Vivas v. Hartford Life & Accident Insurance

49 F. Supp. 3d 1124, 2014 U.S. Dist. LEXIS 140342, 2014 WL 4804782
CourtDistrict Court, S.D. Florida
DecidedSeptember 23, 2014
DocketCase No. 10-22992-CIV
StatusPublished
Cited by2 cases

This text of 49 F. Supp. 3d 1124 (Vivas v. Hartford Life & Accident Insurance) is published on Counsel Stack Legal Research, covering District Court, S.D. Florida primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Vivas v. Hartford Life & Accident Insurance, 49 F. Supp. 3d 1124, 2014 U.S. Dist. LEXIS 140342, 2014 WL 4804782 (S.D. Fla. 2014).

Opinion

ORDER GRANTING DEFENDANT’S MOTION FOR SUMMARY JUDGMENT AND DENYING PLAINTIFF’S MOTION FOR SUMMARY JUDGMENT

JOSE E. MARTINEZ, District Judge.

THIS CAUSE came before the Court upon Plaintiff’s Motion for Summary Judgment (D.E. No. 85) and Defendant’s Motion for Summary Judgment (D.E. No. 77). Plaintiff Ramses Vivas (‘Vivas” or “Plaintiff”) participated in an employee benefit plan funded by a group insurance policy (the “Policy”) that Defendant Hartford Life and Accident Insurance Company (“Hartford” or “Defendant”) issued to his employer, Kendall Imports. (D.E. No. 77 at ¶ 1; D.E. No. 84 at ¶ 1). Plaintiff seeks to overturn Defendant’s decision to discontinue payment of his long-term disability (“LTD”) benefits, and moves for summary judgment on the basis that Defendant’s decision to uphold termination of Plaintiffs LTD benefits was de novo wrong and manifestly unreasonable. Defendant asserts that the complete administrative record [1126]*1126(the “Administrative Record”)1 of Vivas’s LTD claim establishes that its decision to discontinue benefits was not wrong, thus mandating the entry of summary judgment in Hartford’s favor. For the reasons set forth below, this Court grants Defendant’s Motion-for Summary Judgment and denies Plaintiffs Motion for Summary Judgment.

I. Relevant Factual and Procedural Background

This is an action to recover LTD benefits under the Employee Retirement Income Security Act of 1974, 29 U.S.C. § 1101, el seq. (“ERISA”). Plaintiff was employed as the director of information technology for Kendall Imports at all material times (D.E. No. 86 at ¶ 1), and he participated in an employee benefit plan funded by a group insurance policy that Hartford issued to his employer. (D.E. No. 77 at ¶ 1; D.E. No. 84 at ¶ 1). Plaintiff ceased working for Kendall Imports in February 2007. (D.E. No. 77 at ¶ 5; D.E. No. 86 at ¶ 15). Shortly thereafter, on March 9, 2007, he received a separation agreement confirming his release from employment. (AR at H555; D.E. No. 86 at ¶ 15). In February 2007, Plaintiff applied for short-term disability benefits (“STD”) (D.E. No. 77 at ¶ 5), which Hartford initially denied. (AR at H382-83; D.E. No. 86 at ¶ 15). In connection with his STD claim, Plaintiff submitted a letter to Hartford on April 25, 2007, stating that he suffers from severe osteoporosis and is “unable to perform [his] job ... [because] the pain is constant.” (AR at H343). Also on April 25, 2007, Plaintiffs physician, Jose J. Aldrich, M.D. (“Dr. Aldrich”), a rheumatologist, submitted a letter stating that he has treated Plaintiff for a “severe case of osteoporosis since August 2005” and that his condition has worsened to the point that he recommends Plaintiff “stop working because of the possibility of bone fracture.” (AR at H345; D.E. No. 86 at ¶ 16). Plaintiff appealed Hartford’s denial of STD benefits (AR at H298-99; D.E. No. 86 at ¶ 17) and, on July 31, 2007, Hartford reversed its initial decision, finding Vivas totally disabled for the period of February 28, 2007 through the duration of his eligibility for STD benefits. (AR at H278). On August 2, 2007, Hartford confirmed that Plaintiffs STD benefits would last through September 4, 2007.

