Davis v. Hartford Life & Accident Ins. Co.

RICHARD E. DAVIS, Plaintiff, v. HARTFORD LIFE & ACCIDENT INSURANCE COMPANY, Defendant.

Civil Action No. 3:14-CV-507-CHB

UNITED STATES DISTRICT COURT WESTERN DISTRICT OF KENTUCKY LOUISVILLE DIVISION

August 12, 2019

MEMORANDUM OPINION AND ORDER*** *** *** ***

This matter is before the Court on the motion of Plaintiff Richard E. Davis ("Davis") to strike the Declarations of Adam Garcia and Gail Gross [R. 119 (Redacted) Mot. to Strike; R. 120 (Unredacted) Mot. to Strike] attached to Defendant Hartford Life & Accident Insurance Company's ("Hartford Life") Motion for Summary Judgment [R. 115-2, Ex. A, Garcia Decl.; R. 115-4, Ex. C, Gross Decl.]. Hartford Life responded and Davis replied. [R. 127; R. 135 (Redacted) Pl. Reply; R. 133 (Unredacted) Pl. Reply] Thus, this matter is ripe for decision. For the reasons set forth below, the Court will DENY Davis's Motion to Strike.¹

I. Background

This dispute arises from Hartford Life's denial of Davis's disability benefits claim. [R. 1, Compl.] Hartford Life is the underwriter, insurer, and administrator of the long term disability ("LTD") insurance policy at issue in this lawsuit. Id. ¶ 7. Davis, a former U.S. Bank employee, alleges that he stopped working in 2011 and "has remained continuously disabled and unable to function on a full-time basis in any gainful employment." Id. at ¶ 9. Hartford Life provided Davis with short term disability benefits ("STD") from October 2011 through April2012 and LTD benefits from April 2012 to April 2014. Id. at ¶10; [R. 5, Ans., at ¶¶ 6, 10] Following these two time periods, Hartford Life terminated Davis's disability benefits on April 18, 2014. [R. 5, Ans., at ¶ 8] Davis filed this action pursuant to the Employee Retirement Income Security Act of 1974 ("ERISA"), 29 U.S.C. §§ 1132(e)(1), 1132(f), seeking enforcement of the contractual terms of the LTD policy, to obtain past benefits, to receive reinstatement for payment of future benefits, to obtain declaratory relief, other equitable relief, and reasonable attorney's fees and costs. [R. 1, Compl., at ¶¶ 4, 40, 43, 48]

After protracted litigation and several orders from this Court touching on discovery issues and dismissing certain claims from the Complaint, the Court entered an Order establishing deadlines for dispositive motions. [R. 112] The parties complied. See [R. 113 (Redacted) Pl. Mot. Summ. J.; R. 114 (Unredacted) Pl. Mot. Summ. J.; R. 115, Def. Mot. Summ. J.; R. 117 (Redacted) Pl. Resp.; R. 118 (Unredacted) Pl. Resp.; R. 122, Def. (Redacted) Resp.; R. 123 (Unredacted) Def. Resp.; R. 129 (Redacted) Pl. Reply; R. 130 (Unredacted) Pl. Reply; R. 132 (Redacted) Def. Reply; R. 133 (Unredacted) Def. Reply] However, while the parties' dispositive motions were pending, Davis filed the instant Motion to Strike, lodging several arguments in support of striking the Declarations of Adam Garcia (the "Garcia Declaration") and Gail Gross (the "Gross Declaration"), which Hartford Life attached in support of its Motion for Summary Judgment.

A. The Garcia Declaration

In his Declaration, Gross states that he is the Senior Director for Group Insurance Claims on behalf of Hartford Life. [R. 115-2, Ex. A, Garcia Decl., at ¶ 1.] His Declaration describes the relationship between the various Hartford entities. He states that the Hartford Financial Services Group, Inc. ("HIG") is "a holding company that includes a family ofsubsidiary and affiliate companies and does not transact any business. HIG's subsidiary and affiliate companies underwrite and sell a wide range of insurance products." Id. at ¶ 2. Hartford Life is one such entity that issues and underwrites, among other things, group LTD insurance policies. Id. at ¶ 3. Hartford Fire Insurance Company ("Hartford Fire") is another subsidiary of HIG, but according to Garcia, "does not issue or underwrite group or disability products." Id. at ¶ 4. Garcia explains that "[f]or administrative purposes, Hartford Fire pays the salaries of all of the employees of all of HIG's subsidiary and affiliate companies." Id. at ¶ 5.

The Declaration explains that Hartford Life issued the LTD policy involved in this lawsuit to U.S. Bank - Policy No. GLT-675173 ("the Policy"). Id. at ¶ 6. Garcia also clarifies that "[a]s the insurance carrier that issued the Policy, Hartford Life is responsible for the adjudication and payment of any claims for benefits arising thereunder." Id. at ¶ 7. This means Hartford Life is responsible for "the processes, procedures, manuals and/or best practices in place for the adjudication of LTD claims, including [Davis's] claim for benefits under the Policy." Id.

