Schwarz v. Hartford Life and Accident Insurance Company

CourtDistrict Court, N.D. California
DecidedMarch 6, 2020
Docket3:19-cv-02370
StatusUnknown

This text of Schwarz v. Hartford Life and Accident Insurance Company (Schwarz v. Hartford Life and Accident Insurance Company) is published on Counsel Stack Legal Research, covering District Court, N.D. California primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Schwarz v. Hartford Life and Accident Insurance Company, (N.D. Cal. 2020).

Opinion

1 2 3 4 UNITED STATES DISTRICT COURT 5 NORTHERN DISTRICT OF CALIFORNIA 6 7 LISA SCHWARZ, Case No. 19-cv-02370-EMC

8 Plaintiff, ORDER GRANTING PLAINTIFF’S 9 v. MOTION TO REMAND

10 HARTFORD LIFE AND ACCIDENT Docket No. 35 INSURANCE COMPANY, 11 Defendant. 12 13 14 This action is a claim to review the denial of long term disability benefits under an 15 employee benefit plan regulated by the Employee Retirement Income Security Act (“ERISA”). 16 Plaintiff Lisa Schwarz is a former employee of YP Holdings LLC (“YP”) who has suffered from 17 recurring stage IIIC ovarian cancer and related complications for the last eight years. As a result 18 of her condition, Ms. Schwarz began receiving long term disability benefits from Hartford Life 19 and Accident Insurance Company (“Hartford”) in 2017. On August 30, 2018, however, Hartford 20 denied Ms. Schwarz’s claim for benefits; it upheld this denial on appeal the following April. Ms. 21 Schwarz now brings suit against Hartford and YP Holdings LLC Welfare Benefit Plan (“YP 22 Plan”), seeking: (1) an award of benefits in the amount not paid from August 30, 2018; (2) an 23 order determining that she is entitled to future payments as long as she is disabled as defined in the 24 benefit plan; and (3) reasonable attorneys’ fees. Currently pending before the Court is Ms. 25 Schwarz’s motion to expand the Administrative Record or, in the alternative, a stay and remand. 26 Having considered the parties’ briefs, accompanying exhibits and oral arguments, the Court 27 hereby GRANTS Ms. Schwarz’s motion to stay the instant proceedings and remands the matter 1 I. BACKGROUND 2 A. Factual Background 3 Plaintiff Lisa Schwarz began working as an inside salesperson for YP (the corporation 4 establishing and maintaining Defendant YP Holdings LLC Welfare Benefit Plan) in 2007. Docket 5 No. 35 (“Mot.”) at 4. As part of her employment with YP, Ms. Schwarz was covered by a long 6 term disability plan funded by an insurance policy issued by Hartford. Id. at 7. On January 26, 7 2012, Ms. Schwarz was diagnosed with stage III ovarian cancer. Id. at 4. In 2012 and again in 8 2014 (when her cancer resurfaced), she completed four-month intravenous chemotherapy 9 treatments. Id. at 4-5. During these periods, she underwent regular treatment sessions that 10 resulted in “hair loss, constant pain, fatigue, weakness, and nausea.” Id. at 5. 11 When her cancer again returned in October 2015, Ms. Schwarz’s physician prescribed an 12 oral chemotherapy medication instead of intravenous chemotherapy. Id. Her cancer again went 13 into remission two months later. Id. However, in August 2016, Ms. Schwarz learned that her 14 cancer had likely returned once more. Id. at 6. This news, combined with the various symptoms 15 of her anti-cancer drugs—“loss of appetite, severe anxiety, depression, and neuropath[h]ic 16 pains”—led her to leave work again. Id. 17 On January 9, 2017, Ms. Schwarz submitted a claim for long term disability benefits to 18 Hartford. Id. at 8. Hartford approved this claim on February 13 and began to pay Ms. Schwarz 19 disability benefits. Id. During this period, Ms. Schwarz also applied for Social Security disability 20 insurance and was approved without the need for a hearing. Id. 21 Meanwhile, during a January 16, 2017 consultation, Ms. Schwarz’s physician “opined . . . 22 that [her] cancer was active again” and suggested surgery to remove an enlarged lymph node. Id. 23 at 7. Ms. Schwarz thus underwent a robot-assisted surgical dissection of this lymph node on 24 February 22, 2017. Id. The removed node did not show signs of cancer. Id. However, post- 25 surgery analysis from Ms. Schwarz’s surgeon summarized that this did not mean Ms. Schwarz 26 was cancer-free:

