Howard v. Hartford Life & Accident Ins. Co.

929 F.Supp.2d 1264

Kimberly HOWARD, an individual, Plaintiff,

v.HARTFORD LIFE & ACCIDENT INSURANCE COMPANY a/k/a Hartford Life d/b/a The Hartford, a corporation, Defendant.

Case No. 3:10–cv–192–J–34TEM.

United States District Court,

M.D. Florida,

Jacksonville Division.

March 15, 2013.

Alicia Paulino–Grisham, Maggie M. Smith, DI Law Group, Hollywood, FL, for Plaintiff.

Jerel C. Dawson, William J. Gallwey, III, Jonathan M. Fordin, Shutts & Bowen, LLP, Miami, FL, for Defendant.

ORDER

MARCIA MORALES HOWARD, District Judge.

This case, brought pursuant to the Employment Retirement Income Security Act of 1974 (“ERISA”), involves a plan administrator's termination of a plan claimant's long term disability benefits. It is before the Court on cross-motions for summary judgment. Specifically pending are Defendant Hartford Life and Accident Company's (“Hartford”) Dispositive Motion For Summary Judgment With Statement Of Undisputed Material Facts And Memorandum Of Law in Support Thereof (Doc. 208; Hartford Motion for Summary Judgment), and Plaintiff's [Kimberly Howard] Response In Opposition to Defendant's Dispositive Motion For Summary Judgment (Doc. 222; Howard Response); and Plaintiff's Dispositive Motion For Summary Judgment (Doc. 219; Howard Motion for Summary Judgment), which is opposed by Hartford in Defendant's Memorandum Of Law In Opposition To Plaintiff's Dispositive Motion For Summary Judgment. (Doc. 223; Hartford Response). Additionally pending are Plaintiff's Motion In Limine To Exclude Extra Record Evidence Attacking The Character Of Plaintiff's Witness, Sandra Carter, In Dispositive Motion Briefings (Doc. 211; Howard Motion in Limine), to which Hartford responded in Defendant's Memorandum Of Law In Opposition To Plaintiff's “Motion In Limine” (Doc. 220; Hartford Response to Motion In Limine); as well as Defendant's Motion To Strike Exhibits To Plaintiff's Motion For Summary Judgment, With Memorandum Of Law In Support Thereof (Doc. 221; Hartford Motion in Limine) ¹, to which Howard has filed a Response In Opposition To Defendant's Motion To Strike (Doc. 224; Howard Response to Motion in Limine), and Hartford has filed a court-authorized Reply. (Doc. 228; Hartford Reply). The motions are ripe for review.²

On March 3, 2010, Plaintiff Kimberly Howard (“Howard” or “Plaintiff”) filed this action against Hartford, pursuant to Section 502(a)(1)(B) of ERISA, 29 U.S.C. § 1132(a)(1)(B), to recover benefits, to enforce rights under her employment benefits plan, and to clarify her rights under the plan. (Doc. 1; Complaint). Hartford originally approved Howard's application for long-term disability (“LTD”) benefits commencing November 4, 2005. Subsequently, based upon continuing evaluations of updated medical information, surveillance, and a records review by two physicians and a neuro-psychologist, Hartford determined that Howard was no longer qualified for LTD benefits, and discontinued her benefits, as of November 15, 2006. Howard administratively appealed that decision, and Hartford affirmed its decision. The instant suit challenges Hartford's decision on the administrative appeal.

I. Facts³A. The Plan

In April of 2005, Plaintiff worked for Fidelity National Financial, Inc. (“Fidelity”), where she held the position of Business Strategy Manager I. Complaint ¶¶ 5, 12, 13; (Doc. 59; Answer ¶¶ 5, 12, 13; ⁴ Doc. 209; Administrative Record (“AR”) at H429). As a Business Strategy Manager I, Howard was responsible for working with product strategy managers to develop strategic visions for Fidelity's mortgage products; assisting in the development of client communications and presentations; assisting with maintaining product requirements and project activities; developing and writing business cases; researching competitive materials and providing quarterly company updates; and working with analysts to ensure product strategies were communicated. AR at H429; see also id. at H220–21. According to a Hartford “Physical Demands Analysis Form” completed by Fidelity, Howard's job as a Business Strategy Manager required sitting for six hours per day, walking or standing for two hours per day, and lifting up to 10 pounds “frequently” and between 10 and 20 pounds “occasionally.” AR at H1107; see also id. at H577–78; H220–21. The position could also entail “climbing some stairs on campus,” handling papers, stooping or crouching to reach lower drawers, and fingering a keyboard. Id. at H578; see also id. H220–21. The Department of Labor classified Howard's occupation as “sedentary.” AR at H426–28, H1332.

