Vaughn v. Hartford Life & Accident Ins. Co.

387 F. Supp. 3d 1119
CourtDistrict Court, D. Oregon
DecidedJune 12, 2019
Docket3:17-cv-01904-BR
StatusPublished

This text of 387 F. Supp. 3d 1119 (Vaughn v. Hartford Life & Accident Ins. Co.) is published on Counsel Stack Legal Research, covering District Court, D. Oregon primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Vaughn v. Hartford Life & Accident Ins. Co., 387 F. Supp. 3d 1119 (D. Or. 2019).

Opinion

ANNA J. BROWN, United States Senior District Judge

This matter comes before the Court on Plaintiff Stephanie S. Vaughn's Motion (# 49) for Summary Judgment, Defendant Hartford Life and Accident Insurance Company's Cross-Motion (# 53) for Summary Judgment, and Plaintiff's Motion (# 64) to Strike the Declaration (# 63) of Russell S. Buhite in Support of Defendant's Reply. The Court concludes the record is sufficiently developed, and, therefore, oral argument is not required to resolve this matter.

For the reasons that follow, the Court GRANTS Plaintiff's Motion (# 49) for Summary Judgment and DENIES Defendant's Motion (# 53) for Summary Judgment. The Court also DENIES as moot Plaintiff's Motion (# 64) to Strike.

BACKGROUND

I. Plaintiff Vaughn's Claims

Vaughn alleges Hartford violated ERISA law when it terminated Vaughn's Long-Term Disability (LTD) benefits. Pursuant to 29 U.S.C. § 1332(a)(1)(B) Vaughn seeks reinstatement of her LTD benefits from Hartford under the disability plan (Plan) of her employer, Northwest Permanente, P.C. (Kaiser).

*1122II. Procedural Facts

Vaughn was employed by Kaiser as a family-practice physician. Hartford was the insurer for benefits under the group LTD Certificate of Insurance for Kaiser and administered Vaughn's claim for benefits.

In March 2013 Vaughn applied for LTD benefits on the basis that her asthma, prednisone treatment for her asthma, and juvenile onset diabetes mellitus rendered her disabled under the terms of the Plan.

In September 2013 Hartford approved Vaughn's claim effective August 12, 2013, based on its conclusion that Vaughn was unable to perform one or more of the essential duties of her occupation because of her disability. Hartford continued to pay benefits to Vaughn through October 28, 2017.

In March 2017 Hartford conducted a review of Vaughn's claim to determine whether she remained eligible for LTD benefits and referred Vaughn's claim to its Special Investigation Unit (SIU).

On October 19, 2017, following its investigation, Hartford terminated Vaughn's LTD benefits.

On November 29, 2017, Vaughn filed a Complaint in this Court against Hartford for violation of ERISA.

In February 2018 Vaughn appealed Hartford's termination of her LTD benefits.

On March 26, 2018, Hartford upheld its decision terminating Vaughn's LTD benefits.

On February 15, 2019, Vaughn filed a Motion (# 49) for Summary Judgment in this case.

On March 6, 2019, Hartford filed a Cross-Motion (# 53) for Summary Judgment.

On May 10, 2019, Vaughn filed a Motion (# 64) to Strike the Declaration (# 63) of Russell S. Buhite in support of Hartford's Reply.

On May 24, 2019, all Motions were fully briefed, and the Court took this matter under advisement.

STANDARDS

I. Summary Judgment in ERISA Cases

Although this matter is before the Court on cross-motions for summary judgment, the usual summary-judgment standard under Federal Rule of Civil Procedure 56 is not the appropriate standard in an ERISA action. When reviewing a decision to deny or to terminate benefits, "a motion for summary judgment is, in most respects, merely the conduit to bring the legal question before the district court and the usual tests of summary judgment, such as whether a genuine dispute or material fact exists, do not apply." Stephan v. Unum Life Ins. Co. of Am. , 697 F.3d 917, 929-30 (9th Cir. 2012).

II. ERISA Standard of Review

"When a plan does not confer discretion on the administrator 'to determine eligibility for benefits or to construe the terms of the plan,' a court must review the denial of benefits de novo. " Abatie v. Alta Health & Life Ins. Co. , 458 F.3d 955, 963 (9th Cir. 2006) (citing Firestone Tire & Rubber Co. v. Bruch , 489 U.S. 101, 115, 109 S.Ct. 948, 103 L.Ed.2d 80 (1989) ). De novo is the default standard of review. Id. "But if the plan does confer discretionary authority as a matter of contractual agreement, then the standard of review shifts to abuse of discretion." Id. (emphasis in original). "For a plan to alter the standard of review from the default of de novo to the more lenient abuse of discretion, the plan must unambiguously provide discretion to *1123the administrator." Id. (citing Kearney v. Standard Ins. Co. , 175 F.3d 1084, 1090 (9th Cir. 1999) ).

DISCUSSION

I. The standard of review in this case is de novo.

The parties dispute the standard of review to be applied by the Court in this case.

Vaughn contends the standard of review is de novo on the ground that the applicable Plan contains a clear grant of discretionary authority to Hartford.

Hartford, in turn, contends the Plan vests it with discretionary authority to determine eligibility for benefits, and, therefore, the standard of review is abuse of discretion.

A. Background

Hartford contends the applicable Plan is governed by the 2011 Certificate of Insurance, Revised January 1, 2011, that is part of the Administrative Record (AR)(# 43) filed in this case. AR 003169-80.1

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