Winfrey v. Hartford Life & Accident Insurance

127 F. Supp. 3d 1153, 2015 U.S. Dist. LEXIS 114515, 2015 WL 5093280
CourtDistrict Court, D. Kansas
DecidedAugust 28, 2015
DocketCase No. 14-CV-1034-EFM-JPO
StatusPublished
Cited by4 cases

This text of 127 F. Supp. 3d 1153 (Winfrey v. Hartford Life & Accident Insurance) is published on Counsel Stack Legal Research, covering District Court, D. Kansas primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Winfrey v. Hartford Life & Accident Insurance, 127 F. Supp. 3d 1153, 2015 U.S. Dist. LEXIS 114515, 2015 WL 5093280 (D. Kan. 2015).

Opinion

MEMORANDUM AND ORDER

ERIC F. MELGREN, District Judge.

Plaintiff Larry Winfrey brings suit against Hartford Life and Accident Insurance Company and Group Long Term Disability Plan for Employees of Spirit Aero-systems, Inc. (collectively “Hartford”) for recovery of benefits under a disability insurance policy. Before the Court are two motions for summary judgment: one by Winfrey and the other by Hartford. Because the Court finds that Hartford did not abuse its discretion in denying Winfrey long-term disability benefits, the Court grants Hartford’s Motion for Summary Judgment (Doc. 43) and denies Winfrey’s Motion for Summary Judgment (Doc. 52).

I. Factual and Procedural Background1

Plaintiff Larry Winfrey was previously employed as a Marketing and Sales Customer Service Representative at Spirit Aerosystems, Inc., where he began working in January 2006. Winfrey described his position as involving forecasting, reporting, and computer work. The physical demands of his position included the use of a computer, calculator, and telephone; frequent reaching at desk level; occasional reaching at waist and above shoulder level; sitting throughout the day with brief periods of standing and/or walking; and no lifting.

In 2007, Winfrey had a laminectomy at the L4-L5 vertebrae in his back. In May 2010, Winfrey was diagnosed with failed spine surgery syndrome, bilateral lumbar radiculitis, and status post L4-L5 laminec-tomy. In October 2011, Winfrey underwent a psychological evaluation by Don Morgan, Ph.D., to determine his suitability for an implanted spinal stimulator trial. During the evaluation, Winfrey told Dr. Morgan that he experiences pain from sitting and that he uses a TENS unit at work to help with pain. Winfrey ultimately did not have the spinal stimulator surgically implanted after the trial.

In November 2011, a MRI confirmed that Winfrey has lumbar degenerative disc disease even after his 2007 laminectomy. Winfrey continues to experience pain despite undergoing surgical procedures, physical therapy, external electrical simulation, implanted neural stimulators, and medications.

[1157]*1157Spirit’s Short-Term Disability and Long-Term Disability Plans

Hartford issued Group Insurance Policy No. GLT-696984 to Spirit, which insures Spirit’s welfare benefit plan. The policy contains a short-term disability plan (“STD Plan”) and a long-term disability plan (“LTD Plan”). The STD Plan is self-funded, meaning that Hartford administers the plan but Spirit pays out the disability benefits, while the LTD Plan is both administered and paid out by Hartford. Because the LTD Plan is primarily at issue in this case, the Court will outline its terms below.

Pursuant to the LTD Plan, the term “Disability” or “Disabled” means

You prevented from performing one or more of the Essential Duties of:
1) Your Occupation During the Elimination Period;
2) Your Occupation for the 24 month(s) following the Elimination Period, and as a result Your Current Monthly Earnings are less than 80% of Your Indexed Pre-disability Earnings; and
3) after that, Any Occupation

“Essential Duty” means “a duty that is substantial, not incidental; is fundamental or inherent to the occupation; and cannot be reasonably omitted or changed.” The LTD plan defines the term ‘Your Occupation” as ‘Your Occupation: as it is recognized in the general workplace; and for which [the claimant is] qualified by education, training or experience.” The LTD plan defines the term “Elimination Period” as “the longer of the number of consecutive days at the beginning of any one period of Disability which must elapse before benefits are payable or the expiration of any Employer sponsored short term Disability benefits or salary continuation program, excluding benefits required by state law.” Under the LTD Plan, Hartford has “full discretion and authority to determine eligibility for benefits and to construe and interpret all terms and provisions” of the policy.

Winfrey’s Short Term Disability Claim

On September 12, 2012, Winfrey submitted a claim under the STD Plan due to low back pain and radicular neuropathic pain. That same day, Hartford faxed an Attending Physician’s Statement (“APS”) to Plaintiffs treating physician, Dr. Scott Meyers. Dr. Meyers returned the APS to Hartford on September 18, 2012. It stated that Winfrey was unable to work for three months. Hartford approved Winfrey’s STD application based upon Dr. Meyers’ APS and began paying benefits under the Policy on September 13, 2012, which would expire on October 24, 2012.

On October 15, 2012, Hartford sent Dr. Meyers another APS to determine the progression of Winfrey’s capabilities. Winfrey also contacted Hartford on that day, stating that he believed he would be able to return to work on November 15, 2012. On October 17, 2012, Dr. Meyers returned the APS listing a return to work date of December 13, 2012, and the following restrictions: no working, standing, lifting, sitting, carrying, bending, and kneeling. Hartford approved the continuation of Winfrey’s STD benefits through November 14, 2012.

On November 19, 2012, Winfrey contacted Hartford asking to further extend his STD benefits. That same day, Dr. Meyers submitted an updated APS listing a return to work date of December 13, 2012, and the following restrictions: no standing, lifting more than ten pounds, sitting, carrying, bending, kneeling for over two hours. Winfrey also contacted Hartford on November 20, 2012, and stated that his back pain was improving and that he could sit longer than he used to with a new patch and exercise. On December 4, 2012, Hartford faxed another APS to Dr. Meyers, who responded on December 6, 2012, with the same restrictions and listing a return [1158]*1158to work of January 2, 2013. Hartford then approved the continuation of Winfrey’s STD benefits through December 12, 2012.

Hartford contacted Winfrey for additional information on December 12,13, and 17, 2012, to review continuing his benefits past December 12, 2012. On December 26, 2012, a clinical case manager with Hartford sent Dr. Meyers a request for additional information regarding Winfrey’s capabilities and medical condition. The case manager noted that Winfrey was having gradual improvement but was not yet able to sit for a full day. The case manager also noted that Winfrey had indicated that he had planned to return to work on December 15 but would rather go out of town for Christmas break then return to work in January. The case manager asked Dr. Meyers if the restrictions he had given Winfrey were based on Winfrey’s subjective complaints of inability to sit for a full work day, and Dr. Meyers confirmed that they were. Hartford approved the continuation of Winfrey’s STD benefits through January 6, 2012.

Winfrey returned to work on January 7, 2013, but only worked for about a week. After receiving notice from Winfrey that he needed continuing benefits, Hartford sent Dr. Meyers another APS. On January 18, 2013, Dr. Meyers listed Winfrey’s restrictions as no standing, lifting more than ten pounds, carrying, kneeling, no sitting for more than two hours without getting up. He also stated that these restrictions were permanent. On January 22, 2013, Winfrey called Hartford and stated that he could not work anymore due to his pain. Hartford thereafter extended Plaintiffs STD benefits to March 30, 2013.

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Bluebook (online)
127 F. Supp. 3d 1153, 2015 U.S. Dist. LEXIS 114515, 2015 WL 5093280, Counsel Stack Legal Research, https://law.counselstack.com/opinion/winfrey-v-hartford-life-accident-insurance-ksd-2015.