Tortora v. Hartford Life & Accident Insurance

162 F. Supp. 3d 520, 2016 U.S. Dist. LEXIS 14884
CourtDistrict Court, D. South Carolina
DecidedFebruary 8, 2016
DocketC.A. No. 6:15-2471-HMH
StatusPublished
Cited by2 cases

This text of 162 F. Supp. 3d 520 (Tortora v. Hartford Life & Accident Insurance) is published on Counsel Stack Legal Research, covering District Court, D. South Carolina primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Tortora v. Hartford Life & Accident Insurance, 162 F. Supp. 3d 520, 2016 U.S. Dist. LEXIS 14884 (D.S.C. 2016).

Opinion

[523]*523OPINION & ORDER

Henry M. Herlong, Jr., Senior United States District Judge

This matter is before the court for review of the claim administrator’s decision to deny long-term disability (“LTD”) benefits to Ralph J. Tortora (“Tortora”) under an LTD insurance policy (“Policy”) governed by ERISA.1 The Policy is insured and administered by Hartford Life and Accident Insurance Company (“Hartford”). Tortora seeks LTD benefits pursuant to 29 U.S.C. § 1132(a)(1)(B) and attorneys’ fees and costs pursuant to 29 U.S.C. § 1132(g). (Joint Stipulation (“J.S.”) ¶ 1, ECF No. 23.) The parties have filed a joint stipulation and memoranda in support of judgment pursuant to the court’s Specialized Case Management Order for ERISA benefits cases. The parties agree that the court may dispose of this matter consistent with the joint stipulation and memoranda. (Id. ¶ 8, ECF No. 23.) The parties further agree that the court should resolve the following issues: (1) whether Hartford’s claim decision was proper under the applicable standard of review and factors made relevant by Champion v. Black & Decker (U.S.) Inc., 550 F.3d 353 (4th Cir.2008); (2) if the claim decision was improper, whether benefits should be awarded pursuant to 29 U.S.C. § 1132(a)(1)(B), or whether the case should be remanded to Hartford for further evaluation of Tortora’s claim; and (3) if remand is necessary, whether resolution of the issue of retroactive benefits and attorneys’ fees should be deferred until after further evaluation is conducted. (J.S. ¶7, ECF No. 23.) For the reasons set forth below, the court remands the case to Hartford for further consideration.

I. Factual and Procedural History

Tortora’s claim arises under a group disability policy that was issued by Hartford to Tortora’s former employer, Macro Plastic, Incorporated (“MPI”). (Compl. ¶ 4, ECF No. 1.) Tortora was employed by MPI as a sales and marketing manager until January 4, 2006, when he ceased working due to a back injury caused by a fall at home, which required a spinal fusion of T-10 to L-3. (Def. Mem. Supp. J. 4, ECF No. 27.)'As an employee of MPI, Tortora was covered by the Policy as a participant in the employee benefits plan. (Id. at 1, ECF No. 27.) Under the employee benefits plan and the Policy, MPI vested Hartford with discretionary authority to interpret Policy terms and make benefit determinations. (Id., ECF No. 27.)

Tortora applied for LTD benefits on February 18, 2006. (J.S. Exs., ECF No. 24-15, AR 1117-22.) Hartford approved LTD benefits under the Policy and notified Tor-tora by letter dated March 21, 2006. (Id. Exs., ECF No. 24-16, AR 1266-68.) Between 2007 and 2014, Tortora completed several Claimant Questionnaire forms upon Hartford’s request, in which he reported working as a part-time realtor fluctuating between ten to twelve or ten to fifteen hours per week. (Id. Exs., ECF No. 24-13, AR 898-900; Id. Exs., ECF No. 24-13, AR 879-81; Id, Exs., ECF No. 24-10, AR 532-34.) On October 2, 2014, Hartford denied Tortora continuing LTD benefits, finding that Tortora no longer had a “Disability” as that term is defined under the Policy. (Id, Exs., ECF No. 24-16, AR 1145-50.) The decision was upheld on appeal and became final on June 10, 2015. (Id, Exs., ECF No. 24-16, AR 1129-32.) Tortora alleges that he is disabled and that Hartford abused its discretion in terminating his LTD benefits.

The Policy provides in pertinent part as follows:

When do benefits become payable?
You will be paid a monthly benefit if:
[524]*5241. you become Disabled while insured under this plan;
2. you are Disabled throughout the Elimination Period;
3. you remain Disabled beyond the Elimination Period;
4. you are, and have been during the Elimination Period, under the Regular Care of a Physician; and
5. you submit Proof of Loss satisfactory to us.
When will benefit payments terminate?
We will terminate benefit payment on the first to occur of:
1.the date you are no longer Disabled as defined;
* * *
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 Benefit 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.

(J.S. Exs., ECF No. 24-20, AR 1461, 1462, 1470,1471.)

Tortora filed the instant action on June 19, 2015. (Compl., ECF No. 1.) The parties submitted a joint stipulation on December 18, 2015. (J.S., ECF No. 23.) Tortora filed a motion in support of judgment on January 7, 2016. (PI. Mem. Supp. J., ECF No. 26.) Hartford filed a memorandum in support of judgment on January 8, 2016. (Def. Mem. Supp. J., ECF No. 28.) On January 14, 2016, Hartford and Tortora replied. (Def. Reply, ECF No. 31; PI. Reply, ECF No. 32.) This matter is now ripe for consideration.

II. Discussion op the Law

A. Standard of Review

“When.. .an ERISA benefit plan vests with the plan administrator the discretionary authority to make eligibility determinations for beneficiaries, a reviewing court evaluates the plan administrator’s decision for abuse of discretion.” Williams v. Metro. Life Ins. Co., 609 F.3d 622, 629-30 (4th Cir.2010) (citations omitted). Employing this deferential standard, the court will not disturb the determination of the plan administrator if it is reasonable, even if the court, exercising independent judgment, would have reached an alternative decision. Donovan v. Eaton Corp., Long Term Disability Plan, 462 F.3d 321, 326 (4th Cir.2006). A plan administrator’s decision is reasonable, and will be upheld, if it is the product “of a deliberate, principled reasoning process and if it is supported by sübstantial evidence.” Bernstein v.

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Bluebook (online)
162 F. Supp. 3d 520, 2016 U.S. Dist. LEXIS 14884, Counsel Stack Legal Research, https://law.counselstack.com/opinion/tortora-v-hartford-life-accident-insurance-scd-2016.