In August 2007, Vivas submitted a claim for LTD benefits. (AR at H213-16; D.E. No. 77 at ¶ 5; D.E. No. 84 at ¶ 5). In support of this claim, Dr. Aldrich submitted an Attending Physician’s Statement of Disability, reflecting a primary diagnosis of severe osteoporosis, a secondary diagnosis of vertebral compression fracture, and subjective symptoms of back pain. (AR at H224-25). Dr. Aldrich indicated that Plaintiff would have unspecified lifelong limitations regarding certain physical activities (e.g., standing, walking, lifting/carrying; reaching/working overhead; pushing; pulling; driving; keyboard use/repetitive hand motion). Id. at H225. On September 11, 2007, Hartford approved Plaintiffs claim for LTD benefits, with benefits effective as of September 5, 2007. (AR at H198-201; D.E. No. 77 at ¶ 8; D.E. No. 84 at ¶ 8). Pursuant to the terms of the Policy, benefits were payable for the first 24 months while Plaintiff met the definition of “Disability” as related to his own occupation. (AR at H198). Thereafter, Plaintiff was only entitled to benefits if Hartford determined that he could not perform one or more of the essential duties of any occupation. (AR at H199; D.E. No. 86 at ¶ 20).

[1127]*1127In a letter dated March 5, 2009, Hartford informed Vivas that, effective September 5, 2009, he “must be considered totally disabled ... in order to continue to be eligible for LTD benefits.” (AR at H106) (emphasis added). Hartford also requested additional information from Plaintiff, advising him that they had initiated an investigation to determine whether he would qualify for benefits on and after September 5, 2009. Id. To obtain documentation of Plaintiffs functionality, an investigative firm conducted video surveillance of Vivas on January 15 and 16, 2009, at Hartford’s request. (AR at H834-35; D.E. No. 77 at ¶ 10; D-E. No. 84 at ¶ 10). The video surveillance and Plaintiffs medical records were reviewed by David Knapp, M.D. (“Dr. Knapp”), a Board Certified physician in Internal Medicine with a Speciality Certificate in Rheumatology. (AR at H705-09). In a Peer Review Report, Dr. Knapp provided the following analysis of the video surveillance:

A case summary for surveillance on 1/15/09 documents [Vivas] walking and lifting his dog into a vehicle and retrieving bags from the rear passenger section while bending at the waist. [Vivas] was noted to be able to participate in exercises at a fitness gym for approximately and [sic] hour. On 1/16/09 [Vivas] was noted to be able to drive and trim hedges in the garden as well as carry items in a basket while shopping. [Vivas] was noted to be able to dine in a restaurant without difficulty and drive himself. The surveillance on 1/15/09 documents that [Vivas] drove to the fitness gym, was observed walking on a treadmill and exercising with various weight machines. Again [Vivas] was noted to bend at the waist and place a basket on the ground as well as walk his dog. A picture of [Vivas] which appears unremarkable and a back brace is noted. Surveillance on 1/15/2009 reveals [Vivas] to function in a normal and unencumbered manner in the course of driving to a gym and using exercise equipment. He was noted to easily enter and exit his vehicle and was able to twist in order to secure the restraints and back up. He was noted to bend and lift a small piece of luggage and lift and pull a larger piece of luggage on wheels. The weight load on the equipment he used was significant and not light. On 1/16/2009 the claimant engaged in activities that included garden work and shopping. He used both hands without difficult [sic] to prune bushes and was able to carry a grocery basket in the right hand as well as use of a cell phone. He was able to stand and ambulate in a comfortable appearing manner and bent over without difficulty. He carried groceries in a bag without difficulty. [Vivas’s] ambulation and gait patterns appeared unremarkable. [He] stood on line to purchase a beverage without obvious distress as well as walk his dog. He was able to sit without difficulty as well as reach behind over his shoulder. He was noted to bend over and stoop in the course of walking his dog.

(AR at H705-06; see also D.E. No. 33, Notice of Filing Surveillance Discs). Dr. Knapp further stated that:

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Bluebook (online)
49 F. Supp. 3d 1124, 2014 U.S. Dist. LEXIS 140342, 2014 WL 4804782, Counsel Stack Legal Research, https://law.counselstack.com/opinion/vivas-v-hartford-life-accident-insurance-flsd-2014.