Next, the Garcia Declaration sheds light on the decision process that gives rise to this lawsuit. Garcia explains that "Special Investigation Unit Investigative Analyst Joseph Herman ("Herman") terminated [Davis's] claim for benefits under the Policy with the approval of Claims Department Team Leader Jeremy Hunt ("Hunt")[] and Appeal Specialist Mary Floyd ("Floyd") upheld that decision." Id. at ¶ 8. Garcia explains that at the relevant time, Herman, Hunt, and Floyd were "solely responsible" for adjudicating claims under insurance policies issued by Hartford Life. Id. at ¶ 9. Further, Herman, Hunt, and Floyd were "not responsible for adjudicating any claims under insurance policies issued by Hartford Fire" nor did they "hold themselves out as acting on behalf of Hartford Fire in any way." Id. According toGarcia, these three individuals "handled and managed [Davis's] claims for benefits on behalf of Hartford Life, under the authority of Hartford Life, and pursuant to Hartford Life's processes, procedures, manuals, and best practices." Id. at ¶ 10. They were supervised by managers at Hartford Life, not Hartford Fire, and no individuals who were acting on behalf of Hartford Fire adjudicated or paid claims arising under the Policy. Id. at ¶¶ 11-12. In sum, Garcia states that Hartford Life "was solely responsible for the claim decision that forms the basis of this lawsuit." Id. at 13.

B. The Gross Declaration

In her Declaration, Gross states that she is the Clinical Practices Manager for Hartford Life and has held that position since 2011. [R. 115-4, Ex. C, Gross Decl., at ¶ 1] In her Declaration, Gross addresses Hartford Life's "process for obtaining external medical reviews from third-party vendors" as well as various medical statistical information that supported a finding of whether Davis was disabled. See id. at ¶¶ 2-7. According to Gross, "external reviewers do not determine whether claims are paid or denied. Rather, the Hartford [Life] claims analyst reviewing each claim considers the reviewing physician's opinion in conjunction with the relevant policy's terms and conditions, as well as many other considerations in a claims file, in reaching his or her decision as to 'disability' under the relevant policy . . . [I]n making a disability determination, a claims analyst considers not only the review submitted by a particular physician, but all factual, medical, and vocational evidence submitted by a claimant or obtained by Hartford [Life] for a particular claim." Id. at ¶ 5.

II. Discussion

Davis moves to strike both Declarations for several specific (nearly identical) reasons. He first argues that the Court should not consider either Declaration because it must confine itsreview of this ERISA denial decision to the administrative record. [R. 119, at pp. 1, 3-4, 13] Next, Davis alleges that the "sham" affidavit doctrine supports striking both Declarations. Id. at pp. 4-8, 14. Finally, Davis urges the Court to strike both under the Federal Rules of Civil Procedure. See id. at pp. 8-12 (alleging the Garcia Declaration should be stricken under Rule 56(c) and 37(e); 14-15 (alleging the Gross Declaration should be stricken under Rule 56(c)).

Before developing these specific arguments, Davis first attacks the validity of the two Declarations in question on the basis that each contains a "material misrepresentation." [R. 119, at pp. 2, 12] As will be discussed next, once unpacked, this general argument is really an appeal for the Court to undertake a de novo review of Hartford Life's decision to terminate Davis's LTD benefits at the summary judgment stage.

A. Agency v. Employment

The "material misrepresentation" that Davis alludes to concerns the relationship each Declarant has with Hartford Life. He alleges that each Declarant "hold[s] [themselves] out to be an employee of [Hartford Life]," but Davis contends that "in its deposition, [Hartford Life] confirmed it does not have employees." [R. 119, at p. 2] (emphasis in original). Therefore, these Declarants cannot be employees of Hartford Life, as their statements suggest. Id. Davis supports this conclusion by pointing to the Rule 30(b)(6) testimony of Hartford Life, wherein its representative testified in an indirect manner that it did not pay any employees. See [R. 119, at p. 2] Thus, Davis's reasoning is as follows: on direct examination during its Rule 30(b)(6), Davis's counsel asked Hartford Life's representative if she could identify "a single person that has been employed by Hartford Life. . ." [R. 119-1, p. 5, lns. 19-24] The representative responded in the negative. Id. The representative explained during this line of inquiry that Hartford Fire was the entity responsible for paying certain individuals, including the administrators of Davis's claim.Still, based on the answer of its corporate representative that Hartford Life had "no employees," Davis concludes the Declarations both contain material misrepresentations since these Declarants are "holding [themselves] out to be employees" of Hartford Life. [R. 119, at p. 2, 12]

Davis's position on Hartford Life's employees (or lack thereof) is directly connected to his argument concerning the standard of review he urges the Court to adopt in his Motion for Summary Judgement. If Hartford Life had no employees, as his theory goes, then the administrators that decided his benefits did not...