Frerichs v. Hartford Life & Accident Ins. Co.

875 F.Supp.2d 923

Craig FRERICHS, DDS, Plaintiff,

v.HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY, Defendant.

Civil No. 10–3340 (SRN/LIB).

United States District Court, D. Minnesota.

June 21, 2012.

Scott A. Johnson and Todd M. Johnson, Johnson Law Group, LLP, Minnetonka, MN, for Plaintiff.

Anna M. Horning Nygren and Eric C. Tostrud, Lockridge, Grindal, Nauen, PLLP, Minneapolis, MN, for Defendant.

MEMORANDUM OPINION AND ORDER

SUSAN RICHARD NELSON, District Judge.

This matter is before the Court on Defendant's Motion for Summary Judgment [Doc. No. 47] and Plaintiff's Motion for Summary Judgment [Doc. No. 52]. For the reasons set forth herein, Defendant's motion is denied, and Plaintiff's motion is granted.

Plaintiff Craig Frerichs graduated from the University of Minnesota Dental School in 1978 and began working in his field immediately thereafter. ( See Administrative Record (“AR”)-HART000725.) From 1999 through 2006, he was employed by PDG, PA/The Dental Specialists (“PDG” or “Park Dental Group”). (AR–HART000652.) Frerichs was an eligible plan participant in his employer's benefit plan (the “Plan”), for which PDG obtained a group insurance policy (the “Policy”) from Defendant Hartford Life and Accident Insurance Company (“Hartford”). (AR–HART000903–27.) The Policy provided long-term disability coverage and other benefits to eligible employees. ( Id.)

In July 2006, Dr. Frerichs filed a claim for long-term disability under the Policy, identifying spinal degeneration and depression as his disabling conditions. (AR–HART000710.) Initially, Hartford approved Plaintiff's claim and paid benefits from May 2006 until April 2009. (AR–HART000023.) However, after receiving an anonymous tip in 2008, Hartford investigated Plaintiff's claim and conducted surveillance of Dr. Frerichs. (AR–HART000188.) Following its investigation and review of Plaintiff's claim, Hartford terminated his long-term disability benefits in April 2009. (HART000023–29.) Dr. Frerichs appealed the termination decision. (AR–HART000275–96.) Hartford briefly reinstated Frerichs' disability benefits from April to August 2009 while he recovered from rotator cuff surgery (AR–HART000002), but, in November 2009, affirmed its decision that Plaintiff's back pain and depression did not render him totally disabled from working as a dentist. (AR–HART000002–12.)

Plaintiff filed the instant action on August 4, 2010, alleging that Hartford breached its contract by failing to provide long-term disability benefits, in violation of ERISA, 29 U.S.C. § 1132(a)(1)(B). (Compl. [Doc. No. 1].) The parties have filed cross motions for summary judgment.

I. BACKGROUNDA. The Policy

The Policy delegates to Hartford “full discretion and authority to determine eligibility for benefits and to construe and interpret all terms and provisions of the Policy.” (AR–HART000922.) The Policy defines an employee as “disabled” when he or she is “prevented from performing one or more of the Essential Duties of Your Occupation.” (AR–HART000918.) An “essential duty” is one that: “(1) is substantial, not incidental; (2) is fundamental or inherent to the occupation; and (3) can not be reasonably omitted or changed.” ( Id.) “Your Occupation” means “your occupation as it is recognized in the general workplace. Your Occupation does not mean the specific job you are performing for a specific employer or at a specific location.” (AR–HART000921.)

B. Medical Evidence 2005–2006

1. Back Pain

Beginning in approximately 1986, Dr. Frerichs experienced back strain and associated pain. (AR–HART000726.) He found that chiropractic care and massage were helpful in managing his back pain. ( Id.) While at work at Park Dental on September 15, 2005, Plaintiff reported that he was “bending over a patient and twisting” in order to obtain a better view, when he experienced extreme pain in his back and legs. (AR–HART000708.) Dr. Frerichs contends that the pain was so extreme that it took his breath away, sending him to the floor. (AR–HART000727.) Dr. Frerichs met with his treating physician, Dr. Theodore Groskreutz, the following day. (AR–HART000680.) Dr. Groskreutz noted Plaintiff's chronic lower back pain had been present for at least a three year period and that an MRI showed degenerative disc disease. ( Id.) Dr. Groskreutz prescribed a steroid, a Medrol Dosepak, and ordered an MRI of Frerichs' lumbar spine. ( Id.) Dr. Frerichs was off work for approximately 43 days and returned to full-time work on December 1, 2005. (AR–HART000716–17.)

During his time off work in September 2005, Dr. Frerichs treated with orthopedic surgeon Dr. Bryan Lynn at the Institute for Low Back and Neck Care in Minneapolis. (AR–HART000652.) Dr. Lynn noted that Frerich's medical history was significant for lower back pain and depression. ( Id.) He reviewed Plaintiff's most recent MRI scans, which he found to demonstrate moderately advanced disc degeneration at L4–5, with noted reactive endplate changes. ( Id.)

