Topalian v. Hartford Life Insurance

945 F. Supp. 2d 294, 91 Fed. R. Serv. 528, 2013 WL 2147553, 2013 U.S. Dist. LEXIS 70197
CourtDistrict Court, E.D. New York
DecidedMay 16, 2013
DocketNo. 10-CV-1965
StatusPublished
Cited by23 cases

This text of 945 F. Supp. 2d 294 (Topalian v. Hartford Life Insurance) is published on Counsel Stack Legal Research, covering District Court, E.D. New York primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Topalian v. Hartford Life Insurance, 945 F. Supp. 2d 294, 91 Fed. R. Serv. 528, 2013 WL 2147553, 2013 U.S. Dist. LEXIS 70197 (E.D.N.Y. 2013).

Opinion

MEMORANDUM & ORDER

MATSUMOTO, District Judge.

On April 30, 2010, plaintiff Stephen J. Topalian (“plaintiff’ or “Topalian”), a former employee of Alstate Insurance Com[299]*299pany (“Allstate”), commenced this action against Hartford Life Insurance Company (“defendant” or “Hartford”), pursuant to § 502 of the Employee Retirement Income Security Act of 1974 (“ERISA”), 29 U.S.C. § 1132(a)(1)(B), challenging Hartford’s termination of his long term disability (“LTD”) benefits under the Group Long Term Disability Income Plan for Allstate Employees (the “Plan”). (See ECF No. 1, Complaint dated 4/27/10 (“Compl.”).) Plaintiff seeks reversal of Hartford’s decision to terminate his LTD benefits, unpaid LTD benefits retroactive to July 30, 2008, interest on those unpaid benefits, attorneys’ fees, costs, a declaration that he is totally disabled within the meaning of the Plan, and future payment of LTD benefits under the Plan. (See Compl. at 6.)

Presently before the court are the parties’ fully-briefed cross-motions for summary judgment pursuant to Federal Rule of Civil Procedure 56. (ECF No. 55, Hartford’s Motion for Summary Judgment dated 4/20/12 (“Hart. Mot.”); ECF No. 56, Hartford’s Memorandum in Support of Summary Judgment Motion (“Hart. Mem.”); ECF No. 66, Plaintiffs Memorandum in Opposition to Hart. Mot. (“Pl. Opp.”); ECF No., 63, Hartford’s Reply Memorandum (“Hart. Reply”); ECF No. 60, Hartford’s Rule 56.1 Statement (“Hart. 56.1 Stmt.”); ECF No. 66, Exh. 1, Plaintiffs 56.1 Counter-Statement (“Pl. 56.1 Resp.”); ECF No. 64,1 Exh. 1, Plaintiffs Redacted Motion for Summary Judgment dated 2/29/12 (“Pl. Mot.”); ECF No. 64, Exh. 2, Plaintiffs Memorandum in Support of Summary Judgment Motion (“Pl. Mem.”); ECF No. 61, Hartford’s Memorandum in Opposition to Pl. Mot. (“Hart. Opp.”); ECF No. 65, Plaintiffs Reply Memorandum (“Pl. Reply”); ECF No. 64, Exh. 17, Plaintiffs Rule 56.1 Statement (“Pl. 56.1 Stmt.”); ECF No. 62, Hartford’s 56.1 Counter-Statement (“Hart. 56.1 Resp.”).)

For the reasons set forth below, Hartford’s motion for summary judgment is granted, and plaintiffs cross-motion for summary judgment is denied.

BACKGROUND

The following facts, taken from the parties’ Rule 56.1 statements2 and relevant portions of the expansive Administrative Record,3 are undisputed unless otherwise [300]*300noted. The court has considered whether the parties have proffered admissible evi[301]*301dence in support of their positions and, in evaluating each party’s respective summary judgment motion, has viewed the facts in the light most favorable to the non-moving party. See Spiegel v. Schulmann, 604 F.3d 72, 77, 81 (2d Cir.2010).