27 Although I removed all the lymph nodes that were visible on the left more deeply buried so as to make it impossible to see it at surgery. 1 2 Id. (emphasis added). Ms. Schwarz subsequently completed a course of radiation for the involved 3 node from May 1 to May 4, 2017, and the administrating physician opined that she had “recovered 4 well from the acute effects of radiation” on June 26, 2017. Id. 5 On June 25, 2017, Ms. Schwarz again met with her oncologist and reported that she was 6 “getting emotionally exhausted being on chemo” and that her side effects were “not tolerable.” Id. 7 at 8. Her oncologist thus ordered a six- to seven-week break from the chemotherapy drug which 8 was later extended further because her CA 125 numbers1 continued to be low. Id. 9 In March 2018, Ms. Schwarz began regular sessions with therapist Dr. Rik Rusovick for 10 her “major depressive order, recurrent, severe,” and, per Dr. Rusovick, “consistently expressed 11 being in severe physical pain” in her arms, hands, and other areas of her body. Id. 12 B. Claims Handling by Hartford 13 As mentioned, Ms. Schwarz submitted a claim for long term disability benefits on January 14 9, 2017. Id. at 8. Hartford approved the claim and began paying benefits to Ms. Schwarz on 15 February 13, 2017. Id. Hartford continued to assess her entitlement to benefits, and upon 16 receiving Ms. Schwarz’s updated medical records, engaged a consultant—oncologist Dr. Susan 17 Lawrence—on June 1, 2018 to review the records for her work-related limitations. Id. at 9; 18 Docket No. 37 (“Opp.”) at 4. Dr. Lawrence spoke with Ms. Schwarz’s physician, who asserted 19 that “the claimant is doing very well from an oncology standpoint, and is free of disease and is off 20 all treatment” and “has no medically necessary restrictions or limitations from an oncology 21 standpoint.” Id. at 5. Dr. Lawrence concluded that Ms. Schwarz “was able to work 40 hours per 22 week in her own occupation” without reference to Ms. Schwarz’s ongoing pain. Id.; Mot. at 9. 23 Dr. Lawrence did remark that Ms. Schwarz experienced mental health difficulties and deferred to 24 a psychiatry reviewer on this front (but Hartford subsequently failed to engage such a reviewer). 25 Mot. at 9-10. Additionally, Dr. Lawrence summarized Ms. Schwarz’s February 2017 surgical 26 procedure as leaving her “cancer free” despite her surgeon’s comments that she was simply 27 1 “unable to reach the cancerous nodes.” Id. at 9. 2 Following this review, Hartford denied Ms. Schwarz’s claim on August 30, 2018 (effective 3 that day) after “reviewing all of the medical records and submissions” and Dr. Lawrence’s report. 4 Opp. at 5. Hartford’s denial letter used the wrong definition of disability; instead of referencing 5 the essential duties of “Any Occupation,” it discussed whether Ms. Schwarz’s conditions 6 precluded her from performing the essential duties of her “own occupation.” 2 Mot. at 10. 7 Ms. Schwarz appealed her denial on January 10, 2019. Id. at 11. A month later, on 8 February 5, 2019, Ms. Schwarz’s counsel informed Hartford that she had restarted chemotherapy 9 in response to her increasing CA 125. Id. at 12. 10 In response, Hartford commissioned two medical file reviews by psychiatrist Dr. E. Greer 11 Richardson and oncologist Dr. Judy Schmidt. Id. In the instant motion, Ms. Schwarz emphasizes 12 that Dr. Richardson’s psychiatric file review was missing various records of Ms. Schwarz’s 13 psychiatric treatment. Id. at 13. In particular, Ms. Schwarz observes that Dr. Richardson’s review 14 never mentions: (1) her treatment records with psychiatrist Dr. Laurie Lo-Yi Chen from December 15 2016 to April 2017; and (2) her treatment records with Dr. Rusovick from March 12, 2018 to 16 September 2018, which are also missing from the Record—the earliest Dr. Rusovick treatment 17 notes discussed in Dr. Richardson’s review, and indeed the earliest Dr. Rusovick treatment notes 18 included in the Record, are from October 19, 2018. Id. at 12-13. Hartford was aware of Ms. 19 Schwarz’s earlier treatments with Dr. Rusovick: on March 15, 2018, Dr. Chen told one of 20 Hartford’s employees that Ms.

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Schwarz v. Hartford Life and Accident Insurance Company, Counsel Stack Legal Research, https://law.counselstack.com/opinion/schwarz-v-hartford-life-and-accident-insurance-company-cand-2020.