Braddock v. Baker Hughes Inc. Long Term Dis. Plan

461 F.Supp.2d 490

Larry BRADDOCK, Plaintiff v. BAKER HUGHES INCORPORATED LONG TERM DISABILITY PLAN and Hartford Life Group Insurance Company, Defendants.

Civil Action No. 2:05CV2082KS-MTP.

United States District Court, S.D. Mississippi, Hattiesburg Division.

October 30, 2006.

April C. Ladner, Norman G. Hortman, Jr., Brett Woods Robinson, Hortman, Harlow, Martindale, Bassi, Robinson & McDaniel, PLLC, Laurel, MS, for Plaintiff.

Steven H. Begley, Kevin A. Rogers, Wells, Marble & Hurst, Jackson, MS, for Defendants.

MEMORANDUM OPINION AND ORDER

STARRETT, District Judge.

This cause is before the court on a motion for summary judgment filed by defendants Baker Hughes Incorporated Long Term Disability Plan and Hartford Life Group Insurance Company, and on a motion for summary judgment filed by plaintiff Larry Braddock. From its review of all matters made a part of the record of this case as well as applicable law, and being thus fully advised in the premises, the court FINDS that defendants' motion for summary judgment is well taken and should be granted and plaintiffs motion for summary judgment is not well taken and should be denied. The court specifically finds as follows:

FACTUAL BACKGROUND¹

Mr. Braddock was employed by Baker Hughes, Inc. ("Baker Hughes") as a salesman in its Baker Petrolite division in Laurel, Mississippi, from May 10, 1991 until August 22, 1997, when he went on medical leave. Baker Hughes provided long-term disability benefits to its employees, including Mr. Braddock, under the Baker Hughes Disability Benefits Plan, which incorporates the Baker Hughes Long Term Disability Plan as amended and restated on February 28, 1997 (the "Plan").

The Plan provides that long-term disability benefits will be paid to participants determined by the Plan Administrator to have a Total Disability. "Total Disability," for the purposes of long-term disability coverage, is defined as:

a Disability² (i) which prevents a Long Term Disability Participant from engaging in any occupation or employment for which he is qualified, or may reasonably become qualified, based on his training, education, or experience, (ii) for which the Long Term Disability Participant is under the regular care and personal attendance of a Physician for treatment aimed at maximizing such Participant's recovery and return to work, and (iii) during which the Long Term Disability Participant does not engage in any occupation or perform any work for compensation or profit other than Rehabilitative Employment; provided, however, that during the first 12 months of a Disability, Total Disability means a Disability which prevents a Long Term Disability Participant from engaging in his regular occupation and which meets the foregoing requirements under clauses (ii) and (iii). Notwithstanding the foregoing, no Disability shall constitute a Total Disability unless the foregoing conditions are met for the first time with respect to such Disability at a date upon which such individual is a Long Term Disability Participant in the Plan.

After the first twelve months, a participant is not eligible for long-term disability benefits if he is able to engage in any occupation or employment for which he is "qualified, or may reasonably become qualified, based on his training, education or experience." The Plan further provides that "[a]s a condition to the payment of any benefits under the Plan, each Participant shall be required to provide proof of continued Total Disability, including, but not limited to, an examination by a Physician selected by the Plan Administrator, as may be required from time to time by the Plan Administrator."

Baker Hughes is the Plan Administrator and Sponsor of the Plan. Baker Hughes performs certain administrative functions in connection with the Plan and has the right to terminate or modify the Plan. Under the Plan, defendant Hartford Life Group Insurance Company ("Hartford") is the Claims Administrator and is responsible for processing and paying eligible claims. Hartford has sole discretionary authority to determine eligibility for and entitlement to benefits under the Plan and to interpret the terms of the Plan.³

On August 6, 1997, Mr. Braddock saw his treating orthopedist, Dr. Richard Conn, who wrote in a report of that visit: "It is my medical opinion that this gentleman is suffering from his systemic rheumatologic condition to the point that he would be unable to continue to stand for any long periods of time and any squatting, crawling or climbing would be out of the question. I feel this is going to be on a permanent basis." On August 23, 1997, Mr. Braddock submitted a claim to Reliastar for disability benefits.