During her employment with Fidelity, Howard was a participant in the Fidelity National Financial, Inc. Group Benefit Plan (Doc. 1–1; Plan), ⁵ which Hartford issued to Fidelity, insured, and underwrote. Complaint ¶ 6; Answer ¶ 6; see also Hartford Motion for Summary Judgment at 4. As such, Hartford both funded and administered the Plan. The Plan provides that Hartford has “full discretion and authority to determine eligibility for benefits and to construe and interpret all terms and provisions of the [Plan].” Plan at 14. As a Plan participant, Howard would be “entitled to receive disability benefits under the Plan if she meets the definition(s) of disability.” Complaint ¶ 9; Answer ¶ 9; see AR at H470–73. The Plan contains the following definitions:

Disability or Disabled means that during the Elimination Period and for the next 24 months you are prevented by:

1. accidental bodily injury;

2. sickness;

3. Mental Illness;

4. Substance Abuse; or

5. pregnancy,

from performing one or more of the Essential Duties of Your Occupation, and as a result your Current Monthly Earnings are no more than 80% of your Indexed Pre-disability Earnings.

After that, you must be so prevented from performing one or more of the Essential Duties of Any Occupation.

...

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.

...

Any Occupation means an occupation for which you are qualified by education, training, or experience, and that has an earnings potential greater than an amount equal to the lesser of the product of your Indexed Pre-disability Earnings and the Benefit Percentage and the Maximum Monthly Benefit shown in the Schedule of Insurance....

...

Essential Duty means a duty that:

1. is substantial, not incidental;

2. is fundamental or inherent to the occupation; and

3. can not be reasonably omitted or changed.

To be at work for the number of hours in your regularly scheduled workweek is also an Essential Duty.

Plan at 15, 17. Thus, pursuant to the provisions of the Plan, for the first 24 months of a claimed disability, eligibility for LTD benefits was conditioned on the claimant's submission of proof that she was prevented by illness or injury from performing, on a full-time basis, “one or more of the Essential Duties of Your Occupation.”

B. Medical History

On April 2, 2005, Howard's treating physician, internal medicine specialist Dr. Gary Decker, wrote to Hartford stating that he has been treating Howard for “many years”, and in his opinion “she should qualify for total disability” based upon her “multiple debilities.” AR at H669.⁶ Dr. Decker wrote:

Her chief problems over that time have been asthma and an autoimmune disorder. The patient has been diagnosed as having a chronic history of multiple joint pains. The problem has progressed over the past years, to the point that I feel that she is unable to maintain any type of employment. The patient has muscle spasms throughout her body which are debilitating. She is unable to control movements of her hands and legs. She appears fatigued on a chronic basis. It happens even after hours of sleep. She recently has difficulty with sleep. All of these problems have led to a diagnosis of depression also. The patient has trouble concentrating and focusing her thoughts, as well as her short-term memory. She has loss of fine motor control. She has large muscle joint pains with swelling over her joints. She has experienced rashes that have been present intermittently, but are generalized over her torso, arms, extremities, and face. She has frequent headaches, which have not been relieved with any analgesics, and studies that have been done have been unrevealing.

Id. Howard ceased working at Fidelity on April 28, 2005, due to a diagnosis of lupus and fibromyalgia. See AR at H220, H1498.

Dr. Decker reported in a May 3, 2005 Attending Physician's Statement of Disability that Howard was 5'6? tall and weighed “approximately 323.” AR at H663–64; H1274–75. His “Primary diagnosis” was “Lupus, Fibromyalgia, severe joint pain,” and his “Secondary diagnosis(es)” was “Depression, short-term memory loss, asthma.” Dr. Decker stated that his physical examination of Howard found “decreased ROM [range of motion] all extremities, memory deficit, joint pain.” Id. [He noted that he began treating Howard for these conditions in April, 2002.] Dr. Decker listed Howard's “Impairment” as follows:

Walking: causes severe joint pain

Sitting: leg pain, numbness

Lifting/carrying: Upper extremity weakness, poor co-ordination

Reaching/working overhead: ? ROM of upper extremities, severe joint pain

Pushing: Severe joint pain

Pulling: Severe joint pain

Driving: short term memory loss prevents patient for finding destinations

Keyboard use/repetitive hand motion: Unable to do even simple hand motions such as drying hair, removing bottle tops

Id. However, he indicated Howard had no psychiatric impairment and was “Essentially good functioning in all areas.” Id. Dr. Decker opined that Howard “became unable to work due to this impairment” on April 29, 2005, and that the limitations are “permanent.” Id. A second “Attending Physician's Statement of Continued Disability” completed by Dr. Decker on May 18, 2005, listed his primary diagnosis as Lupus, and secondary diagnosis as Fibromyalgia. He...