Dr. Frerichs underwent left L5 nerve root block surgery on September 27, 2005, and reported a 60% decrease in pain symptoms following the procedure. (AR–HART000654.) At a follow-up visit with Dr. Lynn on October 10, 2005, however, he reported a return in pain symptoms. (AR–HART000656.)

On October 20, 2005, Dr. Frerichs underwent a laminectomy of the L5–S1 level, performed by Dr. Lynn. (AR–HART000660.) At a follow-up appointment with Dr. Lynn on November 3, 2005, Dr. Frerichs reported feeling much better following the surgery. (AR–HART000663.) Dr. Lynn discussed Dr. Frerichs' possible return to work on a part-time basis: “I suggested he wear [a] brace to try and help with his twisting.” ( Id.) In a narrative attached to his 2006 application for long-term disability benefits, Dr. Frerichs stated that while the surgery alleviated much of his pain, “there was no way the surgeon could restore my abilities to what they once were.” (AR–HART000729.) Plaintiff indicated that it became “increasingly more evident that [his] back pain affect [ed] everything [he did] in the office.” ( Id.) Dr. Frerichs noted that he could not sit without pain and that he could not take narcotic pain medications because of their adverse effect on his concentration and thinking. ( Id.) As a result, he became “very distraught and deeply depressed.” ( Id.) On February 25, 2006, he took an overdose of his wife's Ativan tablets in an attempt to commit suicide. ( Id.) He was admitted to the hospital for severe depression. (AR–HART000668.)

Also in February 2006, Dr. Frerichs met with Dr. Lynn, who reported that Frerichs had been doing very well until recently, when he fell on the floor. ( Id.) Dr. Lynn diagnosed “acute exacerbation of low back pain.” ( Id.) Dr. Lynn recommended that Plaintiff continue taking Ibuprofen and recommended that he consider the use of a muscle relaxant. ( Id.)

Dr. Frerichs continued treatment with Dr. Lynn, who recommended that Dr. Frerichs undergo a Functional Capacities Evaluation (“FCE”) to “quantify his physical limitations.” (AR–HART000673.) Dr. Lynn recommended the FCE in light of Plaintiff's multiple issues:

The patient has multiple issues, he reports, related to concerns regarding his ability to continue work as a dentist. In my experience, it would be extraordinarily unusual for someone to be completely disabled from work following a lumbar discectomy. I believe a very large percentage of Mr. Frerichs' overall functional disability is related to his depression. However, to quantify his physical limitations, I recommend that we obtain [an FCE]. I also advised him that it would be a good idea to quantify what physical activities are demanded of him in his typical work duties. His lawyer will contact me by letter, if necessary, if other questions need to be answered. I believe at some point in the future, a psychiatric evaluation will have to play a role in determining Mr. Frerichs' degree of disability.

( Id.) At his next appointment with Dr. Lynn, on June 27, 2006, Dr. Lynn noted that Plaintiff continued to report low back discomfort. (AR–HART000674.) At that visit, Dr. Frerichs reported a shooting pain through his back that lasted for approximately five seconds, which he had been experiencing for the previous three or four days. ( Id.) Dr. Lynn recommended a consultation with “a Med–X type of lumbar strengthening/stabilization program.” ( Id.) Dr. Lynn later assessed Dr. Frerichs as “able to work with restrictions” from June 2, 2006 through August 2, 2006. (AR–HART000675.)

2. Depression

As noted, Dr. Frerichs has a history of depression, which he began experiencing in the early 1990's, and for which he sought psychiatric care, including psychotropic medication and counseling. (AR–HART000412; HART000799.) In 2005, Dr. Frerichs treated with Dr. John Curran for his depression, for which he was prescribed medications including Wellbutrin, Trazodone and Effexor. (AR–HART000583; HART000799.) As discussed previously, in February 2006, Plaintiff attempted suicide by taking an overdose of Ativan medication, which resulted in his hospitalization for eight days at Abbott Northwestern Hospital for major depression and suicide attempt. (AR–HART000800; HART000850.) Following outpatient treatment, he met with Dr. Curran again in April 2006 and revealed a previous suicide attempt in December 2005. (AR–HART000585.)

In the spring of 2006, Plaintiff began treating with psychiatrist Dr. Larry Berger, who diagnosed major depression, recurrent, with moderate to severe intensity. (AR–HART000786.) As part of Plaintiff's application for long-term disability, in June 2006, Dr. Berger completed an “Attending Physician's Statement of Disability,” stating that Plaintiff was “not able to do clinical dentistry.” (AR–HART000713.)

C. Claim for Long–Term Disability Benefits

On July 5, 2006, Plaintiff filed a claim for long-term disability benefits with Hartford. (AR–HART000710.) He indicated that he was unable to perform clinical dentistry, noting that he was...