On a November 12, 1997 Attending Physician's Statement of Disability, Dr. Conn checked the box indicating that Mr. Braddock was totally disabled from any occupation and from his regular occupation. Again, on January 30, 1998, Dr. Conn checked the box indicating that Mr. Braddock was "totally disabled for any occupation." Mr. Braddock saw Dr. Conn again on March 5, 1998, and Dr. Conn wrote of this visit: "It is my opinion that this gentleman's ongoing arthritic conditions with his knees and ankle are on a permanent basis. I see no resolution at this time, and feel that this will be on a chronic ongoing basis." Dr. Conn also wrote on a Physical Capacities Evaluation: "Pt is unable to work!!!"

On March 3, 1998 Reliastar approved Mr. Braddock's claim for long-term disability benefits, effective February 28, 1998.

Thereafter, on October 2, 1998, Reliastar referred Mr. Braddock's file to EvaluMed for review by either an orthopedic surgeon or rheumatologist, to determine whether Mr. Braddock was capable of work at that time. Dr. Mark Dahl reviewed Mr. Braddock's medical records and in a report dated October 14, 1998, concluded that Mr. Braddock "should be capable of doing sedentary work." Dr. Dahl also recommended that Mr. Braddock receive an independent medical evaluation by a rheumatologist to evaluate his work capacity. Reliastar then arranged for Mr. Braddock to be evaluated by Dr. John Churchill Huntwork, a Rheumatologist. Dr. Huntwork completed an Independent Medical Evaluation, dated December 8, 1998, in which he generally concurred with the previous diagnoses of inflammatory arthritis and concluded that Mr. Braddock could engage in work activity of an "entirely sedentary nature involving lifting of no more than 25 pounds, freedom of movement, a flexible schedule, no prolonged sitting and no climbing, stooping, crawling, kneeling, pushing or pulling whatsoever."

On January 6, 1999, Reliastar wrote to Dr. Conn enclosing Dr. Huntwork's report and asking if he agreed with Dr. Huntwork's assessment that Mr. Braddock could work in a sedentary capacity. Dr. Conn signed the letter indicating his approval on February 2, 1999 and returned it to Reliastar. Mr. Braddock was then referred to Robin Burris-Thomas, a Rehabilitation Coordinator, for a vocational assessment. On February 22, 1999, Ms. Thomas interviewed Mr. Braddock and completed a Rehabilitation Report. In her report, Ms. Thomas noted that Mr. Braddock stated that his pain was 7.5-8 on a scale of 0 to 10, and he estimated that he could sit for 30-40 minutes, stand for 20-30 minutes and drive for 15-20 minutes. On May 18, 1999, Reliastar wrote to Mr. Braddock informing him that Ms. Thomas had explored vocational alternatives that existed within his physical limitations but that based upon review of this information, "it does not appear that vocational rehabilitation services are appropriate." Reliastar informed Mr. Braddock that it would be transferring his claim to a Social Security Disability Benefit Specialist to review the appropriateness of applying for SSDI benefits.⁴

In a November 9, 1999 Medical Assessment, Dr. Conn stated that Mr. Braddock suffered from degenerative arthritis and concluded: "Pt continues to have joint pain in both knees. And multiple joint pain and tenderness. We see no resolution of this problem at this time." And Dr. Conn noted after a September 20, 2000 visit with Mr. Braddock: "The fact that these conditions are of a chronic and permanent nature relative to his ability to get about and the gentleman continues to be markedly restricted in terms of his activities with no crawling, climbing, limited to sitting and walking tolerance."

Plaintiff then submitted a Disability Claim Form to Hartford dated April 14, 2004 in which he stated that his activities were "very limited" and that he spent his time "either sitting, watching T.V. or reading." Thereafter, in June 2004, Hartford referred Mr. Braddock's claim to the Special Investigation Unit ("SIU") for further investigation. Hartford had become suspicious that Mr. Braddock might have been misrepresenting his disability because his self-reported restrictions and limitations seemed extreme when compared to his medical records. SIU requested that HUB Enterprises conduct surveillance of Mr. Braddock. Twenty hours of surveillance was then conducted on a consecutive Sunday and Monday, June 20 and 21, 2004. A video was made of Mr. Braddock which, according to the November 5, 2004 summary prepared by HUB Enterprises, depicts him on the first day of surveillance standing and walking around his home in a normal manner without any restrictive movement or visible medical devices, and on the second day of surveillance, over nearly a three-hour period, driving from his house to a gas station, getting out of his car to pump gas, going into and out of the gas station, getting back into his car, driving to a store, going into and out of the store, getting back into his car, driving to a nursing home, going into and out of the nursing home twice, going to an investment and insurance company office and driving home. During this trip, Mr. Braddock was not seen wearing or using any medical devices and was seen walking in a normal manner, without any visible signs that he was in pain.⁵

On a ...