Plaintiff, a morbidly obese man in his fifties during the period relevant to this action, is a former Allstate employee who began receiving LTD benefits through the Plan in 2004. In 2008, Hartford terminated those LTD benefits, upon a finding that plaintiff was no longer disabled under the meaning of the Plan. After filing an unsuccessful administrative appeal of Hartford’s termination decision, plaintiff now argues that Hartford’s termination of his LTD benefits was improper, unfair, and unsupported by substantial evidence.

Set forth below is a detailed summary of the Plan documents, plaintiffs personal background and employment history, and the extensive medical evidence and proceedings relevant to Hartford’s termination of plaintiffs LTD benefits.

I. The Plan Documents

Beginning in January 1, 2000, Hartford, a claims administrator, insured and administered the Plan through an insurance policy designated “GLT-673454.”4 (Hart. 56.1 Stmt. ¶ 3; PI. 56.1 Resp. ¶ 3; AR 1, 15-16.) The parties do not dispute that plaintiff enrolled and participated in the Plan and received disability benefits under that Plan. (Hart 56.1 Stmt. ¶ 3; PI. 56.1 Resp. ¶ 3.) The parties disagree, however, regarding whether the documents included in the Administrative Record constitute “the Plan” that lies at the heart of this action. (Compare PI. 56.1 Stmt. ¶¶ 117-20, Pl. 56.1 Resp. ¶¶ 3-6, and Pl. Mem. at 28, with Hart. 56.1 Stmt. ¶¶ 3-8, Hart. Resp. ¶¶ 117-20, and Hart. Opp. at 8-9.) These documents include: (A) the “Group Benefit Plan: Allstate Insurance Company” (the “Group Benefit Plan Document”), (AR 12-39), and (B) the “Amendment to Group Policy 673454 on July 30, 2004” (the “2004 Policy Amendment” or the “Amendment”), (AR 1-11).

A. The Group Benefit Plan Document/Booklet-Certificate

The Group Benefit Plan Document contains a Certificate of Insurance, which explains that

[t]he terms of the Group Insurance Policy which affect an employee’s insurance are contained in the following pages [of the Group Benefit Plan]. This Certificate of Insurance and the following pages will become your Booklet-certificate. The Booklet-certificate is part of the Group Insurance Policy.
This Booklet-certificate replaces any other which Hartford Life may have issued to the Policyholder to give you under the Group Insurance Policy specified herein.

(AR 15.) Additionally, the Group Benefit Plan Document includes a “Schedule of Insurance” document, which provides a “Plan Effective Date” of January 1, 2000, identifies the Group Insurance Policy as “GLT-673454,” and clarifies that the benefits described within the Group Benefit Plan are “those in effect as of January 1, 2003.” (AR 16.) The Schedule of Insurance also specifies that “[t]his plan of Disability Insurance provides you with loss of income protection if you become disabled [302]*302from a covered accidental bodily injury, sickness or pregnancy.” (Id.)

Moreover, in response to the question “Who interprets policy terms and conditions?”, the Group Benefit Plan Document clarifies that Hartford retains “full discretion and authority to determine eligibility for benefits and to construe and interpret all terms and provisions of the Group Insurance Policy.” (AR 27.)

The Group Benefit Plan Document then provides the following definitions of relevant terms:

Any Occupation means an occupation for which you are qualified by education, training or experience, and that has an earnings potential greater than an amount equal to the lesser of the product of your Indexed Pre-disability Earnings and the Benefits Percentage and the Maximum Monthly Benefit shown in the Schedule of Insurance.
Disability or Disabled means that during the Elimination Period and for the next 24 months you are prevented by: 1. accidental bodily injury; 2. sickness; 3. Mental Illness; 4. Substance Abuse; or 5. pregnancy, from performing one or more of the Essential Duties of Your Occupation, and as a result your Current Monthly Earnings are no more than 80% of your Indexed Pre-disability Earnings. After that, you must be so prevented from performing one or more of the Essential Duties of Any Occupation.

Free access — add to your briefcase to read the full text and ask questions with AI

Related

Cite This Page — Counsel Stack

Bluebook (online)
945 F. Supp. 2d 294, 91 Fed. R. Serv. 528, 2013 WL 2147553, 2013 U.S. Dist. LEXIS 70197, Counsel Stack Legal Research, https://law.counselstack.com/opinion/topalian-v-hartford-life-insurance-nyed-2013.