a specific employer at a specific location; rather, it is the job that is recognized in the general workplace. (Id. at 24.) "Any Occupation," however, means any job for which the claimant is qualified, by education, training, or experience. (Id. at 21.) Thus, the Plan offers benefits for the 90-day elimination period and the two years following that period if the claimant cannot perform the essential duties of his or her own occupation. But after those two years, the Plan will only pay benefits if the claimant is unable to perform the essential duties of any occupation for which he or she is qualified. The parties agree that the Plan is an employee benefit plan within the meaning of the Employee Retirement Income Security Act of 1974 ("ERISA"), 29 U.S.C. § 1001, et seq. (Compl. ¶ 4.6; see Def. Mot. at 7.)

Ms. Reetz remained at Byram until March 2014, when she took leave due to *1072persistent pain resulting from fibromyalgia and spondyloarthropathy.4 (AR at 1450.) Ms. Reetz submitted a claim for benefits under the Plan on March 10, 2014, and Hartford paid short-term disability ("STD") benefits from March 7, 2014 to June 5, 2014. (Id. at 1450, 1452.) It is unclear from Hartford's communication what the basis was for these STD benefits. (See id. at 1452-53.) However, Ms. Reetz was being treated by Dr. Sue Romanick for persistent pain in her lower back, hips, and joints. (See, e.g. , id. at 1495.) Dr. Grace Chapman further recognized that Ms. Reetz's health issues were contributing to severe depression and anxiety. (Id. at 1487.)

In June 2014, Hartford began investigating Ms. Reetz's claim for LTD benefits. (Id. at 1392-1406.) By this point, Ms. Reetz had also undergone knee surgery in the spring of 2014 and fell on that knee during recovery in late May, aggravating the injury. (Id. at 1364-65; 1360 (noting "new re-aggravation" with the right knee).) Dr. Cherylann Brown, Ms. Reetz's therapist, further diagnosed her with major depressive disorder. (Id. at 1385.) Additionally, Ms. Reetz's back pain persisted. Dr. Carolyn Marquadt, Ms. Reetz's primary treating physician, commented that Ms. Reetz "has trouble with sitting or standing" and that her back pain has "more recently...been flared up." (Id. at 1061.) Hartford approved LTD benefits on June 23, 2014 (id. at 457), and paid LTD benefits to Ms. Reetz through April 2016 "because [she was] unable to perform the duties of [her] [o]ccupation due to symptoms and impairments resulting from symptoms for [her] back and fibromyalgia" (id. at 338).

B. Ms. Reetz's Medical Condition from June 2014 to May 2016

During the time she received LTD benefits, Ms. Reetz continued to seek treatment for her fibromyalgia and spondyloarthropathy. The court reviews Ms. Reetz's medical history for the years 2014, 2015, and the first half of 2016 leading up to termination.

1. Ms. Reetz's Medical Condition in 2014 and 2015

On December 8, 2014, Dr. Romanick observed that Ms. Reetz had "alot [sic] of back and SI5 joint pains, upper back pain...and left shoulder pains."6 (Id. at 1052.) Dr. Romanick again noted on March 8, 2015, that Ms.

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294 F. Supp. 3d 1068, Counsel Stack Legal Research, https://law.counselstack.com/opinion/reetz-v-hartford-life-accident-ins-co-wawd-2018.