Stout v. Hartford Life & Accident Ins.

58 F. Supp. 3d 1020, 2013 WL 4608129, 2013 U.S. Dist. LEXIS 122932
CourtDistrict Court, N.D. California
DecidedAugust 28, 2013
DocketNo. C 11-6186 CW
StatusPublished

This text of 58 F. Supp. 3d 1020 (Stout v. Hartford Life & Accident Ins.) 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
Stout v. Hartford Life & Accident Ins., 58 F. Supp. 3d 1020, 2013 WL 4608129, 2013 U.S. Dist. LEXIS 122932 (N.D. Cal. 2013).

Opinion

ORDER DENYING DEFENDANTS’ MOTION FOR JUDGMENT AND GRANTING IN PART PLAINTIFF’S CROSS-MOTION FOR JUDGMENT (Docket Nos. 50 & 57).

CLAUDIA WILKEN, United States District Judge

Plaintiff Kathleen Stout moves for judgment on her claims for disability benefits under the Employee Retirement Income Security Act (ERISA). Defendants Hartford Life and Accident Insurance Company and Amazon.com Holding, Inc. Long Term Disability Plan cross-move for judgment. After considering the parties’ submissions and oral argument, the Court grants in part and denies in part Plaintiffs motion for judgment, denies Defendants’ cross-motion for judgment, and remands Plaintiffs claim to the plan administrator to determine whether Plaintiff is eligible for benefits under the “any occupation” standard.

FINDINGS OF FACT

The parties have agreed that the documents submitted with Plaintiffs motion will serve as the administrative record (AR) in this case.1 These findings of fact are based on that record.

I. Plaintiffs Employment History & Disability Diagnoses

In 2008, Plaintiff was hired by Amazon.com to work as a senior technical program manager in Seattle, Washington. AR 390.2 In that role, she oversaw a team of software engineers tasked with collecting and analyzing customer data from Amazon’s website and sharing that data with company executives. Id. Because members of her team lived in both Seattle and Romania, Plaintiff often worked long hours and traveled frequently to supervise them. Id. She regularly worked ten- to twelve-hour days and was expected to be on call even when she was not working. Id.

Beginning in early 2009, Plaintiff began to experience bouts of fatigue and diarrhea as well as episodes of dry eyes and dry mouth. Id. at 1898-99. According to her friends, family, and coworkers, she began to make uncharacteristic mental errors during this period, including simple math and spelling mistakes, and would occasionally lose her train of thought. Id. at 390, 395-96, 399. Plaintiff stopped working in March 2009 after her symptoms worsened. Id. at 149. Plaintiff was granted short-term disability benefits a few weeks later. Id. at 149.

In May 2009, Plaintiff visited Seattle’s Pacific Medical Center to seek a diagnosis. Id. at 1894. Her treating physician, Dr. John Yuen, concluded that Plaintiff “may either have systemic lupus erythematosus or Sjogren’s syndrome. Both of these conditions can be associated with severe fatigue, arthralgia, and some degree of cognitive disturbance, such as poor concentration and memory.” Id. at 1894. Although Plaintiff began taking medication prescribed by Dr. Yuen, her symptoms persisted. Id. at 1891.

[1022]*1022Later that summer, Plaintiff moved to Palo Alto, California, to begin treatment with a new rheumatologist, Dr. Christine Thornburn, and an internist, Dr. Henry Thai, at the Palo Alto Medical Foundation. Id. at 403, 1438-87. There, she underwent additional lab testing which confirmed that she was likely suffering from Sjogren’s syndrome or a similar autoimmune disease. Id. at 1511-13. Examinations of Plaintiffs sleeping habits a few months later, in early 2010, indicated that she was also suffering from obstructive sleep apnea. Id. at 990, 1532-34, 1626-29. Although she was prescribed additional medication, Plaintiff continued to describe feelings of fatigue and cognitive impairment to Drs. Thornburn and Thai over the next several months. Id. at 1438-90.

In March 2010, Plaintiff began a course of cognitive behavioral therapy with Dr. Patrick Whalen at Stanford University. Id. at 1559-73. While these sessions focused on her mental health, she continued to report various physical ailments during this period, as well. See id. Dr. Whalen noted, for instance, that during one session Plaintiff said that “fatigue, feeling like she has the flu most hours most days is by far the most debilitating symptom related to her inability to work.” Id. at 1561. According to Dr. Whalen’s reports, Plaintiff continued to report similar feelings over the course of the next several months. Id. at 739-43.

In August 2010, Plaintiff met with Dr. Peter Karzmark, a Stanford neuropsychol-ogist. Id. at 1414-20. Dr. Karzmark conducted a series of tests to measure Plaintiffs cognitive abilities in the following areas: (1) concentration; (2) learning and memory; (3) problem solving, reasoning, executive abilities, and intelligence; (4) language, academic, visual-spatial, motor, and sensory-perceptual abilities; and (5) personality. Id. The test results revealed that, although Plaintiffs academic abilities were “above average,” her “overall performance on the battery [of tests] was at the 30th percentile” for “someone of her gender, age, and education level.” Id. at 1419. Based on these results, Dr. Karzmark concluded,

It is my overall impression that this patient’s cognitive functioning has declined to a modest extent from baseline. Sjogren’s disease has been associated with cognitive impairment, although this has not been well studied. Her depression may also account for some portion of her cognitive limitation.

Id. at 1419-20.

The following month, in September 2010, Plaintiff began treatment with a new rheu-matologist, Dr. Eliza Chakravarty, at Stanford Hospital. Id. at 725-27, 751-52. Dr. Chakravarty’s examination reports indicate that Plaintiff was still experiencing physical symptoms during that period, including “[increased fatigue” and muscle aches. Id. at 743.

Dr. Chakravarty referred Plaintiff to a neurologist to assess Plaintiffs cognitive impairment. Id. at 754. Reports from that neurologist, Dr. Elias Aboujaude, indicate that Plaintiff was still reporting fatigue, “cognitive difficulties,” and “balance and coordination problems” through at least February 2011. Id. at 736-38.

II. Hartford’s Disability Policy

Plaintiff was insured under Hartford’s Group Policy No. GLT675334, which was issued to Amazon.com Holdings, Inc. Id. at 114. The Policy provides Amazon employees with coverage for long-term disability (LTD) benefits and grants Hartford “full discretion and authority to determine eligibility for benefits and to construe and interpret all [of the Policy’s] terms and provisions.” Id. at 114-16,130.

[1023]*1023The Policy provides two standards for determining whether an employee is “disabled” and qualifies for LTD benefits. Id. at 131. The first, which is known as the “own occupation” standard, applies to LTD claims during the first two years after they are filed. Id. Under this standard, the employee is considered disabled if he or she is unable to perform an essential duty of his or her own occupation. Id. Under this standard, the employee’s own occupation is defined as the employee’s job “as it is recognized in the general workplace,” including comparable positions with other employers. Id. at 134.

The second standard, known as the “any occupation” standard, governs the employee’s eligibility for LTD benefits beyond the first two years of the claim. Id. at 131.

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Cite This Page — Counsel Stack

Bluebook (online)
58 F. Supp. 3d 1020, 2013 WL 4608129, 2013 U.S. Dist. LEXIS 122932, Counsel Stack Legal Research, https://law.counselstack.com/opinion/stout-v-hartford-life-accident-ins-cand-2013.